DOCSLIB.ORG

Medical Profiling and Online Medicine: the Ethics of 'Personalised Healthcare’ in a Consumer Age

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Medical Profiling and Online Medicine: the Ethics of 'Personalised Healthcare’ in a Consumer Age Medical profiling and online medicine: the ethics of ‘personalised healthcare’ in a consumer age Published by Nuffield Council on Bioethics 28 Bedford Square London WC1B 3JS Telephone: 020 7681 9619 Email: [email protected] Website: http://www.nuffieldbioethics.org ISBN: 978-1-904384-21-2 October 2010 To order a printed copy, please contact the Nuffield Council on Bioethics or visit the website. European countries (EU and non-EU) £10 per report (where sold) Countries outside Europe: £15 per report (where sold) Developing countries: Free © Nuffield Council on Bioethics 2010 All rights reserved. Apart from fair dealing for the purpose of private study, research, criticism or review, no part of the publication may be produced, stored in a retrieval system or transmitted in any form, or by any means, without prior permission of the copyright owners. Indexed by: Dr Laurence Errington Printed in the UK by: Nuffield Press 21 Nuffield Way Abingdon Oxfordshire OX14 1RL http://www.nuffield.co.uk Web references throughout this report were accessed August 2010 Medical profiling and online medicine: the ethics of 'personalised healthcare’ in a consumer age Nuffield Council on Bioethics Professor Albert Weale FBA (Chair) Professor Hugh Perry FMedSci (Deputy Chair) Professor Steve Brown FMedSci Professor Roger Brownsword Dr Amanda Burls Professor Robin Gill Professor Sian Harding FAHA FESC Professor Ray Hill FMedSci Professor Søren Holm Professor Christopher Hood FBA* Dr Rhona Knight FRCGP Professor Graeme Laurie FRSE Dr Tim Lewens Professor Ottoline Leyser CBE FRS Professor Anneke Lucassen Professor Alison Murdoch FRCOG Dr Bronwyn Parry Professor Nikolas Rose Professor Dame Marilyn Strathern FBA*** Professor Joyce Tait CBE FRSE** Dr Geoff Watts FMedSci Professor Jonathan Wolff * co-opted member of the Council while chairing the Working Party on Medical profiling and online medicine: the ethics of ‘personalised healthcare’ in a consumer age. ** co-opted member of the Council while chairing the Working Party on New approaches to biofuels. *** co-opted member of the Council while chairing the Working Party on Human bodies in medicine and research. iii Secretariat Hugh Whittall (Director) Tom Finnegan Katharine Wright Kate Harvey Harald Schmidt Varsha Jagadesham Dr Alena Buyx Sarah Bougourd Caroline Rogers Carol Perkins Catherine Joynson Audrey Kelly-Gardner The terms of reference of the Council are: 1. to identify and define ethical questions raised by recent advances in biological and medical research in order to respond to, and to anticipate, public concern; 2. to make arrangements for examining and reporting on such questions with a view to promoting public understanding and discussion; this may lead, where needed, to the formulation of new guidelines by the appropriate regulatory or other body; 3. in the light of the outcome of its work, to publish reports; and to make representations, as the Council may judge appropriate. The Nuffield Council on Bioethics is funded jointly by the Medical Research Council, the Nuffield Foundation and the Wellcome Trust iv Acknowledgements The Council would like to thank the members of the Working Party for their time and contributions to this report. We would also like to express our appreciation to the peer reviewers who provided expert commentary on early drafts of the report; to those who attended our fact-finding meetings; and to those who responded to the consultation. Additionally, we extend our thanks to the team at the Harvard University Program in Ethics and Health, in particular Professor Daniel Wikler and Ms Francesca Holinko, for their work on the joint workshop held with the Council in May 2009. Members are also grateful to those who provided advice on specific areas of the report, including Professor Edward Alan Miller for the production of an evidence review on the provider-patient relationship in the field of telemedicine; the Royal Pharmaceutical Society of Great Britain for providing comments on an early draft of part of the report; and Dr Michael Manolakis and Dr Matthew Wynia for providing valuable advice on online pharmaceutical purchasing and personal health records, respectively. For more information on contributions to the report and our method of working, see Appendix 3. v Foreword In the two years or so that it took to write this report, news media continually threw up stories about new ways of getting access to health information and services online. Many news items emerged as well about developments in testing and scanning technologies that held out the promise of far greater ability to predict susceptibility to disease and even length of life than any earlier generation had known.1 And those two developments are linked in the kinds of tests that operate largely online, such as genetic testing whose only non-virtual element is that of the buyer taking a saliva sample and mailing it off to be tested. What are we to make of this brave new world? Some are entranced by the prospect of encounters with the healthcare system that increasingly take place online and that embrace an ever-expanding array of tests, scans and complex interactive communications systems. Powerful claims about the ability of such developments to transform and indeed extend our lives are made by enthusiastic researchers and companies in the forefront of those changes. But others see those developments in a much less attractive light, as meaning ever-greater medical penetration of everyone’s lives, with new forms of testing and scanning leading either to a medical variant of the Calvinist doctrine of predestination or to more and more health anxiety, or both. Egalitarians will worry that more individualised predictive testing could threaten the ‘risk pooling’ embodied in traditional public welfare systems, while individualists will fear the opposite outcome, namely that such individualised prediction could lead to the collapse of established systems of private health insurance, such that ‘socialised medicine’ expands rather than contracts. Others worry about the greater medicalisation of human life that goes along with ever-more scanning and testing and online health activity. They fear a world resembling that of Jules Romains’ egregious Dr Knock, for whom (long before today’s ideas about so-called personalised medicine) healthcare was to be considered as a form of religion2 and whose academic thesis ‘On Imagined States of Health’ took for its epigraph the statement: ‘Those who are well are sick people who don’t know it’.3 And there are other people who firmly take the more fatalistic view epitomised by the Roman poet Horace whose famous motto carpe diem sums up the argument that it is better to live for the present than to try to foresee the future.4 The view we have generally taken in this report is that these developments may indeed have the potential radically to transform healthcare, but that potential has yet to be realised. Of the idea of personalised healthcare, it could almost be said that ‘Only the future is certain. The past is always changing,’5 since bold visions of the ability of new technology to bring about a new era of personalised, predictive and preventive medicine have been canvassed for nearly two decades now. Perhaps we are still seeing the smoke of a fire that has not yet really kindled.6 But even if the information and power to take control of our health afforded by these developments does indeed turn out to be the modern equivalent of Apollo’s gift of prophecy to Cassandra in classical mythology, it must be recalled that such gifts have their accompanying problems and ethical challenges. In this case, they raise challenging issues of how far the principle of ‘consumerism’ can properly be carried in healthcare, and what responsibilities individuals should take for their health and healthcare. Some 1 For example, over the course of the Working Party’s two-year lifespan, there were about 300 news stories in the Anglophone press and journals alone that were significant and highly relevant to the main themes of our report. That number would certainly rise into the thousands if we included all the news stories and journal articles across the world that were concerned with body imaging, genetic profiling and accessing health information and services online. 2 Requiring ‘confession’ and commitment to the spread of ‘l’esprit pharmaco-médical’. 3 ‘Les gens bien-portants sont des malades qui s’ignorent,’ ludicrously attributed to the experimental physiologist Claude Bernard. See: Romains J (Louis Farigoule) (1973) Knock ou le triomphe de la médicine Alton JB (Editor) (London: Longman), p39. 4 ‘Tu ne quaesieris – scire nefas – quem mihi, quem tibi finem di dederint…Sapias, vina liques, et spatio brevi spem longam reseces…carpe diem, quam minimum credula postero’ Horace, Odes 1.11. 5 In Paul Flynn’s epigram, coined in a quite different context: Flynn P (1999) Dragons Led by Poodles (London: Politico’s), p24. 6 An mac air an spàrr, ‘s a mhàthair gun bhreith’ (‘the son on the roost and the mother unborn’), in the words of the Gaelic proverb. vii people think there are long-term trends in modern societies towards ever-greater ‘consumerisation’ and ‘responsibilisation’; but whether or not you believe that (the evidence is contestable), there are certainly some perplexing ethical challenges represented by the new issues of consumer choice and personal responsibility that are raised by the emerging world of medical profiling and online medicine. Writing this report has been a lengthy and arduous job, during which many tricky issues had to be thought through, and I would like to thank all those who helped to produce this document: the members of the Working Party, the Council, the secretariat, particularly Caroline Rogers, Tom Finnegan and Harald Schmidt, those who responded to our consultation document, and those who came to our fact-finding meetings or responded to our various queries.
Load more

Recommended publications
  • Tactical Biopolitics: Art, Activism, and Technoscience (Leonardo Books)
    Tactical Biopolitics Art, Activism, and Technoscience edited by Beatriz da Costa and Kavita Philip Popular culture in this “biological century” seems to feed on proliferating representations of the fears, anxieties, and hopes around the life sciences, at a time when such basic concepts as scientific truth, race and da Costa and Philip, Tactical Biopolitics gender identity, and the human itself are destabilized Beatriz da Costa does interventionist art using new media/biology/art in the public eye. Public and expert discourses have computing and biotechnologies, and Kavita Philip converged to grapple with the ethical and creative studies colonialism, neoliberalism, and technoscience “Scientists and engineers, if they care for a better world, must more fully understand Tactical Biopolitics challenges that lie at the intersections of life, science, using history and critical theory. Both are Associate the consequences of their actions. Artists must learn more about science and take up and art. What do inquiring, curious, or anxious publics Professors at the University of California, Irvine. the challenge of illuminating our technological world to those who are shaping it. Both need to understand about biology and its current communities, in making their work more accessible to the other, will benefit. Not everyone Art, Activism, and Technoscience research frontiers? How might scientists assess myriad A Leonardo Book will agree with the politics argued here—but that is fine. The need for dialogue has now and often contradictory concerns about
    [Show full text]
  • Medical Prescription Market Definitions
    Horvath Health Policy Innovations in Healthcare Financing Policy PO Box 196, College Park, MD 20741 202/465-5836 [email protected] Medical Prescription (Rx) Market Definitions Drug Product Terminology Small Molecule Drugs: Drugs with an active chemical ingredient that is not live, but chemically synthesized and typically are taken orally or topically, such as capsules, tablets, powders, ointments, and sprays. Brands: Also referred to “small molecule drugs,” brand drugs require original research and development for FDA licensure (also called “FDA approval”). They are approved (or licensed) under a New Drug Application (NDA). They are patent protected for 20 years total (which usually includes years clinical research before the drug is approved, or licensed). They are still referred to as brands even after the patent has expired (which distinguishes these drugs from generics). A brand can be ‘first in class” if it is a new chemical entity or new mechanism of action. It is a “me too drug” if it is not first in class. The definition of “me too” varies – different chemical composition, different mechanism of action. The drug is quite similar but different enough to get a patent. Generic: Small molecule products that are demonstrated to be clinically equivalent to a branded product (e.g., same active ingredient and route of administration, same mechanism of action). Generics do not require original research for FDA approval. Generics come to market only after the patent has expired on the brand product. Licensed under an Abbreviated New Drug Application (ANDA) by the FDA. Large Molecule Drugs: Commonly referred to as “biologics” and “biosimilars.” They contain live active ingredients and are generally infused or injected, and otherwise not taken orally or topically.
    [Show full text]
  • VIDEO COLLECTION: North Carolina Biotechnology Center
    North Carolina Biotechnology Center Video Loan Program V-1 VIDEO COLLECTION: North Carolina Biotechnology Center Note: All videos are in VHS tape format, except where otherwise noted. Biotechnology Career-Related Videos 1. Agricultural Biotechnology: A World of Opportunity (1996), 14 min., Careers 2. Bioscience: Real Jobs, Real People (1999), 10 min., Careers This short video follows four high school students as they visit working companies on "Bioscience Career Day." Students talk with individuals representing a broad range of career tracks such as research, product development, manufacturing and management. Employees explain their day-to- day responsibilities and offer advice about pursuing a bioscience career. In addition, some common misconceptions about employment in the bioscience industry are discussed. For example: A Ph.D. is not a requirement for employment, as many believe... in fact, entry-level positions are often available at all education levels. The video is accompanied by a lesson plan that provides a motivational activity, a class activity and suggestions for closure and extensions. 3. Biotechnology: The Choice for Your Future (1992), 9 min., Careers 4. BioWork Process Overview (2001), 16 min., Careers This video can be used to enhance student career awareness of the growing employment opportunities within the bioprocess manufacturing industry. Opportunities presented here might be particularly attractive to vocationally-oriented students that have taken a biology or chemistry course. The piece features interviews with bioprocess technicians and managers employed by North Carolina biotechnology and pharmaceutical manufacturers Novozymes, Biogen, and Wyeth-Lederle. Viewers get a virtual tour of the manufacturing environment and hear first hand from employees about the significance of and satisfaction they receive from their jobs.
    [Show full text]
  • Mothers in Science
    The aim of this book is to illustrate, graphically, that it is perfectly possible to combine a successful and fulfilling career in research science with motherhood, and that there are no rules about how to do this. On each page you will find a timeline showing on one side, the career path of a research group leader in academic science, and on the other side, important events in her family life. Each contributor has also provided a brief text about their research and about how they have combined their career and family commitments. This project was funded by a Rosalind Franklin Award from the Royal Society 1 Foreword It is well known that women are under-represented in careers in These rules are part of a much wider mythology among scientists of science. In academia, considerable attention has been focused on the both genders at the PhD and post-doctoral stages in their careers. paucity of women at lecturer level, and the even more lamentable The myths bubble up from the combination of two aspects of the state of affairs at more senior levels. The academic career path has academic science environment. First, a quick look at the numbers a long apprenticeship. Typically there is an undergraduate degree, immediately shows that there are far fewer lectureship positions followed by a PhD, then some post-doctoral research contracts and than qualified candidates to fill them. Second, the mentors of early research fellowships, and then finally a more stable lectureship or career researchers are academic scientists who have successfully permanent research leader position, with promotion on up the made the transition to lectureships and beyond.
    [Show full text]
  • BSCB Newsletter 2017D
    2017 BSCB Newsletter BRITISH SOCIETY FOR CELL BIOLOGY Meet the new BSCB President Royal Opening of the Crick Meeting reports 2017 CONTENTS BSCB Newsletter News 2 Book reviews 7 Features 8 Meeting Reports 24 Summer students 30 Society Business 33 Editorial Welcome to the 2017 BSCB newsletter. After several meeting hosted several well received events for our Front cover: years of excellent service, Kate Nobes has stepped PhD and Postdoc members, which we discuss on The head of a Drosophila pupa. The developing down and handed the reins over to me. I’ve enjoyed page 5. Our PhD and Postdoc reps are working hard compound eye (green) is putting together this years’ newsletter. It’s been great to make the event bigger and better for next year! The composed of several hundred simple units called ommatidia to hear what our members have been up to, and I social events were well attended including the now arranged in an extremely hope you will enjoy reading it. infamous annual “Pub Quiz” and disco after the regular array. The giant conference dinner. Members will be relieved to know polyploidy cells of the fat body (red), the fly equivalent of the The 2016 BSCB/DB spring meeting, organised by our we aren’t including any photos from that here. mammalian liver and adipose committee members Buzz Baum (UCL), Silke tissue, occupy a big area of the Robatzek and Steve Royle, had a particular focus on In this issue, we highlight the great work the BSCB head. Cells and Tissue Architecture, Growth & Cell Division, has been doing to engage young scientists.
    [Show full text]
  • Female Fellows of the Royal Society
    Female Fellows of the Royal Society Professor Jan Anderson FRS [1996] Professor Ruth Lynden-Bell FRS [2006] Professor Judith Armitage FRS [2013] Dr Mary Lyon FRS [1973] Professor Frances Ashcroft FMedSci FRS [1999] Professor Georgina Mace CBE FRS [2002] Professor Gillian Bates FMedSci FRS [2007] Professor Trudy Mackay FRS [2006] Professor Jean Beggs CBE FRS [1998] Professor Enid MacRobbie FRS [1991] Dame Jocelyn Bell Burnell DBE FRS [2003] Dr Philippa Marrack FMedSci FRS [1997] Dame Valerie Beral DBE FMedSci FRS [2006] Professor Dusa McDuff FRS [1994] Dr Mariann Bienz FMedSci FRS [2003] Professor Angela McLean FRS [2009] Professor Elizabeth Blackburn AC FRS [1992] Professor Anne Mills FMedSci FRS [2013] Professor Andrea Brand FMedSci FRS [2010] Professor Brenda Milner CC FRS [1979] Professor Eleanor Burbidge FRS [1964] Dr Anne O'Garra FMedSci FRS [2008] Professor Eleanor Campbell FRS [2010] Dame Bridget Ogilvie AC DBE FMedSci FRS [2003] Professor Doreen Cantrell FMedSci FRS [2011] Baroness Onora O'Neill * CBE FBA FMedSci FRS [2007] Professor Lorna Casselton CBE FRS [1999] Dame Linda Partridge DBE FMedSci FRS [1996] Professor Deborah Charlesworth FRS [2005] Dr Barbara Pearse FRS [1988] Professor Jennifer Clack FRS [2009] Professor Fiona Powrie FRS [2011] Professor Nicola Clayton FRS [2010] Professor Susan Rees FRS [2002] Professor Suzanne Cory AC FRS [1992] Professor Daniela Rhodes FRS [2007] Dame Kay Davies DBE FMedSci FRS [2003] Professor Elizabeth Robertson FRS [2003] Professor Caroline Dean OBE FRS [2004] Dame Carol Robinson DBE FMedSci
    [Show full text]
  • The Control of Shoot Branching: an Example of Plant Information Processing
    Plant, Cell and Environment (2009) 32, 694–703 doi: 10.1111/j.1365-3040.2009.01930.x The control of shoot branching: an example of plant information processing OTTOLINE LEYSER Department of Biology, Area 11, University of York, York YO10 5YW, UK ABSTRACT the apical–basal axis defined by the establishment of the shoot apical meristem at one end, and the root apical mer- Throughout their life cycle, plants adjust their body plan istem at the other. Post-embryonically, the meristems give to suit the environmental conditions in which they are rise to the entire shoot and root systems, respectively. Fur- growing. A good example of this is in the regulation of thermore, the tissues they establish can produce secondary shoot branching. Axillary meristems laid down in each leaf meristems, which if activated can produce entirely new formed from the primary shoot apical meristem can remain axes of growth with the same developmental potential as dormant, or activate to produce a branch. The decision the primary root or shoot from which they were derived. whether to activate an axillary meristem involves the assess- Thus, the body plan of a plant is determined continuously ment of a wide range of external environmental, internal throughout its life cycle, allowing it to be exquisitely envi- physiological and developmental factors. Much of this infor- ronmentally responsive. Plants can alter their body plan to mation is conveyed to the axillary meristem via a network suit their environment, and thus the environmentally regu- of interacting hormonal signals that can integrate inputs lated development of new growth axes is functionally from diverse sources, combining multiple local signals to equivalent to environmentally regulated animal behav- generate a rich source of systemically transmitted informa- iours.
    [Show full text]
  • Oct/Nov 2019
    CTAVIANTHE Octavia Books’ bi-monthly newsletter for booklovers Voted Best Locally Owned Bookstore Octob er / No vemb er 2 019 Epic Human Experiences Olive, Again The Water by Elizabeth OCTAVIA BOOKS Dancer Strout 513 Octavia Street by Ta-Nehisi #1 NYT bestselling New Orleans, LA 70115 author and Pulitzer 504-899-READ (7323) Coates Prize winner Elizabeth octaviabooks.com Hiram Walker was born Strout continues the into bondage. When his life of Olive Kitteridge, [email protected] mother was sold, Hiram a character who has cap- was robbed of all memory tured the imaginations STORE HOURS of her—but was gifted with of millions. Prickly, wry, Open 10 am - 6 pm a mysterious power that, resistant to change yet years later, saves him from a empathetic and ruthlessly Monday - Saturday near drowning. This brush honest, the iconic Olive Sunday 10 am - 5 pm with death inspires Hiram to escape from the only home he’s ever struggles to understand not only her own life but the known, and the resulting journey takes him from Virginia’s planta- lives of those around her in Crosby, Maine. Whether tions to guerrilla cells in the wilderness. Even as he’s enlisted in the with a teenager coming to terms with the loss of her underground war between slavers and the enslaved, Hiram resolves father, a woman about to give birth during a hilariously to rescue the family he left behind. This is the story of an atrocity inopportune moment, a nurse who confesses a high inflicted on generations of women, men, and children—the violent school crush, or a lawyer who struggles with an unwanted and capricious separation of families—and the war they waged to inheritance, the unforgettable Olive will continue to simply make lives with the people they loved.
    [Show full text]
  • The Internet and Adolescent Non-Medical
    The Internet and Adolescent Non‐Medical Use of Prescription Drugs Background Sales of psychoactive prescription drugs over the Internet are becoming a major enterprise, presenting new challenges to drug abuse prevention and treatment. Adolescent non- medical use of highly addictive prescription opioid drugs, such as Vicodin and Oxycontin; sedatives, such as Ambien; and tranquilizers, such as Valium and Xanax, is increasing (Johnston et al 2005, SAMHSA 2005). These increases are occurring in the face of the otherwise encouraging news that among youth ages 12 to 17, past month illicit drug use overall has declined 19% since 2001 (SAMHSA 2005). Although the reasons for increasing adolescent non-medical use of addictive prescription drugs are not known, we do know that they are widely advertised and sold over the internet without prescription. Ready availability through “non-prescription websites (NPWs)” may be one important contributing factor to increasing adolescent use of these drugs (Kissinger 2004). The Director of the National Institute on Drug Abuse (NIDA), the Director of the Office of National Drug Control Policy (ONDCP) and the Administrator of the Drug Enforcement Administration (DEA) all believe that “rogue online pharmacies” have become a significant source of drugs for adolescents (Volkow 2004, Office of National Drug Control Policy 2004). The global reach of the internet now makes it as easy for an adolescent to buy drugs as it is to buy a book or CD with a credit card, PayPal, or even cash. Some sites provide drugs initially for free without immediate payment. Unlike many scams on the internet, there is ample evidence that these drugs of abuse are real, potent, and actually delivered to buyers.
    [Show full text]
  • FAQ Prescription Questions By: Kandi Rasmussen, LVT
    10261 County Road P38A ~ OMAHA, NE 68142 PHONE: 402-533-1151 ~ FAX: 402-533-1159 Email: [email protected] Michael J. Black D.V.M. Michael P. Thomassen D.V.M. Kimberly N. Conover D.V.M. ______________ Exp: ______ Th FAQ Prescription Questions By: Kandi Rasmussen, LVT Every day we prescribe medications to treat our patients. Every day we answer questions and requests concerning medications from our clients. We love your questions but we have come to realize that there are a few common questions that are asked routinely. These routine questions sparked this article. Are all medications we dispense to clients prescription items? No they are not. A prescription medication or drug is defined as a pharmaceutical drug that legally requires a medical prescription to be dispensed. In contrast, over-the-counter drugs (OTC) can be obtained without a prescription. Just like human medicine there are two kinds, prescription and OTC, we use and recommend both. Many medications are prescription only because prescription drugs are only effective for specific problems, and may actually be harmful to your horse if used without that critical veterinary examination and diagnosis. Having these drugs available as prescription-only medications ensures that they are used appropriately. Can I get a prescription for a medication? This question has two answers. Yes, every time we prescribe a prescription drug or medication your horse then has a prescription for that specific medication with specific instructions to be give for a specific amount of time to treat a specific problem. No, we cannot prescribe a medication for a horse or a problem that we have not seen because “Veterinary prescription drugs are those drugs restricted by federal law to use by or on the order of a licensed veterinarian.” In order for a veterinarian to order a medication there must be a valid Veterinarian/Client/Patient Relationship (VCPR).
    [Show full text]
  • WHO EDM QSM 00.1 Eng.Pdf
    ©World Health Organization (2000) This document is not a formal publication of the World Health Organization (WHO). All rights are reserved by WHO. The document may, however, by freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or use in conjunction with commercial purposes. The views expressed in this document by named authors are solely the responsibility of those authors. Guidelines for the Regu latory Assessment of Medicinal Products for use in Self-Medication World Health Organization Geneva 2000 1. Introduction Self-care can be defined as the primary public health resource in the health care system. It consists of the health activities and health-related decision-making of individuals, families, friends, colleagues at work, and so on. It includes self-medication, non-drug self-treatment, social support in illness, and first aid in everyday life. The reclassification of medicinal products from sale on prescription only to non­ prescription (over-the-counter, or OTG) sale is of great current interest in many countries. Drug regulatory and health authorities have to consider the types of medicinal products for which reclassification is appropriate, safe and rational in the interest of public health. It has become widely accepted that self-medication has an important place in the health care system. Recognition of the responsibility of individuals for their own health and awareness that professional care for minor ailments is often unnecessary have contributed to this view. Improvements in people's general knowledge, level of education and socioeconomic status in many countries form a reasonable basis for successful self-medication.
    [Show full text]
  • Annual Report 2015
    Annual Report 2015 Clare College Cambridge Contents Master’s Introduction .................................................................... 3 Teaching and Research .............................................................. 4–5 Selected Publications by Clare Fellows ....................................... 6–9 College Life ........................................................................... 10–12 Access & Outreach ..................................................................... 13 Financial Report ..................................................................... 14–15 Development ....................................................................... 16–17 List of Master & Fellows............................................................... 18 Captions ..................................................................................... 19 2 Master’s Introduction The past year has been full of many introductions for me two new CDs. They are fantastic ambassadors for the College and met some of our alumni in New as a relatively new Master - to student life in its various York - looking ahead; in 2016 they travel to Hong Kong, Malaysia and Singapore for more concerts. forms, to colleagues, and to our alumni at various events at home and abroad. The College continues to be in Last year I mentioned the need to refurbish Old Court, and this is still very much our priority. The good form, and weathering various new initiatives from Fellowship has just approved - in principle - plans which are now before Historic England,
    [Show full text]