Synchronic and diachronic responsibility

This paper distinguishes between synchronic responsibility (SR) and diachronic responsibility (DR). SR concerns an agent's responsibility for an act at the time of the action, while DR concerns an agent's responsibility for an act at some later time. While most theorists implicitly assume that DR is a straightforward matter of personal identity, I argue instead that it is grounded in psychological connectedness. I discuss the implications this distinction has for the concepts of apology, forgiveness, and punishment as well as the way in which this distinction can be used to defend quality of will accounts of responsibility against objections involving psychological manipulation. I argue that the intuition that a manipulated agent is not responsible can be explained by appeal to the conditions of DR and, as such, does not unproblematically shed light on the conditions of SR

Pharmacoeconomic aspects of poor adherence: can better adherence reduce healthcare costs?

Background: Poor adherence to medical treatment is one of the main reasons why patients do not achieve the full benefits of their therapy. It also has a substantial financial weight in terms of money wasted for unused medication and increased healthcare costs including hospitalization due to clinical complications. Objective: To provide an overview and examples of the financial and economic consequences of poor adherence to treatment, techniques and devices for monitoring adherence and interventions for improvement of treatment adherence. Results: New electronic devices with monitoring features may help to objectively monitor patients' adherence to a treatment regimen that can help a healthcare professional determine how to intervene to improve adherence and subsequent clinical outcome. Interventions that aim to enhance adherence may confer costeffectiveness benefits in some indications and settings. The nature of the intervention(s) used depends on a range of factors, including patient preference, therapy area and cost of the intervention. However, there is a pressing need for rigorous trials, as current studies often have major flaws in the economic methodology, especially in terms of incremental analysis and sensitivity analysis. Limitations: This review has focused on a limited number of therapeutic areas as coverage of a more extensive range of diseases may be beyond the scope of such a summary. Nevertheless, the examples are representative of the challenges encountered in many other diseases. Conclusions: The clinical and economic consequences of non-adherence and interventions to improve compliance reflect the nature and severity of non-adherence, as well as the pathophysiology and severity of the disease. Interventions that aim to enhance adherence may confer cost-effectiveness benefits in some indications and settings, and good adherence can help payers and providers contain costs by extracting maximum value from their investment in therapies

Stereotype Threat and Health Disparities: What Medical Educators and Future Physicians Need to Know

Patients’ experience of stereotype threat in clinical settings and encounters may be one contributor to health care disparities. Stereotype threat occurs when cues in the environment make negative stereotypes associated with an individual’s group status salient, triggering physiological and psychological processes that have detrimental consequences for behavior. By recognizing and understanding the factors that can trigger stereotype threat and understanding its consequences in medical settings, providers can prevent it from occurring or ameliorate its consequences for patient behavior and outcomes. In this paper, we discuss the implications of stereotype threat for medical education and trainee performance and offer practical suggestions for how future providers might reduce stereotype threat in their exam rooms and clinics