The Doctor-Patient Relationship, Partnership Theory, and the Patient as Partner: Finding a Balance Between Domination and Partnership.

It is perhaps most useful to approach the Doctor-Patient relationship (DPR) by admitting that it's complicated. We review some of the strategies that have been employed to mitigate this complexity, zeroing in on one that promises to capture the main features of the DPR without eliminating some of its more important, existential components; pieces of the puzzle that must be retained if we are to avoid oversimplification and the errors that can arise by ignoring important foundational properties. We believe that a useful way to look at the DPR and to capture essential features that must be balanced in the process is provided by Partnership Theory and its definition in terms of the so-called domination and partnership systems.

The transition from inquiry to evidence to actionable clinical knowledge: A proposed roadmap.

Rationale, Aims, And Objectives: We consider the question "What should we do?" in the context of clinical research/practice. There are several steps along the way to providing a satisfactory answer, many of which have received considerable attention in the literature. We aim to provide a unified summary and explication of these "steps along the way".

Fishing in a Puddle of Doubt and Disbelief?: A Rejoinder to the Speed et al. Commentary.

In the article "Religiously/Spiritually Involved, but in Doubt or Disbelief-Why? Healthy?", Mrdjenovich (in J Relig Health  https://doi.org/10.1007/s10943-018-0711-2 , 2018) explored the practices of religious attendance and prayer among atheists and agnostic theists.

Authors Disclosing Their Theistic Orientation in Journal Articles on Religion and Health? Infrequent, Informal, and Mostly Inconsistent with Conflict of Interest.

An international survey was conducted of authors (N = 288) in the religion-health (R-H) research field concerning the disclosure of their theistic orientation (T-O) (i.e., whether they believe in God[s], a Higher Power, or a universal spirit) in their journal articles.

Scientism recognizes evidence only of the quantitative/general variety.

Rationale, Aims And Objectives: McHugh and Walker introduced a model of knowledge to demonstrate that EBM is a form of scientism that ignores important sources of knowledge thereby impairing the practice of medicine. We study the development of this model and explore additional applications.

Methods: Review of the relevant literature and identification of possible areas for fruitful application.

Religiously/Spiritually Involved, but in Doubt or Disbelief-Why? Healthy?

The question of why atheists and agnostic theists attend religious services and pray (and what that might mean for their health) is examined through (1) a thematic analysis of commentaries, perspective pieces, and news articles from the popular literature, and (2) a critical review of scholarly research involving comparisons between religious and nonreligious individuals on a variety of health-related outcomes. Findings suggest that atheists and agnostic theists can take pleasure in attending religious services, and they may be driven to pray at times. In many cases, this was explained by their efforts to stay connected and avoid or manage conflict with family members.

Schemata, CONSORT, and the Salk Polio Vaccine Trial.

In this essay, we defend the design of the Salk polio vaccine trial and try to put some limits on the role schemata should play in designing clinical research studies. Our presentation is structured as a response to de Freitas and Pietrobon (de Freitas, R. S.

The Ethics of Clinical Care and the Ethics of Clinical Research: Yin and Yang.

The Belmont Report's distinction between research and the practice of accepted therapy has led various authors to suggest that these purportedly distinct activities should be governed by different ethical principles. We consider some of the ethical consequences of attempts to separate the two and conclude that separation fails along ontological, ethical, and epistemological dimensions. Clinical practice and clinical research, as with yin and yang, can be thought of as complementary forces interacting to form a dynamic system in which the whole exceeds the sum of its parts.

Beware Dichotomies.

This essay combines our thoughts concerning the generally destructive practice of dichotomization with a selective review of the literature supporting our critique. The apparent simplicity of dichotomous thinking encourages its use even when a dyadic representation is totally inadequate to understanding complex situations, and this "simpler is better" mantra continues to stymie our understanding of many of the world's complexities. The identification and naming of two distinct, opposing categories often results in their being seen as in opposition to one another, and that it is somehow incumbent upon us to choose one or the other.

Analysis of the Nature of IRB Contingencies Required for Informed Consent Document Approval.

The University of Michigan Human Research Protection Program formed a six-member committee to analyze the nature of Institutional Review Board (IRB) staff and board contingencies for the approval of informed consent documents. Of the 100 studies examined, 87% had one or more informed consent contingencies. "Omissions" in documentation (40%) and "better clarity" (24%) accounted for the majority, while "word-smithing" accounted for only 10%.

Comparative effectiveness research: decision-based evidence.

In the clinical research context, comparative effectiveness research (CER) refers to the comparison of several health-care interventions administered under real-world conditions to individuals representative of the day-to-day clinical practice target population. We provide a brief history of CER and argue that CER can be used to deliver useful, but currently lacking information. Three study designs that can accomplish this are discussed, and incorporating CER into cost-benefit analyses is examined.

Patient preference clinical trials: why and when they will sometimes be preferred.

In a preference clinical trial (PCT), two or more health-care interventions are compared among several groups of patients, at least some of whom have purposefully chosen the intervention to be administered to them. This stands in contrast to the randomized, controlled clinical trial (RCT), where patients are randomly assigned to receive one of the available test interventions. This article argues that when comparing two interventions, A and B, when blinding (or masking) the interventions is difficult or impossible and at least some of the potential participants prefer one or the other of the interventions, then the use of a PCT merits consideration.

Providing guidance on the health effects of religious/spiritual involvement: a national assessment of university counseling professionals.

This study assessed the perceptions and practices of a national sample of university counseling professionals (n = 306) regarding their provision of guidance on the health effects of religious/spiritual involvement. Relatively few (21%) discussed the physical health effects of religiosity/spirituality with their clients. The majority (52%) were unsure that such discussions would result in lower health risks; however, nearly half (48%) indicated that these would promote recovery.

College counselors' perceptions and practices regarding anticipatory guidance on firearms.

Objectives: This study assessed college counselors' anticipatory guidance on firearms for student clients.

Participants: The membership of the Association for University and College Counseling Center Directors was used to identify a national random sample of counseling centers (n = 361). One counselor from each center was selected to survey.