Building legitimacy by criticising the pharmaceutical industry: a qualitative study among prescribers and local opinion leaders.

PRINCIPLES: The literature has described opinion leaders not only as marketing tools of the pharmaceutical industry, but also as educators promoting good clinical practice. This qualitative study addresses the distinction between the opinion-leader-as-marketing-tool and the opinion-leader-as-educator, as it is revealed in the discourses of physicians and experts, focusing on the prescription of antidepressants. We explore the relational dynamic between physicians, opinion leaders and the pharmaceutical industry in an area of French-speaking Switzerland. METHODS: Qualitative content analysis of 24 semistructured interviews with physicians and local experts in psychopharmacology, complemented by direct observation of educational events led by the experts, which were all sponsored by various pharmaceutical companies. RESULTS: Both physicians and experts were critical of the pharmaceutical industry and its use of opinion leaders. Local experts, in contrast, were perceived by the physicians as critical of the industry and, therefore, as a legitimate source of information. Local experts did not consider themselves opinion leaders and argued that they remained intellectually independent from the industry. Field observations confirmed that local experts criticised the industry at continuing medical education events. CONCLUSIONS: Local experts were vocal critics of the industry, which nevertheless sponsor their continuing education. This critical attitude enhanced their credibility in the eyes of the prescribing physicians. We discuss how the experts, despite their critical attitude, might still be beneficial to the industry's interests

Differences and similarities in instant countertransference towards patients with suicidal ideation and personality disorders.

Previous findings showed that suicidal patients elicit mostly negative countertransference such as distress, hopelessness, feelings of inadequacy, and apprehension, and that a concurrent personality disorder is associated with more feelings of entrapment and mistreatment, among other adverse reactions. No studies were however conducted on instant countertransference (iCT), i.e., after a single encounter, for example in an emergency setting. We aimed to evaluate the impact of suicidal ideations, self-harm and presence of personality disorders on instant Countertransference (iCT). Caregivers rated their iCT with two validated and standardized questionnaires after a first emergency or outpatient consultation. Suicidal ideation, self-harm and personality disorders were tested as predictors for iCT in a multivariate and multilevel analysis. Thirty caregivers rated their iCT towards 321 patients. Personality disorders and suicidal ideation, but neither recent nor past history of self-harm, predicted iCT. Common iCT included tension, lack of self-confidence and feeling of being tied. iCT specifically associated with suicidal ideation included distress, lack of hope, confusion, and sense that the patient's life had little worth. In contrast, iCT towards patients with personality disorders suggested tension in the therapeutic relationship (low affiliation with patient, anger, disappointment, devaluation). Caregiver's characteristics were not considered in the analysis. Furthermore, while countertransference also includes unconscious phenomena, only conscious iCT was assessed. Patients with suicidal ideation and personality disorders elicit common but also specific negative iCT. Mental health institutions need to devote specific resources (such as clinical supervision and training) to help caregivers manage their iCT

Transmission Properties of the oscillating delta-function potential

We derive an exact expression for the transmission amplitude of a particle moving through a harmonically driven delta-function potential by using the method of continued-fractions within the framework of Floquet theory. We prove that the transmission through this potential as a function of the incident energy presents at most two real zeros, that its poles occur at energies $n\hbar\omega+\varepsilon^*$ ($0<Re(\varepsilon^*)<\hbar\omega$), and that the poles and zeros in the transmission amplitude come in pairs with the distance between the zeros and the poles (and their residue) decreasing with increasing energy of the incident particle. We also show the existence of non-resonant "bands" in the transmission amplitude as a function of the strength of the potential and the driving frequency.Comment: 21 pages, 12 figures, 1 tabl

Localization of interacting electrons in quantum dot arrays driven by an ac-field

We investigate the dynamics of two interacting electrons moving in a one-dimensional array of quantum dots under the influence of an ac-field. We show that the system exhibits two distinct regimes of behavior, depending on the ratio of the strength of the driving field to the inter-electron Coulomb repulsion. When the ac-field dominates, an effect termed coherent destruction of tunneling occurs at certain frequencies, in which transport along the array is suppressed. In the other, weak-driving, regime we find the surprising result that the two electrons can bind into a single composite particle -- despite the strong Coulomb repulsion between them -- which can then be controlled by the ac-field in an analogous way. We show how calculation of the Floquet quasienergies of the system explains these results, and thus how ac-fields can be used to control the localization of interacting electron systems.Comment: 7 pages, 6 eps figures V2. Minor changes, this version to be published in Phys. Rev.