Applying science in practice: the optimization of biological therapy in rheumatoid arthritis

Most authorities recommend starting biological agents upon failure of at least one disease-modifying agent in patients with rheumatoid arthritis. However, owing to the absence of head-to-head studies, there is little guidance about which biological to select. Still, the practicing clinician has to decide. This review explores the application of published evidence to practice, discussing the goals of treatment, the (in) ability to predict individual responses to therapy, and the potential value of indirect comparisons. We suggest that cycling of biological agents, until remission is achieved or until the most effective agent for that individual patient is determined, deserves consideration in the current stage of knowledge

Old law meets new medicine: revisiting involuntary psychotropic medication of the criminal defendant

Summary: ... The government initially argued that Weston could adequately control his delusions in order to stand trial. ... Besides avoiding the ultimate constitutional question, the Court also expressly declined to specify under what circumstances involuntary psychotropic medication of a pretrial defendant could occur - that is, what substantive standard the government would have to meet in order to justify involuntary medication. ... Mental health conditions rendering one imminently dangerous justify emergency involuntary psychotropic medication, notwithstanding one\u27s status as a pretrial criminal defendant, but general standards for medication for the purpose of restoring competence to stand trial cannot be based solely upon emergency or dangerousness requirements. ... Restoring or maintaining a criminal defendant\u27s competence to stand trial, through involuntary psychotropic medication, may be a compelling government interest. ... Restoring or maintaining a criminal defendant\u27s competence to stand trial - through involuntary psychotropic medication - may implicate specific trial-related rights, which must be independently protected anytime involuntary medication is undertaken. ... Maintaining or restoring the defendant\u27s competence to stand trial cannot alone justify involuntary psychotropic medication without a searching inquiry that medications are medically appropriate, that there is no less intrusive alternative to achieve competence, and that the defendant\u27s trial-related rights are protected. ..