Introduction: The Many Facets of Precautionary Logic

The collection of contributions to this issue of Erasmus Law Review illustrates the breadth of the academic writing on the theme of precaution. This broadening of academic interest in precaution can be explained by the fact that the application of the PP is often highly contested. The European Union’s claim that the PP is a received principle of international environmental law is problematic, at least in the sense that questions of when and how to apply it always give rise to considerable controversy. The PP can therefore be considered a ‘contested concept’

Food Safety At The Molecular Level: Crossing The Ecological Threshold

The zero-tolerance precautionary approach to ban certain antibiotics from food has proven unworkable as a result of continuing analytical progress. New regulatory standards on chemical residues do not adequately address the situation, leaving technical progress, not toxicological relevance, to determine undesirable levels. As new chemical substances are identified in nature, detection must identify toxicity in terms of actual levels of exposure, but also whether a causal link between chemical and illegal conduct can be established

Verantwoordelijkheid en voorzorg bij 'de overgewichtepidemie'. Onzekerheid en transparantie bij preventief leefstijlbeleid

Dat overgewicht gezondheidsrisico’s zoals hartkwalen en suikerziekte met zich meebrengt, wordt door onder andere de WHO geclaimd maar door anderen juist ontkend. Toch vormt het idee van een ‘obesogene samenleving’ de kern van het huidige overgewichtbeleid in Nederland. Het is daarbij de verantwoordelijkheid van de overheid om ervoor te zorgen dat ‘de gezonde keus gemakkelijk is’. Het blijft de verantwoordelijkheid van de burger om ‘de gezonde keus’ te maken. Bezien vanuit het heersende medisch paradigma is hierbij sprake van evenwichtige interventies. Een kritische analyse van dat paradigma roept hierover echter twijfel op. De onzekerheid van de medische kennis, het ontbreken van effectieve interventies en het meewegen van stigmatisering als negatieve bijwerking van het beleid vragen om serieuze heroverweging van het overgewichtbeleid. zeker in relatie met de noodzaak van transparantie in een democratische rechtsstaat

Dubbelzinnig Recht

De drie artikelen in deze bundel zijn speciaal geschreven voor de cursus Inlei-ding Rechtssociologie. Het fundament van de cursus is De samenleving als schouwspel en op die basis wordt in deze artikelen verder gewerkt. De tekst over Dahrendorf en 'Dubbelzinnig recht' werden eerder gebruikt in de cursus van 1996/1997. 'Rechtssociologische inzichten' is een nieuwe tekst. Er worden onderwerpen in uitgewerkt die in de twee andere teksten kort worden aan-geroerd. Daarom zijn die teksten – in vergelijking met het vorige cursusjaar – enigszins aangepast.Pieterman, R. (1998) Dubbelzinnig Recht. Rotterdam: Donner

Installation, Operation, and Maintenance Strategies to Reduce the Cost of Offshore Wind Energy

Currently, installation, operation, and maintenance (IO&M) costs contribute approximately 30% to the LCOE of offshore wind plants. To reduce LCOE while ensuring safety, this paper identifies principal cost drivers associated with IO&M and quantifies their impacts on LCOE. The paper identifies technology improvement opportunities and provides a basis for evaluating innovative engineering and scientific concepts developed subsequently to the study. Through the completion of a case study, an optimum IO&M strategy for a hypothetical offshore wind project is identified

‘Quality in, quality out’, a stepwise approach to evidence-based medicine for rare diseases promoted by multiple endocrine neoplasia type 1

Rare diseases pose specific challenges in the field of medical research to provide physicians with evidence-based guidelines derived from studies with sufficient quality. An example of these rare diseases is multiple endocrine neoplasia type 1 (MEN1), which is an autosomal dominant endocrine tumor syndrome with an estimated occurrence rate of 2–3 per 100,000. For this complex disease, characterized by multiple endocrine tumors, it proves difficult to perform both adequate and feasible studies. The opinion of patients themselves is of utmost importance to identify the gaps in the evidence-based medicine regarding clinical care. In the search for scientific answers to clinical research questions, the aim for best available evidence is obvious. Observational studies within patient cohorts, although prone to bias, seem the most feasible study design regarding the disease prevalence. Knowledge and adaptation to all types of bias is demanded in the strive for answers. Guided by our research on MEN1 patients, we elaborate on strategies to identify sufficient patients, to maximize and maintain patient enrolment and to standardize the data collection process. Preferably, data collection is performed prospectively, however, under certain conditions, data storage in a longitudinal retrospective database with a disease-specific framework is suitable. Considering the global challenges on observational research on rare diseases, we propose a stepwise approach from clinical research questions to scientific answers

Health-Related Quality of Life in Patients with Multiple Endocrine Neoplasia Type 1

Introduction: Multiple endocrine neoplasia type 1 (MEN1) is a hereditary endocrine tumor syndrome characterized by the triad of primary hyperparathyroidism, duodenopancreatic neuroendocrine tumors (pNETs), and pituitary tumors. Patients are confronted with substantial morbidity and are consequently at risk for an impaired quality of life (QOL). Meticulous assessment of QOL and associated factors in a representative population is needed to understand the full spectrum of the burden of the disease. Patients and Methods: A cross-sectional study was performed using the national Dutch MEN1 cohort. Patients with a confirmed MEN1 mutation received the SF-36 Health Related Quality of Life questionnaire and questions regarding sociodemographic and medical history. Results: A total of 227 of 285 (80%) eligible MEN1 patients returned the questionnaires. Health-related QOL scores (HRQOL) in MEN1 patients were significantly lower for the majority of subscales of the SF-36 in comparison with the general Dutch population. The most consistent predictor for HRQOL was employment status, followed by the presence of a pituitary tumor. 16% of patients harboring a pNET and 29% of patients with a pituitary tumor according to the medical records, reported that they were unaware of such a tumor. These subgroups of patients had several significant better QOL scores than patients who were aware of their pNET or pituitary tumors. Conclusion: Patients with MEN1 have an impaired QOL in comparison with the general Dutch population warranting special attention within routine care. For daily practice, physicians should be aware of their patients' impaired QOL and of the impact of unemployment on QOL