Rational Prescription and Cost-Effective Medication: Challenges and Opportunities in Pakistan

Pakistan is one of the countries with the highest number of medications filled per prescription due to overly prescribed antibiotics and injectable drugs. This is due to a lack of ethical practices in prescribing because doctors are significantly influenced by lucrative financial incentives of pharmaceutical companies rather than clinical findings. This immoral activity has become significantly amplified over the past few years and continues to be a challenge in Pakistan. Currently, there is no code of ethics for marketing and promotional activities of pharmaceutical companies. This year, authorities have step up and are in the process of creating policies to regulate companies and practitioners. Implementation of these new policies needs vigilance from health officials, strong professional commitment and institutional collaboration. If executed correctly, these polices should create an environment of professionalism within the healthcare sector. Article Type: Letter

Gamblers’ (mis-)interpretations of Problem Gambling Severity Index items: Ambiguities in qualitative accounts from the Swedish Longitudinal Gambling Study

The Problem Gambling Severity Index (PGSI) is a screening instrument frequently used to identify risk and problem gambling. Even though the PGSI has good psychometric properties, it still produces a large proportion of misclassifications. Aims: To explore possible reasons for misclassifications in problem gambling level by analysing previously classified moderate-risk gamblers’ answers to the PGSI items, in relation to their own current and past gambling behaviours. Methods: Semi-structured telephone interviews were conducted with 19 participants reporting no negative consequences from gambling. They were asked the PGSI questions within an eight-year time frame (2008 to 2016). Ambiguous answers to PGSI items were subject to content analysis. Results: Several answers to the PGSI items contained ambiguities and misinterpretations, making it difficult to assess to what extent their answers actually indicated any problematic gambling over time. The item about feelings of guilt generated accounts rather reflecting self-recrimination over wasting money or regretting gambling as a meaningless or immoral activity. The item concerning critique involved mild interpretations such as being ridiculed for buying lottery tickets or getting comments for being boring. Similar accounts were given by the participants irrespective of initial endorsement of the items. Other possible reasons for misclassifications were related to recall bias, language difficulties, selective memory, and a tendency to answer one part of the question without taking the whole question into account. Conclusions: Answers to the PGSI can contain a variety of meanings based on the respondents’ subjective interpretations. Reports of lower levels of harm in the population should thus be interpreted with caution. In clinical settings it is important to combine use of screening instruments with interviews, to be able to better understand gamblers’ perceptions of the gambling behaviour and its negative consequences.

DILEMA NEGARA KOLONIAL: SEKSUALITAS DAN MORALITAS DI HINDIA BELANDA AWAL ABAD XX

Artikel ini bertujuan untuk mengelaborasi persoalan seksualitas di Hindia Belanda pada awal abad ke-20. Perdebatan tentang seksualitas, dalam bentuk praktik pergundikan dan pengaturan pelacuran, selalu saja dikaitkan dengan persoalan moralitas. Kenyataan bahwa pemerintah kolonial pada satu periode memperbolehkan dua aktivitas ini dan melarangnya di periode yang lain merupakan contoh betapa otoritas kolonial tidak pernah memiliki penilaian yang sama terkait permasalahan ini. Hal ini disebabkan oleh adanya tegangan antara kepentingan ekonomi dan semangat pemberadaban dari kolonialisme. Memperbolehkan praktik pergundikan dan pelacuran akan memberi kesan bahwa pemerintah bersekutu dalam laku amoral, sementara larangan terhadapnya akan menjadi ancaman buat kepentingan ekonomi kolonial. Artikel ini akan mencoba menganalisis dilema yang dihadapi otoritas kolonial terkait masalah ini; apa yang membuat penilaian pemerintah selalu berubah; terakhir, artikel ini juga akan menunjukkan satu studi kasus terkait persoalan dilema moral ini. This article seeks to elaborate the question of sexuality in the Dutch Indies in the beginning of the twentieth century. The debate about sexuality, particularly in the common practice of the concubinage and the regulation of the prostitution is always linked to the issue of morality. The fact that the colonial government allowed the two activities in one period and prohibited these in other period, was an example to which extent the stance of the colonial authority toward this question changed. This inconsistency arose from the tension between the economic interest and the civilizing mission of the colonialism. Allowing the concubinage and prostitution will create the impression that the government allied to the immoral activity, while prohibiting it will endanger the economic interest of the colonialism. This article will try to analyze the dilemma of the colonial authority regarding this question; the reason why the government change their judgment; and lastly, to discuss this moral dilemma in a specific case.

Denishawn (1915–1931)

Denishawn, a for-profit enterprise combining a school and dance company, was founded in Los Angeles in 1915 by the internationally acclaimed solo performer Ruth St. Denis and her husband, then up-and-coming dancer and choreographer Ted Shawn. Denishawn paved the way for modern dance in the United States by challenging American perceptions of dancing as a degenerate or immoral activity and presenting dance instead as a theatrical art. The company performed at private society events and women’s clubs, on vaudeville circuits, and eventually on legitimate concert stages, such as Carnegie Hall. In 1925–27, it became the first U.S. dance company to tour Asia, presenting dances to both colonial elites and local audiences. The Denishawn School of Dance and its Related Arts (and later satellites in New York and other major U.S. cities) trained generations of middle-class American adolescents, several of whom went on to become prominent modern dancers and choreographers, including Martha Graham, Doris Humphrey, and Charles Weidman, as well as Hollywood choreographer Jack Cole. Moreover, many aspiring actresses enrolled at the Denishawn school to study the art of physical expression, several of whom later became silent film stars, including Dorothy and Lillian Gish, Margaret Loomis, and Louise Brooks.