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Since 1997 the US National Institute on Drug Abuse has advocated a brain disease model of addiction (BDMA). We assess the strength of evidence for the BDMA in animals, neuroimaging studies of people with addiction, and current research on the role of genetics in addiction. We critically assess claims about the medical and social benefits of use of the BDMA because the social implications are often implied as a reason to accept this model. Furthermore, we argue that the BDMA is not supported by animal and neuroimaging evidence to the extent its advocates suggest; it has not helped to deliver more effective treatments for addiction; and its effect on public policies toward drugs and people with addiction has been modest. The focus of the BDMA is on disordered neurobiology in a minority of severely addicted individuals, which undermines the implementation of effective and cost-effective policies at the population level to discourage people from smoking tobacco and drinking heavily. The pursuit of high technology direct brain interventions to cure addiction when most individuals with addiction do not have access to effective psychosocial and drug treatments is questionable., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

It is argued that food addiction explanations of obesity may reduce the significant stigma levelled at obese and overweight individuals. We surveyed 479 adults to determine the prevalence of food addiction in the U.S. (n = 215) and, for the first time, in Australia (n = 264) using the Yale Food Addiction Scale (YFAS). We also assessed the level of weight-based stigma in this population. The prevalence of food addiction in our Australian sample was 11%, similar to U.S. participants and consistent with previous studies. Those who met criteria for diagnosis had a larger mean BMI (33.8 kg/m2) than those who did not (26.5 kg/m2). Overall, the level of stigma towards others was low and differed significantly based on BMI, predominately among normal weight and obese participants (p = 0.0036). Obese individuals scored higher on certain measures of stigma, possibly reflecting individual experiences of stigma rather than negative attitudes towards other obese individuals (p = 0.0091). Despite significant support for a "food addiction" explanation of obesity, participants still valued personal responsibility in overcoming obesity and did not support coercive approaches to treat their "addiction".

In the debate on the ethics of the non-medical use of pharmaceuticals for cognitive performance enhancement in healthy individuals there is a clear division between those who view "cognitive enhancement" as ethically unproblematic and those who see such practices as fraught with ethical problems. Yet another, more subtle issue, relates to the relevance and quality of the contribution of scholarly bioethics to this debate. More specifically, how have various forms of speculation, anticipatory ethics, and methods to predict scientific trends and societal responses augmented or diminished this contribution? In this paper, we use the discussion of the ethics of cognitive enhancement to explore the positive and negative contribution of speculation in bioethics scholarship. First, we review and discuss how speculation has relied on different sets of assumptions regarding the non-medical use of stimulants, namely: (1) terminology and framing; (2) scientific aspects such as efficacy and safety; (3) estimates of prevalence and consequent normalization; and (4) the need for normative reflection and regulatory guidelines. Second, three methodological guideposts are proposed to alleviate some of the pitfalls of speculation: (1) acknowledge assumptions more explicitly and identify the value attributed to assumptions; (2) validate assumptions with interdisciplinary literature; and (3) adopt a broad perspective to promote more comprehensive reflection. We conclude that, through the examination of the controversy about cognitive enhancement, we can employ these methodological guideposts to enhance the value of contributions from bioethics and minimize potential epistemic and practical pitfalls in this case and perhaps in other areas of bioethical debate.

Purpose: To report successful treatment of refractive glaucoma in a patient submitted to osteo-odonto-keratoprosthesis surgery for Stevens-Johnson syndrome., Methods: An interventional case report., Results: The patient is a 62-year-old Indian man with known Stevens-Johnson syndrome since 1972 secondary to tetracycline therapy, with bilateral dry eye and corneal blindness. He underwent symblepharon release surgery with mucous membrane graft in both eyes. Osteo-odonto-keratoprosthesis surgery was later performed on the left eye. He was submitted to 2 Ahmed valve implants to control secondary glaucoma but visual fields continued to worsen; hence, he underwent endoscopic 140° cyclophotocoagulation with a good control of IOP., Conclusion: Endoscopic cyclophotocoagulation as alternative treatment provides good results in refractory glaucoma after osteo-odonto-keratoprosthesis surgery.

Background: Donepezil, an acetylcholinesterase inhibitor used in the treatment of Alzheimer's disease, has been widely cited in media and bioethics literature on cognitive enhancement (CE) as having the potential to improve the cognitive ability of healthy individuals. In both literatures, this claim has been repeatedly supported by the results of a small study published by Yesavage et al. in 2002 on non-demented pilots (30-70 years old). The factors contributing to this specific interpretation of this study's results are unclear., Methods: We examined print media and interdisciplinary bioethics coverage of this small study, aiming to provide insight into how evidence from research may be shaped within different discourses, potentially influencing important policy, ethics, and clinical decisions. Systematic qualitative content analysis was used to examine how this study was reported in 27 media and 22 bioethics articles. Articles were analyzed for content related to: (1) headlines and titles; (2) colloquialisms; and, (3) accuracy of reporting of the characteristics and results of the study., Results: In media and bioethics articles referencing this small study, strong claims were made about donepezil as a CE drug. The majority of headlines, titles, and colloquialisms used enhancement language and the majority of these suggest that donepezil could be used to enhance intellectual ability. Further, both literatures moved between reporting the results of the primary study and magnifying the perceived connection between these results and the CE debate that was alluded to in the primary study. Specific descriptions of the results overwhelmingly reported an improvement in performance on a flight simulator, while more general statements claimed donepezil enhanced cognitive performance. Further, a high level of reporting accuracy was found regarding study characteristics of the original study, but variable levels of accuracy surrounded the presentation of complex characteristics (i.e., methods) or contentious properties of the CE debate (i.e., initial health status of the study subjects)., Conclusions: Hyped claims of CE effects cannot be completely accounted for by sheer inaccuracy in reporting. A complex interaction between the primary and secondary literature, and expectations and social pressures related to CE appears to drive enthusiastic reports.

Aim: To evaluate the benefits of the internal limiting membrane removal in patients with rhegmatogenous retinal detachment who underwent pars plana vitrectomy., Material and Methods: The first study group (B) consisted of 26 patients who underwent vitrectomy with the internal limiting membrane peeling. The second control group (K) consisted of 15 patients, in whom vitrectomy was performed without he internal limiting membrane peeling. Macular detachment was confirmed preoperatively in all patients. Ophthalmic examination was performed 6 months after surgery. This included the best corrected visual acuity for distance and near, M-Charts, fundus examination and spectral domain--optical coherent tomography., Results: The results were statistically analyzed using the Shapiro-Wilk test and the Ch2 test of homogeneity. In the study group (B), the mean postoperative best corrected visual acuity for distance was 0.46, while in the control group (K) it was 0.35 (p = 0.35). The best corrected visual acuity for near in group B was 0.83 and 1.01 (p = 0.63) in group K. Central retinal thickness in group B was 268.64 μm, while in group K it was 335.07 μm (p = 0.20). The statistical analysis revealed significant differences between the two groups regarding the prevalence of defects in the ellipsoidal layer (p = 0.004). They were found to occur more frequently in group K (64.29%) than in group B (20.00%). The prevalence of epiretinal membrane was higher in group K (28.57%) than in group B (3.85%) (p = 0.02)., Conclusions: The internal limiting membrane peeling reduces the risk of secondary epiretinal membrane, restores the ellipsoidal layer integrity and does not affect the visual acuity for distance and near.

Enhancing cognitive performance with substances--especially prescription drugs--is a fiercely debated topic among scholars and in the media. The empirical basis for these discussions is limited, given that the actual nature of factors that influence the acceptability of and willingness to use cognitive enhancement substances remains unclear. In an online factorial survey, contextual and substance-specific characteristics of substances that improve academic performance were varied experimentally and presented to respondents. Students in four German universities rated their willingness to use and moral acceptance of different substances for cognitive enhancement. We found that the overall willingness to use performance enhancing substances is low. Most respondents considered the use of these substances as morally unacceptable. Situational influences such as peer pressure, policies concerning substance use, relative performance level of peers, but also characteristics of the substance, such as perceptions of substance safety, shape the willingness and acceptability of using a substance to enhance academic performance. Among the findings is evidence of a contagion effect meaning that the willingness was higher when the respondents have more CE drug users in their social network. We also found deterrence effects from strong side effects of using the substance, as well as from policy regulations and sanctions. Regulations might activate social norms against usage and sanctions can be seen as costly to users. Moreover, enhancement substances seem to be most tempting to low performers to catch up with others compared to high performers. By identifying contextual factors and substance characteristics influencing the willingness and acceptability of cognitive enhancers, policy approaches could consider these insights to better manage the use of such substances.

The existence of diverging discourses in the media and academia on the use of prescription medications to improve cognition in healthy individuals, i.e. "cognitive enhancement" (CE) creates the need to better understand perspectives from stakeholders. This qualitative focus-group study examined perspectives from students, parents and healthcare providers on CE. Stakeholders expressed ambivalence regarding CE (i.e. reactions to, definitions of, risks, and benefits). They were reluctant to adopt analogies to performance-enhancing steroids and caffeine though these analogies were useful in discussing concepts common to the use of different performance-enhancing substances. Media coverage of CE was criticized for lack of scientific rigor, ethical clarity, and inadvertent promotion of CE. Ambivalence of stakeholders suggests fundamental discomfort with economic and social driving forces of CE. Forms of public dialogue that voice the unease and ambivalence of stakeholders should be pursued to avoid opting hastily for permissive or restrictive health policies for CE.

Background: There is substantial evidence that methylphenidate (MPH; Ritalin), is being used by healthy university students for non-medical motives such as the improvement of concentration, alertness, and academic performance. The scope and potential consequences of the non-medical use of MPH upon healthcare and society bring about many points of view., Methods: To gain insight into key ethical and social issues on the non-medical use of MPH, we examined discourses in the print media, bioethics literature, and public health literature., Results: Our study identified three diverging paradigms with varying perspectives on the nature of performance enhancement. The beneficial effects of MPH on normal cognition were generally portrayed enthusiastically in the print media and bioethics discourses but supported by scant information on associated risks. Overall, we found a variety of perspectives regarding ethical, legal and social issues related to the non-medical use of MPH for performance enhancement and its impact upon social practices and institutions. The exception to this was public health discourse which took a strong stance against the non-medical use of MPH typically viewed as a form of prescription abuse or misuse. Wide-ranging recommendations for prevention of further non-medical use of MPH included legislation and increased public education., Conclusion: Some positive portrayals of the non-medical use of MPH for performance enhancement in the print media and bioethics discourses could entice further uses. Medicine and society need to prepare for more prevalent non-medical uses of neuropharmaceuticals by fostering better informed public debates.

This interventional case report presents an anterior chamber intraocular lens (AC-IOL) translocation technique to manage a case of uveitis-glaucoma-hyphema (UGH) syndrome associated with posterior dislocation of nuclear fragments and vitreitis as a consequence of capsule rupture during cataract surgery. Pars plana vitrectomy followed by an AC-IOL translocation from the anterior chamber to the sulcus without additional surgical corneal incision was performed. At 12 months' follow-up, the original AC-IOL was in stable position in the posterior chamber, with binocular refractive balance and no further astigmatism and resolution of the UGH syndrome.