Practical guidance and considerations for transitioning patients from oxcarbazepine or carbamazepine to eslicarbazepine acetate--Expert opinion.

There is currently a lack of guidance on methodology and special considerations for transitioning patients from oxcarbazepine (OXC) or carbamazepine (CBZ) to eslicarbazepine acetate (ESL), if deemed clinically necessary. An advisory panel of epilepsy experts was convened to share their experience on the use of adjunctive ESL in clinical practice and to provide practical recommendations to help address this gap. When changing over from OXC to ESL, an OXC:ESL dose ratio of 1:1 should be employed to calculate the ESL target dose, and the changeover can take place overnight. No changes to comedication are required. Since CBZ has a different mechanism of action to ESL and is a stronger inducer of cytochrome P450 (CYP) enzymes, the transitioning of patients from CBZ to ESL requires careful consideration on a patient-by-patient basis. In general, a CBZ:ESL dose ratio of 1:1.3 should be employed to calculate the ESL target dose, and patients should be transitioned over a minimum period of 1-2weeks. Special considerations include adjustment of titration schedule and target dose in elderly patients and those with hepatic or renal impairment and potential adjustment of comedications metabolized by CYP enzymes. In summary, due to structural distinctions between ESL, OXC, and CBZ, which affect mechanism of action and tolerability, there are clinical situations in which it may be appropriate to consider transitioning patients from OXC or CBZ to ESL. Changing patients over from OXC to ESL is generally more straightforward than transitioning patients from CBZ to ESL, which requires careful consideration.

Les neurosciences au Tribunal : de la responsabilité à la dangerosité, enjeux éthiques soulevés par la nouvelle loi française

AIM: In the past few years, spectacular progress in neuroscience has led to the emergence of a new interdisciplinary field, the so-called "neurolaw" whose goal is to explore the effects of neuroscientific discoveries on legal proceedings and legal rules and standards. In the United States, a number of neuroscientific researches are designed specifically to explore legally relevant topics and a case-law has already been developed. In Europe, neuroscientific evidence is increasingly being used in criminal courtrooms, as part of psychiatric testimony, nourishing the debate about the legal implications of brain research in psychiatric-legal settings. Though largely debated, up to now the use of neuroscience in legal contexts had not specifically been regulated by any legislation. In 2011, with the new bioethics law, France has become the first country to admit by law the use of brain imaging in judicial expertise. According to the new law, brain imaging techniques can be used only for medical purposes, or scientific research, or in the context of judicial expertise. This study aims to give an overview of the current state of the neurolaw in the US and Europe, and to investigate the ethical issues raised by this new law and its potential impact on the rights and civil liberties of the offenders. METHOD: An overview of the emergence and development of "neurolaw" in the United States and Europe is given. Then, the new French law is examined in the light of the relevant debates in the French parliament. Consequently, we outline the current tendencies in Neurolaw literature to focus on assessments of responsibility, rather than dangerousness. This tendency is analysed notably in relation to the legal context relevant to criminal policies in France, where recent changes in the legislation and practice of forensic psychiatry show that dangerousness assessments have become paramount in the process of judicial decision. Finally, the potential interpretations of neuroscientific data introduced into psychiatric testimonies by judges are explored. RESULTS: The examination of parliamentary debates showed that the new French law allowing neuroimaging techniques in judicial expertise was introduced in the aim to provide a legal framework that would protect the subject against potential misuses of neuroscience. The underlying fear above all, was that this technology be used as a lie detector, or as a means to predict the subject's behaviour. However, the possibility of such misuse remains open. Contrary to the legislator's wish, the defendant is not fully guaranteed against uses of neuroimaging techniques in criminal courts that would go against their interests and rights. In fact, the examination of the recently adopted legislation in France shows that assessments of dangerousness and of risk of recidivism have become central elements of the criminal policy, which makes it possible, if not likely that neuroimaging techniques be used for the evaluation of the dangerousness of the defendant. This could entail risks for the latter, as judges could perceive neuroscientific data as hard evidence, more scientific and reliable than the soft data of traditional psychiatry. If such neuroscientific data are interpreted as signs of potential dangerousness of a subject rather than as signs of criminal responsibility, defendants may become subjected to longer penalties or measures aiming to ensure public safety in the detriment of their freedom. CONCLUSION: In the current context of accentuated societal need for security, the judge and the expert-psychiatrist are increasingly asked to evaluate the dangerousness of a subject, regardless of their responsibility. Influenced by this policy model, the judge might tend to use neuroscientific data introduced by an expert as signs of dangerousness. Such uses, especially when they subjugate an individual's interest to those of society, might entail serious threats to an individual's freedom and civil liberties.

La viande et la santé publique [Meat and public health].

La presse a donné un large écho à une récente publication émanant du Centre international de recherche sur le cancer, une agence spécialisée de l'Organisation mondiale de la santé. Cette publication présente la reclassification de certains aliments carnés comme agents cancérigènes. Comme institution universitaire de santé publique, l'IUMSP souhaite apporter des précisions

La surveillance bancaire belge de 1935 façonnée sur le modèle suisse: un discret transfert de politique publique?

Suite aux graves crises bancaires et financières qui ont secoué la plupart de sociétés occidentales au début des années 1930, on assiste à un foisonnement de réglementations publiques sur les activités bancaires. Parmi les très nombreux pays qui mettent en place des législations bancaires, l'on compte notamment la Suisse et la Belgique. Plus précisément, la loi fédérale suisse sur les banques de novembre 1934 précède de quelques mois l'arrêté royal belge no 185 de juillet 1935. Alors que le contexte historique et l'élaboration respective de chacune de ces réglementations ont déjà fait l'objet de plusieurs analyses, la comparaison et la question des éventuels liens entre ces deux régimes de surveillance bancaire très proches sont encore largement inexplorées. Une analyse détaillée du processus d'élaboration de la réglementation bancaire belge révèle que la loi suisse a joué un rôle de modèle mis en avant en premier chef par les représentants du monde bancaire. Cette influence helvétique a contribué à façonner la régulation bancaire dans une perspective libérale ; elle répondait ainsi à deux besoins essentiels: limiter l'interventionnisme étatique au minimum, et court-circuiter le pouvoir de la banque centrale. Cette parenté de naissance entre les deux lois bancaires trouve son pendant dans les activités clés deux organismes de surveillance créés pour l'occasion, la Commission fédérale des banques à Berne et la Commission bancaire à Bruxelles. Disposant toutes deux de moyens d'actions limités, ces deux instances ont connu des parcours analogues au cours de leurs premières années d'activité.

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.

Les Neurosciences au Tribunal: de la responsabilité à la dangerosité

In recent years, an explosion of interest in neuroscience has led to the development of "Neuro-law," a new multidisciplinary field of knowledge whose aim is to examine the impact and role of neuroscientific findings in legal proceedings. Neuroscientific evidence is increasingly being used in US and European courts in criminal trials, as part of psychiatric testimony, nourishing the debate about the legal implications of brain research in psychiatric-legal settings. During these proceedings, the role of forensic psychiatrists is crucial. In most criminal justice systems, their mission consists in accomplishing two basic tasks: assessing the degree of responsibility of the offender and evaluating their future dangerousness. In the first part of our research, we aim to examine the impact of Neuroscientific evidence in the assessment of criminal responsibility, a key concept of law. An initial jurisprudential research leads to conclude that there are significant difficulties and limitations in using neuroscience for the assessment of criminal responsibility. In the current socio-legal context, responsibility assessments are progressively being weakened, whereas dangerousness assessments gain increasing importance in the field of forensic psychiatry. In the second part of our research we concentrate on the impact of using neuroscience for the assessment of dangerousness. We argue that in the current policy era of zero tolerance, judges, confronted with the pressure to ensure public security, may tend to interpret neuroscientific knowledge and data as an objective and reliable way of evaluating one's dangerousness and risk of reoffending, rather than their responsibility. This tendency could be encouraged by a utilitarian approach to punishment, advanced by some recent neuroscientific research which puts into question the existence of free will and responsibility and argues for a rejection of the retributive theory of punishment. Although this shift away from punishment aimed at retribution in favor of a consequentialist approach to criminal law is advanced by some authors as a more progressive and humane approach, we believe that it could lead to the instrumentalisation of neuroscience in the interest of public safety, which can run against the proper exercise of justice and civil liberties of the offenders. By advancing a criminal law regime animated by the consequentialist aim of avoiding social harms through rehabilitation, neuroscience promotes a return to a therapeutical approach to crime which can have serious impact on the kind and the length of sentences imposed on the offenders; if neuroscientific data are interpreted as evidence of dangerousness, rather than responsibility, it is highly likely that judges impose heavier sentences, or/and security measures (in civil law systems), which can be indeterminate in length. Errors and epistemic traps of past criminological movements trying to explain the manifestation of a violent and deviant behavior on a biological and deterministic basis stress the need for caution concerning the use of modern neuroscientific methods in criminal proceedings.