Methadone maintenance treatment and St. John's Wort - a case report.

St. John's wort, a popular over-the-counter drug for treatment of depression, might reduce concentrations of drugs such as cyclosporin and indinavir and lead to drug resistance and treatment failure. No studies as yet have examined its influence on methadone plasma levels. The trough methadone plasma levels were measured in four patients (2 males, median age: 31 years; range 19 - 40 years) in methadone maintenance treatment just before the introduction of St. John's wort (900 mg/d) and after a median period of 31-day treatment (range 14 - 47). The study was proposed to addict patients about to start an antidepressant therapy. Introduction of St. John's wort resulted in a strong reduction of (R,S)-methadone concentration-to-dose ratios in the four median patients included, with a median decrease to 47 % of the original concentration (range: 19 % - 60 % of the original concentration). Two patients reported symptoms that suggested a withdrawal syndrome. Thus, prescription of St. John's wort might decrease methadone blood levels and induce withdrawal symptoms which, if not correctly identified and handled (by changing the antidepressant or by increasing the methadone dose), might cause unnecessary discomfort to the patient, lead to resumption of illicit drug uses, or be a risk factor for discontinuation of the methadone or antidepressant treatment.

Le compas & le bistouri. Architecture de la médecine et du tourisme curatif : l'exemple vaudois (1760-1940)

Les établissements médicaux vaudois construits entre 1760 et 1940 sont des témoins privilégiés de l'émergence de l'architecture rationnelle ainsi que de phénomènes historiques et sociaux tels que la médicalisation de la société et du territoire, l'essor du tourisme médical, le transfert des modèles et des technologies. L'étude des hôpitaux, des sanatoriums, des cliniques et des établissements de bains montre comment l'invention d'une « architecture à soigner » est le fait conjoint du médecin et de l'architecte, tous deux cherchant à faire de ces établissements des faire-valoir de leur pratique ainsi que des monuments à la gloire de la santé publique ou de la philanthropie.

Les limites de la performativité des énoncés économiques: les apports de John Searle

The problematic of performativity has recently produced several criticisms and debates about the status of the economic discourse. Indeed the affirmation that economist shapes the world by describing it could leads to the subjectivist idea that each theory can in fine be 'true' and each theory can perform the social world in his specific way. This work clarifies this problematic in connecting it with the institutional theory of John Searle. We define performativity as a particular type of assignment of function. Finally, this enables us to show that performativity is limited by two kinds of factors : brut facts and social facts.