Background:Despite the relatively high expenditure on healthcare in Saudi Arabia, its health system remains highly centralized in the main cities with its primary focus on secondary and tertiary care rather than primary care. This has led to numerous ethical challenges for the healthcare providers. This article reports the results of a study conducted with a panel of practitioners, and non-clinicians, in Saudi Arabia, in order to identify the top ten ethical challenges for healthcare providers, patients, and their families.Materials and Methods:The study design was a cross-sectional, descriptive, and qualitative one. The participants were asked the question: “What top ten ethical challenges are Saudis likely to face in health care?” The participants were asked to rank the top ten ethical challenges throughout a modified Delphi process, using a ranking Scale. A consensus was reached after three rounds of questions and an experts’ meeting.Results:The major 10 ethical issues, as perceived by the participants in order of their importance, were: (1) Patients’ Rights, (2) Equity of resources, (3) Confidentiality of the patients, (4) Patient Safety, (5) Conflict of Interests, (6) Ethics of privatization, (7) Informed Consent, (8) Dealing with the opposite sex, (9) Beginning and end of life, and (10) Healthcare team ethics.Conclusion:Although many of the challenges listed by the participants have received significant public and specialized attention worldwide, scant attention has been paid to these top challenges in Saudi Arabia. We propose several possible steps to help address these key challenges.

BackgroundSaudi Arabia is considered one of the most influential Muslim countries being as the host of the two most holy places for Muslims, namely Makkah and Madina. This was reflected in the emphasis on teaching medical ethics in a lecture-based format as a part of the subject of Islamic culture taught to medical students. Over the last few years, both teaching and evaluation of medical ethics have been changing as more Saudi academics received specialized training and qualifications in bioethics from western universities.MethodsThis study aims at studying the current teaching methods and evaluation tools used by the Saudi public medical schools. It is done using a self-administered online questionnaire.ResultsOut of the 14 medical schools that responded, the majority of the responding schools (6; 42.8%), had no ethics departments; but all schools had a curriculum dedicated to medical ethics. These curricula were mostly developed by the faculty staff (12; 85.7%). The most popular teaching method was lecturing (13; 92.8%). The most popular form of student assessment was a paper-based final examination (6; 42.8%) at the end of the course that was allocated 40% or more of the total grade of the ethics course. Six schools (42.8%) allocated 15-30% of the total grade to research.ConclusionAlthough there is a growing interest and commitment in teaching ethics to medical students in Saudi schools; there is lack of standardization in teaching and evaluation methods. There is a need for a national body to provide guidance for the medical schools to harmonize the teaching methods, particularly introducing more interactive and students-engaging methods on the account of passive lecturing.

BackgroundSub-clinical hypothyroid dysfunction, a relatively understudied disorder in the Kingdom of Saudi Arabia (KSA), has significant clinical implications if not properly monitored. Also from KSA, more than 50% of the population suffer from hypovitaminosis D (<50 nmol/l). In this cross-sectional case-control study, we described the differences and associations in the metabolic patterns of adult Saudis with and without hypothyroid dysfunction in relation to their vitamin D status, PTH, calcium and lipid profile.MethodsA total of 94 consenting adult Saudis [52 controls (without subclinical hypothyroidism), 42 cases (previously diagnosed subjects)] were included in this cross-sectional study. Anthropometrics were obtained and fasting blood samples were taken for ascertaining lipid and thyroid profile, as well as measuring PTH, 25(OH) vitamin D and calcium.ResultsCases had a significantly higher body mass index than the controls (p < 0.001). Circulating triglycerides was also significantly higher in cases than the controls (p = 0.001). A significant positive association between HDL-cholesterol and PTH (R = 0.56; p = 0.001), as well as a negative and modestly significant negative association between LDL-cholesterol and PTH (R = - 20.0; p = 0.04) were observed. FT3 was inversely associated with circulating 25 (OH) vitamin D (R = -0.25; p = 0.01).ConclusionsPatients with hypothyroid dysfunction possess several cardiometabolic risk factors that include obesity and dyslipidemia. The association between PTH and cholesterol levels as well as the inverse association between vitamin D status and FT3 needs to be reassessed prospectively on a larger scale to confirm these findings.

Background:Relationships between physicians and pharmaceutical & other medically related industries have received considerable attention in recent years. We surveyed physicians all around Saudi Arabia (SA) to collect information about their knowledge, behaviors and attitudes regarding their relationships with the industry.Methods:A cross-sectional survey that used a 47-item, anonymous, self-administered questionnaire, was sent to all accessible doctors in SA. The questionnaire was developed based on literature review, discussed between authors and reviewed by experts. The surveyResults:600 doctors (physicians and surgeons), 15% of them were psychiatrists who filled in the survey. Preliminary results of only 15% of the total sample indicated that 40.9% (n = 38) of participants have encountered a pharmaceutical company representatives (PRs) at least once in their life. Psychiatrists were among the top specialties in accepting gifts and promotions presented to them by PRs. 4.3% (n = 4) of participants mentioned that PRs almost always offer a gift and promotion after every meeting. The most frequently mentioned gifts presented to participants by PRs are stationary such as pens or notepads (26.9%). Although 60.2% (n = 56) of participants had been educated about the ethics in physician industry relationships, 34.4% of participants accept gifts and promotions presented to them by PRs.The final results of this study will be ready by Feb 2013. It will be presented fully in the EPA 2013.Conclusions:The results of this survey indicate that relationships between physicians and industry are common and underscore the variation among such relationships according to specialty, practice type, and professional activities.