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The popularity of and market for natural medicines (herbal remedies, dietary supplements, and vitamins) is accelerating. At the same time, evidence for their effectiveness (both in general and for specific conditions) and safety remains poor in many instances. Independent evaluations have identified products that are poorly manufactured, contaminated, or mislabeled. We examine data on cannabidiol (CBD) to exemplify these problems. Yet consumers often are unaware of these concerns and problems and continue to believe that "natural" means "safe." The current US regulatory framework founded in the 1994 Dietary Supplement Health and Education Act (DSHEA) does not adequately protect the health of US consumers and urgently needs to be revised. At the same time, clinicians should update themselves regularly with the best available evidence on the natural medications most relevant to their areas of practice. We recommend some evidence-based resources that will help clinicians and their patients remain current in this area.

This commentary examines 4 ethical issues in a case of clinicians considering conducting research on children in conflict zones: (1) whether any time or resources should be taken away from treating acute injuries in order to conduct research; (2) obtaining consent for children to participate in research, which is particularly challenging given that children can be separated from parents or guardians; (3) whether the research is feasible at the moment, since starting research that stands little chance of being completed is ethically questionable; and (4) maintaining neutrality, impartiality, and humanity. Research that puts participants and researchers at risk of additional harm must be considered carefully. Here, we propose that both research and clinical care might occur simultaneously when researchers engage humbly with involved communities as the research is being designed, conducted, and reported in order to understand and resolve ethical issues involved.

The objective of this multisite study was to explore the professional and personal experiences of US nurse managers (NMs) during the COVID-19 pandemic.NMs are the most accessible and visible nurse leaders to the frontline staff during this pandemic.Thirty-nine NMs from 5 health systems across the US participated in focus groups in this qualitative study. Data were analyzed using a constant comparative method.Three major themes were identified: challenges, feelings and emotions, and coping. Subthemes emerged within each major theme.NMs across the country accepted considerable responsibility at great professional and personal consequence during the pandemic. NMs experienced challenges, ethical dilemmas, and expressed negative emotions. As the usual coping strategies failed, NMs reported that they are considering alternative career choices. This work provided evidence to help senior leaders strategize about mechanisms for reducing managerial dissonance during times of stress.

Research is needed to make responses to disasters and humanitarian emergencies more evidence-based. Such research must also adhere to the generally accepted principles of research ethics. While research into health interventions used in disasters raises distinctive ethical concerns, seven ethical principles developed for clinical research are applied here to disaster research. Practical examples from disaster settings are used to demonstrate how these ethical principles can be applied. This reveals that research ethics needs to be seen as much more than a mechanism to obtain ethical approval for research. Research ethics involves ethical principles and governance frameworks, but must also consider the role of ethical virtues in research. Virtues are essential to ensure that researchers do what they believe is ethically right and resist what is unethical. Research ethics that truly protects participants and promotes respect needs to include training in ethical virtues to ensure disaster research is carried out to the highest ethical standards. This article is based on a presentation at the Evidence Aid Symposium on 20 September 2014, in Hyderabad, India.