Novel Medicine: Healing, Literature, and Popular Knowledge in Early Modern China. By Andrew Schonebaum. Seattle: University of Washington Press, 2016. Pp. viii + 283. $50.

There has been a move in medicine towards patient-centred care, leading to more demands from patients for particular therapies and treatments, and for wish-fulfilling medicine: the use of medical services according to the patient's wishes to enhance their subjective functioning, appearance or health. In contrast to conventional medicine, this use of medical services is not needed from a medical point of view. Boundaries in wish-fulfilling medicine are partly set by a physician's decision to fulfil or decline (...) a patient's wish in practice. In order to develop a better understanding of how wish-fulfilling medicine occurs in practice in The Netherlands, a qualitative study (15 semistructured interviews and 1 focus group) was undertaken. The aim was to investigate the range and kind of arguments used by general practitioners and plastic surgeons in wish-fulfilling medicine. These groups represent the public funded realm of medicine as well as privately paid for services. Moreover, GPs and plastic surgeons can both be approached directly by patients in The Netherlands. The physicians studied raised many arguments that were expected: they used patient autonomy, risks and benefits, normality and justice to limit wish-fulfilling medicine. In addition, arguments new to this debate were uncovered, which were frequently used to justify compliance with a patient's request. Such arguments seem familiar from conventional medicine, including empathy, the patient–doctor relationship and reassurance. Moreover, certain arguments that play a significant role in the literature on wish-fulfilling medicine and enhancement were not mentioned, such as concepts of disease and the enhancement–treatment dichotomy and ‘suspect norms’. (shrink)

I recently taught an upper-division Honors class in Medicine and Literature with students ranging from a pre-physician’s assistant student and nursing student to English, French, History, and Technical Writing majors. The common thread connecting these students initially was their self-described fear of and helplessness with poetry. However, as the semester drew to a close, their class discussion and journals revealed not only increased comfort with poetry but also a preference for it. The information and insight they got from poetry, (...) they said, were the reason they took a medical humanities course in the first place and commented that the poetry we read provoked more substantial “medicine and literature” discussions than prose. Poetry provides a good starting place to analyze complex human relationships, and the focus on language and form levels the intellectual playing field: students are all unfamiliar with how to do it and are learning a new skill together. This could be accomplished, of course, with a literary short story, but for the diverse population of students in this class, the brevity of poetry made it all the more appealing. (shrink)

This essay is an attempt to plumb the conventions which exist at a specific historical moment in both the aesthetic and scientific spheres. I will assume the existence of a web of conventions within the world of the aesthetic—conventions which have elsewhere been admirably illustrated—but will depart from the norm by examining the synchronic existence of another series of conventions, those of medicine. I do not mean in any way to accord special status to medical conventions. Indeed, the world (...) is full of overlapping and intertwined systems of conventions, of which the medical and the aesthetic are but two. Medicine offers an especially interesting source of conventions since we do tend to give medical conventions special “scientific” status as opposed to the “subjective” status of the aesthetic conventions. But medical icons are no more “real” than “aesthetic” ones. Like aesthetic icons, medical icons may iconographic in that they represent these realities in a manner determined by the historical position of the observers, their relationship to their own time, and to the history of the conventions which they employ. Medicine uses its categories to structure an image of the diversity of mankind; it is as much at the mercy of the needs of any age to comprehend this infinite diversity as any other system which organizes our perception of the world. The power of medicine, at least in the nineteenth century, lies in the rise of the status of science. He conventions of medicine infiltrate other seemingly closed iconographic systems precisely because of this status. In examining the conventions of medicine employed in other areas, we must not forget this power.One excellent example of the conventions of human diversity captured in the iconography of the nineteenth century is the linkage of two seemingly unrelated female images—the icon of the Hottentot female and the icon of the prostitute. In the course of the nineteenth century, the female Hottentot comes to represent the black female in nuce, and the prostitute to represent the sexualized woman. Both of these categories represent the creation of classes which correspondingly represent very specific qualities. While the number of terms describing the various categories of the prostitute expanded substantially during the nineteenth century, all were used to label the sexualized woman. Likewise, while many groups of African blacks were known to Europeans in the nineteenth century, the Hottentot remained representative of the essence of the black, especially the black female. Both concepts fulfilled an iconographic function in the perception and the representation of the world. How these two concepts were associated provides a case study for the investigation of patterns of conventions, without any limitation on the “value” of one pattern over another. Sander L. Gilman is professor of Humane Studies in the Department of German Literature and Near Eastern Studies and professor of Psychiatry in the Cornell Medical College, Cornell University. He is the author or editor of numerous studies of European cultural history with a focus on the history of stereotypes. In addition, he has coedited Degeneration with J. E. Chamberlin. His study Jewish Self-Hatred is forthcoming. (shrink)

The medical literature in Rome firstly lives on Greek scientific works, because Latin language, inappropriate for speculative matters, couldn’t be succeeded to express the grandiosity and precision of the subject. So, Roman medicine assimilates the Greek medical culture. Roman doctors dedicate themselves to a public hygiene, prudently systematizing practice and concrete knowledge of other cultures. Pliny, the elder writes a work untitled Natural History, composed in thirty seven books, and interests us most those dedicated to medicine, its history (...) and dissemination among ancient people, up to its arrival and reception in Rome, at the first century. (shrink)

This article presents a brief general view of the recent literature and the scholarly activity in the field of philosophy of medicine in Scandinavia. The focus of attention is not on medical ethics, but on studies on topics like decision theory, medical classification, causality, causal explanations, concept formation, and on analyses of different ideals of medical science and clinical practice. A few principal works on medical ethics are mentioned by way of introduction and a brief account of a highly (...) topical debate on the legislation on artificial insemination in Sweden is given at the end. (shrink)

This is a review of the literature in the philosophy of medicine published in China from 1930 to 1980. The topics dealt with include the relationship between medicine and philosophy, the basic concepts of medicine, etiology and causality, the bearing of psychology on physiology and pathology, epistemology in diagnostics, methodology of medical sciences, philosophical and methological problems in traditional Chinese medicine, philosophical problems in health policy, and medical ethics.

The volume examines the interrelationships between the history of medicine and literature from the 17th until the 19th centuries. The papers in the volume analyse these interrelationships using the styles of medical and literary texts, which show how the dimensions of knowledge and of representation determine each other – for example in the case of narrative structures in medical case histories or a diagnostic narrative stance in a novel.

Cette étude s’intéresse à la période 1760-1800. Elle porte sur les rapports entre d’une part les représentations médicales et littéraires de la sexualité féminine post-pubertaire, et d’autre part le sentiment de « dégradation culturelle » nourri par de nombreux lettrés de l’époque – un sentiment qui recoupe à la fois l’idée d’une dégénérescence de la race et celle d’une décadence des mœurs entraînées par les raffinements excessifs de la société contemporaine. Mary McAlpin défend la thèse selo...

This report explores the relationship between philosophy and medicine in the Netherlands. In Section 1 we outline the ups and downs of medico-philosophical research in our country: pre-war flourishing, post-war decline, and modern renaissance. In Section 2 we review recent Dutch literature in the philosophy of medicine. The topics dealt with include methodology of medical science, alternative medicine, the basic concepts of medicine, anthropological medicine, medicalization, medicine and culture, and health care ethics.

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 10.2 (2000) 175-188 [Access article in PDF] Scope Note 38 Bioethics Resources on the Web * Once described as an "enormous used book store with volumes stacked on shelves and tables and overflowing onto the floor" (Pool, Robert. 1994. Turning an Info-Glut into a Library. Science 266 (7 October): 20-22, p. 20), Internet resources now receive numerous levels of organization, from basic directory listings (...) to elaborate "links" (cross-references to other Internet documents) that flash and glow in the dark. In many ways, the Internet functions as a direct extension of the traditional library. Following linked references across various sites is an electronic version of browsing library stacks, and the serendipitous discoveries made while "surfing the Net" recall the wonders of physically going "book-to-book." Although many of the Internet's best aspects augment library strengths by eliminating physical distance from sources, Net resources pose unique problems for researchers. It is not always clear who is responsible for the content of Web documents, when the document was produced, or how often (if ever) it is updated. Internet resource tools, then, must enable researchers to identify appropriate resources and to evaluate what they find when they get there. Web Research as Taking "Snapshots" Given the Internet's visual nature and fluid content, the process of conducting research on the Web has been likened to taking an informal picture of information on a specific date at a particular time. This metaphor also conveys the "zoom-in" aspect of searching through Web pages by going from general to specific categories. In the first section of this Scope Note, National Reference Center for Bioethics Literature (NRCBL) staff present a snapshot of bioethics resources taken during the spring months of 2000. Entries are divided into the categories of directories, electronic journals, full-text documents, news/current awareness, and teaching resources. In the two subsequent sections, this series of categories is repeated for entries on a specific topic within bioethics-genetics-and again for general search and evaluation tools. Where a Web site may contain pages applicable [End Page 175] to more than one category, multiple entries are made for that site with appropriate information for each category.Much as telecommunication advances have strengthened the relationship of patients and providers as partners, the dynamic nature of the Internet acknowledges that the researcher functions as a librarian whenever accessing the Web. It is our hope that BIOETHICSLINE and the other NRCBL databases not only will enable researchers to search the Web more efficiently, but also will help them to evaluate what they find when they get there. Bioethicsline on the Web: An International Plan in Progress Once only available through libraries, the U.S. National Library of Medicine (NLM), the funding agency for the ongoing development of the BIOETHICS LINE® database from the Kennedy Institute, has provided free Web access to that database of 63,000 citations since September 1998 through Internet Grateful Med. Plans are now underway to eliminate such specialty databases and incorporate all citations into PubMed (for journal articles) or LOCATORplus (for book-like materials and chapters in books). Both of these databases are likewise available at no cost on the Web. In the transition to PubMed and LOCATORplus some features of BIOETHICSLINE that presently are available may be lost. Researchers are encouraged to contact the National Reference Center for Bioethics Literature with search requests or for search strategy assistance with either the current or the future system ([email protected]).The inclusion of bioethics citations in PubMed and LOCATORplus will have several advantages. First, unique keywords from the Bioethics Thesaurus will be considered for inclusion in Medical Subject Headings (MeSH), the indexing vocabulary for PubMed and LOCATORplus, thereby enhancing retrieval of relevant clinical literature by offering more precise terminology covering ethical issues. Second, it will be easier to identify foreign-language materials, which are not currently included in the scope of BIOETHICSLINE. Third, the updating schedule will become more frequent. On the other hand, there may be some loss of searching precision because certain specialized features... (shrink)

Evidence-Based Medicine (EBM) developed from the work of clinical epidemiologists at McMaster University and Oxford University in the 1970s and 1980s and self-consciously presented itself as a "new paradigm" called "evidence-based medicine" in the early 1990s. The techniques of the randomized controlled trial, systematic review and meta-analysis have produced an extensive and powerful body of research. They have also generated a critical literature that raises general concerns about its methods. This paper is a systematic review of the critical (...) literature. It finds the description of EBM as a Kuhnian paradigm helpful and worth taking further. Three kinds of criticism are evaluated in detail: criticisms of procedural aspects of EBM (especially from Cartwright, Worrall and Howick), data showing the greater than expected fallibility of EBM (Ioaanidis and others), and concerns that EBM is incomplete as a philosophy of science (Ashcroft and others). The paper recommends a more instrumental or pragmatic approach to EBM, in which any ranking of evidence is done by reference to the actual, rather than the theoretically expected, reliability of results. Emphasis on EBM has eclipsed other necessary research methods in medicine. With the recent emphasis on translational medicine, we are seeing a restoration of the recognition that clinical research requires an engagement with basic theory (e.g. physiological, genetic, biochemical) and a range of empirical techniques such as bedside observation, laboratory and animal studies. EBM works best when used in this context. (shrink)

This essay examines historical and contemporary connections between Buddhist and medical traditions through a study of the Accomplishing Medicine ( sman sgrub ) practice and the Yuthok Heart Essence ( G.yu thog snying thig ) anthology. Accomplishing Medicine is an esoteric Buddhist yogic and contemplative exercise focused on several levels of “alchemical” transformation. The article will trace the acquisition of this practice from India by Tibetan medical figures and its assimilation into medical practice. It will propose that this (...) alchemical practice forms the central nexus of connection between Tibetan medicine and the Buddhist Nyingma tradition, and that this little-studied link is not a marginal feature of Tibetan medicine but rather one that has had a significant shaping factor on each tradition throughout history. (shrink)

Medicine and Ethics in Black Women's Speculative Fiction engages the complex nexus of black women's health, the fraught history of medicine as it relates to black women, and the problems with the inconsistent application of medical ethics that should concern us all through the lens of black women's literary speculation.

In this essay, I look back at some of the earliest attempts by the first generation of literature-and-medicine scholars to answer the question: Why teach literature and medicine? Reviewing the development of the field in its early years, I examine statements by practitioners to see whether their answers have held up over time and to consider how the rationales they articulated have expanded or changed in the following years and why. Greater emphasis on literary criticism, narrative ethics, narrative (...) theory, and reflective writing has influenced current work in the field in ways that could not have been foreseen in the 1970s. The extraordinary growth of interest and work in the field nationally and, especially since 1996, internationally has included practitioners in many additional areas such as disability studies, film studies, therapeutic writing, and trauma studies. Along with the emergence of narrative medicine, this diverse community of scholars and practitioners—affiliated more through their use of narrative methodologies than the teaching of literature—makes the perennial challenge of evaluation and assessment even more complicated. (shrink)

The fundamental problem of Jan Srzednicki’s new epistemology is the question: how thoughts surpass the resistance of that what is ontologically present, how this process is possible? In Srzednicki’s opinion, thinking is a process of distancing from the pressure of ontological presence. His ideas offer a splendid inspiration for philosophy of medicine which attempts to answer the question “whether (and how) a disease is cognizable?” This question refers directly to and is translated into the question of the capacity to (...) diagnose particular diseases. Answering to the above stated question whether disease is cognizable we should answer in the affirmative, however, in a “modified” form that its pre-cognitive resistance to reality is formed at the articulated level. Somewhat intuitively we feel the presence of a disease before we express it in words as a disease according to our scientific or informal thought style. (shrink)

We are more used to thinking of medicine in relation to the ways that it alleviates the effects of violence. Yet an important thread in the academic literature acknowledges that medicine can also be responsible for perpetuating violence, albeit unintentionally, against the very individuals it intends to help. In this essay, I discuss definitions of violence, emphasizing the importance of understanding the term not only as a physical perpetration but as an act of power of one person over (...) another. I next explore the paradox of a healing profession that is permeated with violence sometimes necessary, often unintentional, and almost always unrecognized. Identifying the construct of “physician arrogance” as contributory to violence, I go on to identify different manifestations of violence in a medical context, including violence to the body; structural violence; metaphoric violence; and the practice of speaking to or about patients (and others in the healthcare system in ways that minimize or disrespect their full humanity. I further suggest possible explanations for the origins of these kinds of violence in physicians, including the fear of suffering and death in relation to vicarious trauma and the consequent concept of “killing suffering”; as well as why patients might be willing to accept such violence directed toward them. I conclude with brief recommendations for attending to root causes of violence, both within societal and institutional structures, and within ourselves, offering the model of the wounded healer. (shrink)

The use of metaphors and analogies was widespread in English political literature during the sixteenth and early seventeenth centuries, and for contemporary readers they were more than merely rhetorical artifices – they were used to illustrate and, in some cases, even to provide evidence. In this regard, none was more apt than the most prominent of these analogies: that between the human body and the state. The political thought of the time established an unshakeable connection between the two, building an (...) argument for how their structures and ways of functioning mirrored each other. This paper examines one of the most extensive and thorough examples of corporal analogies in early modern English political literature – that of Edward Forset’s A Comparative Discourse of the Bodies Natural and Politique (1606) – and shows how such corporal analogies were used to construct an absolutist political model wherein the king was depicted as the soul, the head and the heart of the body politic. The paper integrates Forset’s A Comparative Discourse within the context of the ideological struggles from the end of the sixteenth century and the beginning of the seventeenth, while its place within the larger picture of the medieval and early modern metaphor of the body politic is also examined, in order to assess the lineage and originality of Forset’s ideas and point out how the same kind of analogies could be used to provide significantly different political interpretations. (shrink)

There are various ways in which medicine and literature interact, but this paper concentrates on the contribution which literature can make to 'whole person understanding'. Scientific understanding is concerned with seeing events and actions in terms of patterns or similarities. But 'whole person understanding' is concerned with uniqueness or with what it is for a given person to have an illness. Literature can in various ways develop this kind of understanding.

BackgroundDefensive medicine (DM) practice refers to the ordering or prescription of unnecessary treatments or tests while avoiding risky procedures for critically ill patients with the aim to alleviate the physician’s legal responsibility and preserve reputation. Although DM practice is recognized, its dimensions are still uncertain. The subject has been highly investigated in developed countries, but unfortunately, many developing countries are unable to investigate it properly. DM has many serious ramifications, exemplified by the increase in treatment costs for patients and (...) health systems, patients’ exposure to risks, and negative effects on the psychological health of both health providers and recipients. Ultimately, the most serious consequence is the ethical consequences.MethodsThis work is based on a review of the literature related to DM worldwide and a comparison with the available knowledge found in Jordan. It is qualitative with a descriptive nature, aiming to diagnose the current DM practice in Jordan.ResultsThis is the first published article that discusses DM in Jordan by diagnosing its ethical and economic consequences for the health system as well as for patients. Despite the knowledge of the reasons that support its practice, little is being done to solve this issue. The absence of agreeable medical malpractice law, the dearth of unified medical protocols, the overwhelming pressure imposed by patients on medical staff, and the deteriorating patient-physician relationship are some of the causes of DM practice. Surely, the solution to these issues is to focus on fortifying the ethical and humanitarian aspects on the side of both the physician and the patient to ensure positive collaboration. The ethical aim of the physician to treat the patient faithfully and do what is possible to help combined with the appreciation of the physician’s efforts and the choice to not take advantage of the physician through litigation could be the most reasonable solution in the near future.ConclusionJordan is suffering from DM due to the limited financial expenditure on the health sector and the impracticality of medical malpractice law. The authors highlight that the cardinal step in solving this dilemma is restoring the ethical dimension of the patient-physician relationship. (shrink)

From governments to the general public, one may ask about the possible contributions of historians, if any, to the understanding and management of global disasters, as e.g. the ongoing coronavirus disease 2019. Given the confuse situation at the onset of the pandemic in terms of diagnosis, treatment, and prevention, a look into past experience with nonconventional medicine seemed relevant. In the present study I surveyed secondary literature on the role of Chinese medicine, Āyurveda, and homeopathy over time. The (...) quantitative results were disappointing: nothing on Āyurveda, and one single study each on Chinese medicine and homeopathy. The quality of the former compensates for the numerical short age. The case of homeopathy is rather sui generis, since this medical system was born and blossomed during epidemics and pandemics. I conclude with a short comment on reference sources, which might serve as point of departure for future studies of Āyurveda in epidemics. (shrink)

What is considered normal determines clinical practice in medicine and has implications at an individual level, doctor-patient relationship and health care policies. With the increase in medical information and technical abilities it is urgent to have a clear concept of normality in medicine so that crucial discussions can be held with unequivocal terms.The different meanings for normality were analyzed throughout the literature and grouped according to their relevance in the academic community in models, namely the Biostatistical Theory (BST), (...) Health, Ideal, Process and Biological advantage. The BST is the most established naturalistic approach, however normal variability can arguably constitute a problem. Health is similar and raises the question of setting the boundaries of pathology. Normality as an Ideal is an useful tool but is naturally unrealistic. As a Process it is comprehensible but is hard to frame for practical purposes. If considered as a Biological Advantage, seems intuitive but abnormality should tend to disappear.After, three examples were presented to discuss these models. They were Anemia, Psychiatric diseases and Psychopathy. In the case of Anemia the BST was applied and the arbitrary boundaries but with social impact were exposed. Psychiatric diseases was discussed under the process of self-organization and non-suffering ideal. With Psychopathy the boundaries of biological advantage are questioned.This review appeals to the importance of redesigning of the concept of normality in medicine according to current times and stresses the importance of integrating concepts such as variability and autonomy. (shrink)

Women’s access to health and medicine in developed countries has been characterized by a range of inconsistent inclusions and exclusions. Health policy has been asymmetrically interested in women’s reproductive capacities and has sought to regulate, control, and manage aspects of women’s reproductive decision making in a manner unwitnessed in relation to men’s reproductive health and reproductive decision making. In other areas, research that addresses health concerns that affect both men and women sometimes is designed so as not to yield (...) data relating to the ways in which women’s physiology and gendered location may affect their experience of the condition and its response to treatment, despite a literature on the significance of sex and gender differences in health research. This paper draws on the situation in Australia to explore the ethical significance of these inconsistencies as failing the ideals of high-quality medical research and evidenced-based health care. (shrink)

Mark Geller is well known to everyone in his field and, unsurprisingly, his Festschrift is a bulging volume of contributions—from thirty-four scholars in a variety of different specialties. Like most Festschriften, it is of uneven quality, but there are some very fine articles, including useful text editions and offerings that raise interesting scholarly questions. Although there is nothing here on economics, there are articles that engage historical and/or anthropological questions, exegetical issues, and matters of composition of literary texts, including one (...) offering on Akkadian grammar. None of these would be expected from a volume entitled Mesopotamian Medicine and Magic, but their presence is a testimony to the very broad interests of the honoree. (shrink)

Medicine and the humanities have been exploring new ways to improve the quality of healthcare. One such collaboration is the practice of narrative medicine which uses literature to teach physicians to better meet their patients’ needs. Narrative medicine, however, draws primarily from Anglophone literature, yet post-war French literature, philosophy and criticism have much to add to the theoretical and practical underpinnings of narrative medicine. As well, such scholarship provokes a number of questions that expose certain weaknesses (...) in narrative medicine as it is practiced currently. As this paper demonstrates, drawing post-war French literature into narrative medicine opens new ways to think about life, narrative and the place of the patient in the modern healthcare system. (shrink)

In this paper I have not, of course, presented all the embryological data that can be collected from the Talmudic and Midrashic literature. More details can be found in Julius Preuss' classical work on biblical and talmudic medicine, now available in Fred Rosner's English translation and in a French M.D. thesis by Martine Michel.75 I also did not present any data on teratology, and did not deal with the very rich Jewish mystical lore, the Cabbala. But a few comments (...) are in order here about the material on embryology.There are very few original ideas in the Talmudic corpus on embryology, but it is obvious that the Sages were well aware of the Greek and Roman theories on embryology.The fact that the Talmud is a compilation that was built up slowly, during several centuries, explains why the information recorded in it cannot be ascribed solely to one school of thought or one clear-cut influence.When a definite problem was difficult to solve because there were many different theories about it, the Sages based their opinion on a famous experiment that seemed to offer guarantees of validity. This was the case with the controversial problem of the formation of the embryo and its sexual differentiation, where the Sages made use of an experiment allegedly initiated by Cleopatra.The Sages were ready to discuss scientific problems with non-Jewish scholars and even to accept their arguments. This was the case with the important topic of the time of the entry of the soul into the embryo. But the legal conclusions drawn from the Sages' opinion were not consistent with those declared by Churth Fathers such as Tertullian. Embryotomy, for instance, was permitted by Jewish law.Wide interest, scholarly discussions, suggestive descriptions and readiness to inquire and to obtain detailed information characterized the Talmudic discussions of embryology.In conclusion, I quote a Talmudic text that reviews the whole process of embryological development through the sequence of prayers of a faithful Jew who learns that his wife is expecting a baby.The first three days, [he should pray to the Lord] that the seed should not putrefy.From the third to the fortieth day: that the child should be a male.From the fortieth day to the third month: that there should not occur any superfetation, which could lead the first embryo to be a fetus compressus.From the third to the sixth month: that an abortion should not occur.From the sixth to the ninth month: that the birth should be without problems.76. (shrink)

In recent years, personalized medicine (PM) has become a highly regarded line of development in medicine. Yet, it is still a relatively new field. As a consequence, the discussion of its future developments, in particular of its ethical implications, in most cases can only be anticipative. Such anticipative discussions, however, pose several challenges. Nevertheless, they play a crucial role for shaping PM’s further developments. Therefore, it is vital to understand how the ethical discourse on PM is conducted, i.e. (...) on what – empirical and normative – assumptions ethical arguments are based regarding PM’s current and future developments. (shrink)

This book contains the results of two European/American preparatory workshops for the First World Conference on Ethics Codes in Medicine and Biotechnology (October 1997, Freiburg, Germany) supported by the leading national institutions in the field. It aims to stimulate research about codes, the effects of codification and other forms of implementing ethics. It breaks new ground with interdisciplinary and international discourse on the subject, emphasising the need for a complete collection of codes for systematic research and evaluation and filling (...) the gap in literature on the subject to date. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Laying Medicine Open: Understanding Major Turning Points in the History of Medical EthicsLaurence B. McCullough (bio)AbstractAt different times during its history medicine has been laid open to accountability for its scientific and moral quality. This phenomenon of laying medicine open has sometimes resulted in major turning points in the history medical ethics. In this paper, I examine two examples of when the laying open of (...) class='Hi'>medicine has generated such turning points: eighteenth-century British medicine and late twentieth-century American medicine. In the eighteenth century, the Scottish physician-philosopher, John Gregory (1724–1773), concerned with the unscientific, entrepreneurial, self-interested nature of then current medical practice, laid medicine open to accountability using the tools of ethics and philosophy of medicine. In the process, Gregory wrote the first professional ethics of medicine in the English-language literature, based on the physician’s fiduciary responsibility to the patient. In the late twentieth century, the managed practice of medicine has laid medicine open to accountability for its scientific quality and economic cost. This current laying open of medicine creates the challenge of developing medical ethics and bioethics for population-based medical science and practice.Reading the Histories of Medicine, Bioethics, and Medical EthicsThere are many ways in which to read the history of medi-cine and therefore of medical ethics and bioethics. For example, the history of medicine can be usefully understood in terms of successive advances or revolutions in biomedical science and its clinical applications, with medical ethics understood as a moral response to scientific and technological change. On this reading, which has been common in the history of bioethics for the past three decades, moral response is required to address scientific and technological changes that are unprecedented and therefore threaten to outstrip society’s moral capacities [End Page 7] to understand and manage those changes well. Much recent work on the ethical, legal, and social issues raised by the genome project appeals to this reading. The history of medicine can also be read in social terms, with medicine understood as a major social institution shaped by various factors, not limited to science. In this perspective, medicine and society are understood in terms of a complex and dynamic synergy. Bioethics and medical ethics become part of this synergy and are to be explained—perhaps even explained away—by social historical factors. There are, of course, other ways to read the history of medicine and therefore of bio-ethics and medical ethics—e.g., in terms of key figures and movements that are thought to have shaped developments in crucial ways.I want to suggest another way to read these histories, namely, the successive laying open of medicine to accountability that sometimes results in key turning points in the development of medical ethics and bioethics. On this reading, ethics is understood as an intellectual and practical discipline that makes medicine as a social institution and its practitioners, physicians, morally accountable for their clinical judgment, decision making, and behavior. This differs from Robert Veatch’s (1981) reading of the history of medical ethics either as particular—informed by intellectual, moral, and experiential resources thought to be available only to physicians—or universal—informed by intellectual, moral, and experiential resources generally available in the culture (present and past). Veatch sees medical ethics as open when it is universal and closed, and unacceptable, when it is particular. I read the history of medical ethics as always universal and medicine as a social institution and practice as sometimes closed—i.e, not accountable for its scientific and moral integrity—and sometimes as open, accountable for such integrity. When medicine is “laid open,” medical ethics itself is sometimes transformed. The same may well be the case for the other health care professions. The histories of medical ethics and bioethics, therefore, can be usefully read as responses to the laying open of medicine and the health care professions generally at various times in their histories. In what follows, I examine two important examples of laying medicine open that create key turning points in the history of medical ethics—Scottish medicine from the eighteenth century and American medicine from the end of the twentieth century.The... (shrink)

Ayahuasca is a psychoactive traditional plant medicine preparation used by the indigenous tribes of the Upper Amazon in their shamanic traditions. Its use has become popular amongst Westerners seeking alternative means of healing, and the medicine has now spread across the globe via syncretic spiritual healing traditions such as the Santo Daime Church. Despite the increased use of the medicine, little research exists on its effectiveness for healing depression. The existing literature does not contain a detailed self-reported (...) phenomenological account of ayahuasca healing a case of depression. The aim of this paper is to share a personal account of healing depression using ayahuasca in a Santo Daime ritual in Johannesburg, South Africa. This experience was unplanned and unexpected and resulted in a profoundly transformative healing process. Based on my experience, I describe ayahuasca’s ingestion as having created a powerful mind-body-spirit connection that resulted in what appeared and felt like a profound reconfiguration of the bio-electrical energy system in my body and a powerful anti-depressant action on my mind. These effects were catalyzed by a strong intention to heal and trust in and take responsibility for myself. Other South African Santo Daime members have reported healing of depression with ayahuasca, although in longer and different processes. It appears that the medicine engages the individual’s unique collective self (life-history, physical and mental disposition, beliefs and intents) resulting in different outcomes for different individuals. Thus, from my own and others’ experience, I describe ayahuasca as a spiritual medicine; one that promotes enhanced awareness and deeper connection to one’s core self, to others and the greater universe, while facilitating the manifestation of one’s intentions and beliefs. This encounter with ayahuasca provided me a first-hand experience of learning and healing from the medicine, making real to me the indigenous Amazonian description of plants as being teachers and doctors. (shrink)

It is often said that clinical research and the practice of medicine are fraught with uncertainties. But what do we mean by uncertainty? Where does uncertainty come from? How do we measure uncertainty? Is there a single theory of uncertainty that applies across all scientific domains, including the science and practice of medicine? To answer these questions, we first review the existing theories of uncertainties. We then attempt to bring the enormous literature to bear from other disciplines to (...) address the issue of uncertainty in clinical research and medical practice. Our main and overarching goal is to review and classify uncertainties in clinical medicine. (shrink)

Collection of essays on the connection between medicine and literature and how novelists and physicians are both, in a sense, diagnosticians; the book focuses, in particular, on Walker Percy, a writer who had trained as a pathologist.

In lieu of an abstract, here is a brief excerpt of the content:Microaggressions in Medicine:Narratives, Trauma, and SilenceElizabeth Lanphier (bio)Lauren Freeman and Heather Stewart (2024) have written a richly researched and argued, while also highly engaging and accessible, book with Microaggressions in Medicine. They argue for why microaggressions are best understood on a harm-based account and situate this view within timely examples from a range of healthcare experiences. In their view, focusing on the harms produced by microaggressions shifts (...) the locus of concern from the agent committing a microaggression to the agent receiving it, and it enables an attribution of a microaggression regardless of an agent's intent or even awareness.Freeman and Stewart leave the reader with an expanded understanding of what microaggressions are and how they function. They also offer concrete and actionable suggestions for how healthcare environments and healthcare providers can work to prevent patients from receiving microaggressions in clinical care. Thinking alongside this book, I raise three points intended to further a conversation. The first is about narrative medicine as an additional resource. The second is the possibility for trauma-informed care to address background structural conditions that were beyond the book's scope. The third is to briefly inquire about whether this harm-based account could characterize certain cases of individual and institutional silence as a microaggression.1. Narrative medicineFreeman and Stewart situate their book within the philosophical literature on epistemic injustice, social justice, and feminist theory. So, it is not necessarily surprising that they only mention "narrative medicine," a term coined by Rita Charon (2001) about twenty-five years ago, in passing. They do cite core narrative medicine literature, including Sayantani DasGupta's (2008) account of "narrative humility," Arthur Frank's (1995) book The Wounded Storyteller, and a paper on listening to patient stories (Goldie 2011) in their recommendations and resources for mitigating microaggressions. When they do reference narrative [End Page 163] medicine, it is to suggest that "attending to the identities of patients ought to be more widely recognized as constitutive of good care" (Freeman and Stewart 2024, 182). But beyond illustrating the caring capacities of compassionate and skilled clinicians, narrative medicine offers a potential roadmap for how to get there.What I have elsewhere called a "technical definition of narrative medicine" (Lanphier 2021, 2024) is the narrative medicine methodology of close reading and reflective writing intended to produce three aims: attention (to texts or story), representation (trying to see the perspective of a story), and affiliation (partnering with a story's teller in a solidaristic way). This technical understanding of narrative medicine provides a method for developing skills of "ethical listening" and "medical humility" that Freeman and Stewart recommend. It also affords a structured form of training and practice that institutions can support to better enable healthcare workers to implement individual and environmental correctives to address microaggressions.Although narrative medicine is a resource poised to counter and respond to the very kinds of failures of listening, epistemic injustices, and quick assumptions with which Freeman and Stewart are concerned, narrative practices are not necessarily a fix for epistemic failures or bias. They also run their own risks, including narrative presumptions (Lanphier and Anani 2019), or narrative neglect (Saulnier 2020). Moreover, while the potential exists to scale narrative medicine through structured learning opportunities and broader institutional support, it primarily remains a tool for individual edification and enactment, not systems change.2. Trauma-informed careFreeman and Stewart (2024) describe how "microaggressions occur at the individual level and can be perpetrated by individuals, environments, or institutions" but that "ultimately, they are manifestations or symptoms of structural-level problems. Regardless of the level on which they occur, microaggressions always happen against the backdrop of social and structural oppression" (12). As other commentators point out, the authors recommend correctives primarily at individual and environmental levels (i.e., changing individual behaviors, making small modifications to clinical environments). Freeman and Stewart understand the limits of this scope, saying, "[W]e are well aware that such individual-level fixes can only ever take us so far and that they alone will never dismantle the oppressive structures themselves" (13). It is reasonable to identify achievable individual actions for the "unjust meantime" (Jaggar 2019) concurrent with social and structural... (shrink)

Purpose: This review identifies the prominent topics in the literature pertaining to the ethical, legal, and social issues raised by research investigating personalized genomic medicine. Methods: The abstracts of 953 articles extracted from scholarly databases and published during a 5-year period were reviewed. A total of 299 articles met our research criteria and were organized thematically to assess the representation of ELSI issues for stakeholders, health specialties, journals, and empirical studies. Results: ELSI analyses were published in both scientific and (...) ethics journals. Investigational research comprised 45% of the literature reviewed and the remaining 55% comprised normative analyses. Traditional ELSI concerns dominated the discourse including discussions about disclosure of research results. In fact, there was a dramatic increase in the number of articles focused on the disclosure of research results and incidental findings to research participants. Few papers focused on particular disorders, the use of racial categories in research, international communities, or special populations. Conclusion: Considering that strategies in personalized medicine increasingly target individuals’ unique health conditions, environments, and ancestries, further analysis is needed on how ELSI scholarship can better serve the increasingly global, interdisciplinary, and diverse PGM research community. (shrink)

The persistence, and international expansion, of food banks as a non-governmental response to households experiencing food insecurity has been decried as an indicator of unacceptable levels of poverty in the countries in which they operate. In 1998, Poppendieck published a book, Sweet charity: emergency food and the end of entitlement, which has endured as an influential critique of food banks. Sweet charity‘s food bank critique is succinctly synthesized as encompassing seven deadly “ins” (1) inaccessibility, (2) inadequacy, (3) inappropriateness, (4) indignity, (...) (5) inefficiency, (6) insufficiency, and (7) instability. The purpose of this paper is to examine if and how the contemporary food bank critique differs from Sweet charity’s “ins” as a strategy for the formulation of synthesizing arguments for policy advocacy. We used critical interpretive synthesis methodology to identify relationships within and/or between existing critiques in the peer-reviewed literature as a means to create “‘synthetic constructs’ (new constructs generated through synthesis)” of circulating critiques. We analyzed 33 articles on food banks published since Sweet charity, with the “ins” as a starting point for coding. We found that the list of original “ins” related primarily to food bank operations has been consolidated over time. We found additional “ins” that extend the food bank critique beyond operations (ineffectiveness, inequality, institutionalization, invalidation of entitlements, invisibility). No synthetic construct emerged linking the critique of operational challenges facing food banks with one that suggests that food banks may be perpetuating inequity, posing a challenge for mutually supportive policy advocacy. (shrink)

Despite an expansive literature on communication in medicine, the role of language is dealt with mostly indirectly. Recently, narrative medicine has emerged as a strategy to improve doctor-patient communication and integrate patient perspectives. However, even in this field which is predicated on language use, scholars have not specifically reflected on how language functions in medicine. In this theoretical paper, the authors consider how different models of language use, which have been proposed in the philosophical literature, might be (...) applied to communication in medicine. In particular, the authors contrast the traditional, indexical thesis of language with new models that focus on interpretation instead of standardization. The authors demonstrate how paying close attention to the role of language in medicine provides a philosophical foundation for supporting recent changes in doctor-patient communication. In particular, interpretive models are at the foundation of new approaches such as narrative medicine, that emphasize listening to patient stories, rather than merely collecting information. Ultimately, debates regarding the role of language which have largely resided in non-medical literatures, have important implications for describing communication in medicine. In particular, interpretive models of language use provide an important rationale for facilitating a more robust dialogue between doctors and patients. (shrink)

Background Medical research so flawed as to be retracted may put patients at risk by influencing treatments. Objective To explore hypotheses that more patients are put at risk if a retracted paper appears in a journal with a high impact factor (IF) so that the paper is widely read; is written by a ‘repeat offender’ author who has produced other retracted research; or is a clinical trial. Methods English language papers (n=788) retracted from the PubMed database between 2000 and 2010 (...) were evaluated. Only those papers retracting research with humans or freshly derived human material were included; 180 retracted primary papers (22.8%) met inclusion criteria. Subjects enrolled and patients treated were tallied, both in the retracted primary studies and in 851 secondary studies that cited a retracted primary paper. Results Retracted papers published in high-IF journals were cited more often (p=0.0004) than those in low-IF journals, but there was no difference between high- and low-IF papers in subjects enrolled or patients treated. Retracted papers published by ‘repeat offender’ authors did not enrol more subjects or treat more patients than papers by one-time offenders, nor was there a difference in number of citations. However, retracted clinical trials treated more patients (p=0.0002) and inspired secondary studies that put more patients at risk (p=0.0019) than did other kinds of medical research. Conclusions If the goal is to minimise risk to patients, the appropriate focus is on clinical trials. Clinical trials form the foundation of evidence-based medicine; hence, the integrity of clinical trials must be protected. (shrink)