Showing papers in "Perspectives in Biology and Medicine in 2011"
TL;DR: The aims of classification, their embodiment in medical diagnosis, and the historical traditions of medical classification are explored, as well as how classifications operate as social framing devices that enable and disable communication, assert and refute authority, and are important items for sociological study.
Abstract: Classification shapes medicine and guides its practice Understanding classification must be part of the quest to better understand the social context and implications of diagnosis Classifications are part of the human work that provides a foundation for the recognition and study of illness: deciding how the vast expanse of nature can be partitioned into meaningful chunks, stabilizing and structuring what is otherwise disordered This article explores the aims of classification, their embodiment in medical diagnosis, and the historical traditions of medical classification It provides a brief overview of the aims and principles of classification and their relevance to contemporary medicine It also demonstrates how classifications operate as social framing devices that enable and disable communication, assert and refute authority, and are important items for sociological study
68 citations
TL;DR: In this paper, the authors reviewed the cultural history of man's relationship with tobacco and the steps in the discovery of tobacco addiction and discussed the reasons for the difficulty of quitting addictions/habits and highlight possible solutions.
Abstract: This article reviews the cultural history of man's relationship with tobacco and the steps in the discovery of tobacco addiction. Nicotine dependence (ND) or nicotine addiction (NA), among other forms of drug addiction, continues to be a significant public health problem in the world, as it is associated with major severe diseases such as cardiovascular disease and cancer. Evidence for a genetic influence on smoking behavior and ND has prompted a search for susceptibility genes. Proof has recently accumulated that single nucleotide polymorphisms (SNPs) in the genetic region encoding the nicotinic acetylcholine receptor (nAChR) subunits α5, α3, and β4 are associated with smoking and ND. In this review, we consider tobacco as the archetype of substance addiction and describe the evolution of the tobacco habit from elite users to lower socioeconomic abusers (by mass marketing and specific targeting of vulnerable groups by the tobacco industry) to exemplify detrimental behavior with major threats to public health. Finally, we discuss the reasons for the difficulty of quitting addictions/habits and highlight possible solutions.
65 citations
TL;DR: The principles of the New Integrated Curriculum reflect the vision for a curriculum that fosters a partnership between students and faculty in the pursuit of scholarship and leadership.
Abstract: In 1985, Harvard Medical School adopted a "New Pathway" curriculum, based on active, adult learning through problem-based, faculty-facilitated small-group tutorials designed to promote lifelong skills of self-directed learning Despite the successful integration of clinically relevant material in basic science courses, the New Pathway goals were confined primarily to the preclinical years In addition, the shifting balance in the delivery of health care from inpatient to ambulatory settings limited the richness of clinical education in clinical clerkships, creating obstacles for faculty in their traditional roles as teachers In 2006, Harvard Medical School adopted a more integrated curriculum based on four principles that emerged after half a decade of self-reflection and planning: (1) integrate the teaching of basic/population science and clinical medicine throughout the entire student experience; (2) reestablish meaningful and intensive faculty-student interactions and reengage the faculty; (3) develop a new model of clinical education that offers longitudinal continuity of patient experience, cross-disciplinary curriculum, faculty mentoring, and student evaluation; and (4) provide opportunities for all students to pursue an in-depth, faculty-mentored scholarly project These principles of our New Integrated Curriculum reflect our vision for a curriculum that fosters a partnership between students and faculty in the pursuit of scholarship and leadership
51 citations
TL;DR: A post-Flexnerian curriculum for medical education is proposed in this article, which is based on the notion of physician as healer and professional, which is similar to the one presented in this paper.
Abstract: Although he did not write extensively about professionalism, Abraham Flexner clearly understood its critical role in medical practice. In discerning the basics of medical education he characterized scientific methodology as the instrumental minimum. He left open to future generations the task of defining its necessary complement, the "noble behaviors and fine feelings" required of the medical practitioner. Situated within the current professionalism movement, and informed by previous commentary on the enduring attributes of medicine, a curriculum based on "Physicianship"--the physician as healer and professional--can serve as a logical post-Flexnerian curriculum. The conceptual armature of Physicianship and the attributes necessary for the fulfillment of both the professional and healer role can assist in the selection of students and constitute the educational blueprint for medical teaching. The critically important concepts of identity formation and the requirements for the valid and reliable assessment of professional behaviors of students and faculty are essential components. A Physicianship curriculum, as conceived and deployed at the McGill University Faculty of Medicine, might resonate with Flexner.
39 citations
TL;DR: The biological background is explored and the neuroscientific evidence for shared brain pathways for aesthetics and morals is discussed, which has implications for both altruism and morality.
Abstract: For centuries, only philosophers debated the relationship between aesthetics and morality Recently, with advances in neuroscience, the debate has moved to include the brain and an evolved neural underpinning linking aesthetic reactions and moral judgment Biological survival emphasizes mate selection strategies, and the ritual displays have been linked to human aesthetics in the arts, in faces, and in various daily decision making In parallel, cultural human practices have evolved to emphasize altruism and morality This article explores the biological background and discusses the neuroscientific evidence for shared brain pathways for aesthetics and morals
33 citations
TL;DR: An operational definition of medical humility includes four distinct but closely related personal characteristics that are central to good doctoring: unpretentious openness, honest self-disclosure, avoidance of arrogance, and modulation of self-interest.
Abstract: Humility is the medical virtue most difficult to understand and practice. This is especially true in contemporary medicine, which has developed a culture more characterized by arrogance and entitlement than by self-effacement and moderation. In such a culture, humility suggests weakness, indecisiveness, or even deception, as in false modesty. Nonetheless, an operational definition of medical humility includes four distinct but closely related personal characteristics that are central to good doctoring: unpretentious openness, honest self-disclosure, avoidance of arrogance, and modulation of self-interest. Humility, like other virtues, is best taught by means of narrative and role modeling. We may rightly be proud of contemporary medical advances, while at the same time experiencing gratitude and humility as healers.
32 citations
TL;DR: Recently discovered records, including extensive written and photographic data from the studies, shed new light on the methods and motives of the research team, and its implications for the scientific and ethical assessment of the study are described.
Abstract: Loss of consciousness in pilots during rapid ascent after bombing missions was a major problem in World War II, and experiments were undertaken to study the cause of this phenomenon. Postulating impaired cerebral blood flow as a likely mechanism, the investigators developed a neck device, the KRA Cuff, which when inflated could shut off blood supply to the brain. With cessation of blood flow for up to 100 seconds, the investigators observed a sequence of responses, including unconsciousness, followed by dilated pupils, tonic/clonic movements, loss of bladder and eventually bowel control, and appearance of pathological reflexes. This study, carried out in prisoners and patients with schizophrenia in 1941-42, largely disappeared from public discourse for a number of years. It has received occasional attention subsequently and been considered controversial. Recently discovered records, including extensive written and photographic data from the studies, shed new light on the methods and motives of the research team. We describe here this new information and its implications for the scientific and ethical assessment of the study.
26 citations
TL;DR: The article analyzes Flexner's discussion of medical education and shows that his message—the importance of academic excellence, professional leadership, proper financial support, and service and altruism—is timeless, as applicable to the proper education of physicians today and tomorrow as in the past.
Abstract: The Flexner Report had its roots in the recognition in the mid-19th century that medical knowledge is not something fixed but something that grows and evolves. This new view of medical knowledge led to a recasting of the goal of medical education as that of instilling the proper techniques of acquiring and evaluating information rather than merely inculcating facts through rote memorization. Abraham Flexner, a brilliant educator, had the background to understand and popularize the meaning of this new view of education, and he took the unprecedented step of relating the developments in medical education to the ideas of John Dewey and the progressive education movement. Although the Flexner Report is typically viewed as a historical document--due to an understandable tendency to refer only to the second half of the report, where Flexner provides his famous critiques of the medical schools that existed at the time--this article argues that the Flexner Report is actually a living educational document of as much significance to medical educators today as in Flexner's time. The article analyzes Flexner's discussion of medical education and shows that his message--the importance of academic excellence, professional leadership, proper financial support, and service and altruism--is timeless, as applicable to the proper education of physicians today and tomorrow as in the past.
25 citations
TL;DR: It is argued that schizophrenia is the result of a mismatch between the post-Neolithic human social environment and the design of the social brain, which explains a range of epidemiological findings on schizophrenia related to the risk of migration and urbanization, the improved prognosis in underdeveloped countries, and variations in the prevalence of the disorder.
Abstract: This article proposes a reformulation of the social brain theory of schizophrenia. Contrary to those who consider schizophrenia to be an inherently human condition, we suggest that it is a relatively recent phenomenon, and that the vulnerability to it remained hidden among our hunter-gatherer ancestors. Hence, we contend that schizophrenia is the result of a mismatch between the post-Neolithic human social environment and the design of the social brain. We review the evidence from human evolutionary history of the importance of the distinction between ingroup and out-group membership that lies at the heart of intergroup conflict, violence, and xenophobia. We then review the evidence for the disparities in schizophrenia incidence around the world and for the higher risk of this condition among immigrants and city dwellers. Our hypothesis explains a range of epidemiological findings on schizophrenia related to the risk of migration and urbanization, the improved prognosis in underdeveloped countries, and variations in the prevalence of the disorder. However, although this hypothesis may identify the ultimate causation of schizophrenia, it does not specify the proximate mechanisms that lead to it. We conclude with a number of testable and refutable predictions for future research.
24 citations
TL;DR: Some of the more striking examples of atavisms are presented, some of the currently controversial issues like human quadrupedalism are discussed, and the progress made in explaining some the mechanisms that can lead to atavistic features are reviewed.
Abstract: Traits expected to be lost in the evolutionary history of a species occasionally reappear apparently out of the blue. Such traits as extra nipples or tails in humans, hind limbs in whales, teeth in birds, or wings in wingless stick insects remind us that certain genetic information is not completely lost, but can be reactivated. Atavisms seem to violate one of the central evolutionary principles, known as Dollo's law, that "an organism is unable to return, even partially, to a previous stage already realized in the ranks of its ancestors." Although it is still not clear what triggers and controls the reactivation of dormant traits, atavisms are a challenge to evolutionary biologists and geneticists. This article presents some of the more striking examples of atavisms, discusses some of the currently controversial issues like human quadrupedalism, and reviews the progress made in explaining some of the mechanisms that can lead to atavistic features.
23 citations
TL;DR: The social contract metaphor may be a heuristic device prompting reflection on social responsibility, but when this metaphor is elevated to the status of a theory, it has well-known limits.
Abstract: Conceptions of professionalism in medicine draw on social contract theory; its strengths and weaknesses play out in how we reason about professionalism. The social contract metaphor may be a heuristic device prompting reflection on social responsibility, and as such is appealing: it encourages reasoning about privilege and responsibility, the broader context and consequences of action, and diverse perspectives on medical practice. However, when this metaphor is elevated to the status of a theory, it has well-known limits: the assumed subject position of contractors engenders blind spots about privilege, not critical reflection; its tendency to dress up the status quo in the trappings of a theoretical agreement may limit social negotiation; its attempted reconciliation of social obligation and self-interest fosters the view that ethics and self-interest should coincide; it sets up false expectations by identifying appearance and reality in morality; and its construal of prima facie duties as conditional misdirects ethical attention in particular situations from current needs to supposed past agreements or reciprocities. Using philosophical ideas as heuristic devices in medical ethics is inevitable, but we should be conscious of their limitations. When they limit the ethical scope of debate, we should seek new metaphors.
TL;DR: The problems encountered in the development of ganciclovir provide guidance on how future drugs to treat life-threatening diseases can be developed.
Abstract: This history chronicles the unusual development of the antiviral drug ganciclovir. The first compound with activity against human cytomegalovirus (CMV), ganciclovir was so clearly efficacious that a placebo-controlled clinical trial could not ethically be done, and the FDA rejected the first application to market the drug. Used to treat a blinding eye infection in patients with AIDS, the story of ganciclovir paralleled the spread of the AIDS epidemic. Both ganciclovir and AIDS caught the federal government off guard. Caught in a Catch-22 situation, the pharmaceutical company developing ganciclovir gave the drug away free for five years under compassionate use guidelines. The problems encountered in the development of ganciclovir provide guidance on how future drugs to treat life-threatening diseases can be developed.
TL;DR: A committee to evaluate the premedical and medical school science curricula made a number of recommendations, most important were that competencies replace course requirements and that the physical sciences and mathematics be better integrated with the biological sciences and medicine.
Abstract: One hundred years ago, Flexner emphasized the importance of science in medicine and medical education Over the subsequent years, science education in the premedical and medical curricula has changed little, in spite of the vast changes in the biomedical sciences The National Research Council, in their report Bio 2010, noted that the premedical curriculum caused many students to lose interest in medicine and in the biological sciences in general Many medical students and physicians have come to view the premedical curriculum as of limited relevance to medicine and designed more as a screening mechanism for medical school admission To address this, the Association of American Medical Colleges and the Howard Hughes Medical Institute formed a committee to evaluate the premedical and medical school science curricula The committee made a number of recommendations that are summarized in this essay Most important were that competencies replace course requirements and that the physical sciences and mathematics be better integrated with the biological sciences and medicine The goal is that all physicians possess a strong scientific knowledge base and come to appreciate the importance of this to the practice of medicine While science education needs to evolve, Flexner's vision is as relevant today as it was 100 years ago
TL;DR: Three roles are suggested for medical decision making in medical education, which could serve as a unifying principle in the design of the medical curriculum, integrating other curricular content around the need to create physicians who are competent and caring decision makers.
Abstract: The Flexner Report highlighted the importance of teaching medical students to reason about uncertainty. The science of medical decision making seeks to explain how medical judgments and decisions ought ideally to be made, how they are actually made in practice, and how they can be improved, given the constraints of medical practice. The field considers both clinical decisions by or for individual patients and societal decisions designed to benefit the public. Despite the relevance of decision making to medical practice, it currently receives little formal attention in the U.S. medical school curriculum. This article suggests three roles for medical decision making in medical education. First, basic decision science would be a valuable prerequisite to medical training. Second, several decision-related competencies would be important outcomes of medical education; these include the physician's own decision skills, the ability to guide patients in shared decisions, and knowledge of health policy decisions at the societal level. Finally, decision making could serve as a unifying principle in the design of the medical curriculum, integrating other curricular content around the need to create physicians who are competent and caring decision makers.
TL;DR: The value of an evolutionary approach to medicine has become increasingly recognized and Evolutionary biology should become a foundational science for the medical education of the future.
Abstract: Evolutionary biology was a poorly developed discipline at the time of the Flexner Report and was not included in Flexner's recommendations for premedical or medical education. Since that time, however, the value of an evolutionary approach to medicine has become increasingly recognized. There are several ways in which an evolutionary perspective can enrich medical education and improve medical practice. Evolutionary considerations rationalize our continued susceptibility or vulnerability to disease; they call attention to the idea that the signs and symptoms of disease may be adaptations that prevent or limit the severity of disease; they help us understand the ways in which our interventions may affect the evolution of microbial pathogens and of cancer cells; and they provide a framework for thinking about population variation and risk factors for disease. Evolutionary biology should become a foundational science for the medical education of the future.
TL;DR: It is argued that patients who express a wish to die should receive a comprehensive care assessment that addresses their physical and mental condition before rushing to provide lethal medication.
Abstract: This article presents a recent disconcerting event that took place at a rehabilitative nursing home in Tel Aviv in light of Israel's Dying Patient Law, which came into effect in 2005. It probes the double effect doctrine as it is relevant to the case at hand and the role of the medical profession and of the family in making decisions at the end of life, and it argues that patients who express a wish to die should receive a comprehensive care assessment that addresses their physical and mental condition before rushing to provide lethal medication. The article concludes by offering some guidelines to help practitioners address the intricate questions they face when patients ask to die.
TL;DR: It is argued that the placebo response is a developmental achievement, rooted in implicit procedural memories that are linked to background affects of well-being evoked by a relational dynamic with a caregivers, and that it is dependent on developmental attachment dynamics.
Abstract: The placebo response represents an enigmatic element of therapeutics. The potency of placebo effects is highlighted by the fact that the current gold standard for determining therapeutic efficacy, the randomized controlled clinical trial, is based on identifying treatment responses that are statistically superior to those elicited by a placebo. Although much has been written concerning the phenomenology of placebos, little is known concerning how they are elicited, although recent research has demonstrated that placebo effects are mediated via objective physiological pathways. I have previously argued that the placebo response is a developmental achievement, rooted in implicit procedural memories that are linked to background affects of well-being evoked by a relational dynamic with a caregiver. This article develops this idea further, suggesting that placebo response represents a nervous-system response aimed at countering the dysphoric effects attributable to chronic stress, and that it is dependent on developmental attachment dynamics. A range of behaviors by caregivers that mimic those achieved during secure attachment are suggested to promote placebo responses.
TL;DR: The rise and fall of gene therapy for CF is considered and it is suggested that CF may provide a particularly compelling case study of a failed genomic technology, perhaps even of a medical “canary.”
Abstract: In 1989 the gene that causes cystic fibrosis (CF) was identified in a search accompanied by intense anticipation that the gene, once discovered, would lead rapidly to gene therapy. Many hoped that the disease would effectively disappear. Those affected were going to inhale vectors packed with functioning genes, which would go immediately to work in the lungs. It was a bewitching image, repeatedly invoked in both scientific and popular texts. Gene therapy clinical trials were carried out with a range of strategies and occasionally success seemed close, but by 1996 the idea that gene therapy for CF would quickly provide a cure was being abandoned by the communities engaged with treatment and research. While conventional wisdom holds that the death of Jesse Gelsinger in an unrelated gene therapy trial in 1999 produced new skepticism about gene therapy, the CF story suggests a different trajectory, and some different lessons. This article considers the rise and fall of gene therapy for CF and suggests that CF may provide a particularly compelling case study of a failed genomic technology, perhaps even of a medical "canary." The story of CF might be a kind of warning to us that genetic medicine may create as many problems as it solves, and that moving forward constructively with these techniques and practices requires many kinds of right information, not just about biology, but also about values, priorities, market forces, uncertainty, and consumer choice.
TL;DR: In this article, the authors elucidate ideas from lesser-known works by Jahr, especially those considering animal protection and teaching, which might be helpful for the further reform and broadening of modern bioethics.
Abstract: Since the discovery of his work in 1997, Fritz Jahr (1895-1953) has slowly become recognized as the author of the term and concept of bioethics. Jahr's ideas on bioethics were partly different from those shaped by Van Rensselaer Potter in the 1970s and, therefore, might be helpful for the further reform and broadening of modern bioethics. In this article, the authors elucidate ideas from lesser-known works by Jahr, especially those considering animal protection and teaching.
TL;DR: Medical educators are facing a challenge today that is quite analogous to that addressed by Abraham Flexner, namely how to transform a legacy system of education that is no longer preparing future physicians adequately to meet contemporary expectations and responsibilities, and must adapt their curricula and pedagogical methods to the demanding new paradigms of medical education.
Abstract: Medical educators are facing a challenge today that is quite analogous to that addressed by Abraham Flexner, namely how to transform a legacy system of education that is no longer preparing future physicians adequately to meet contemporary expectations and responsibilities. In facing up this challenge, however, today's educators not only must equip students to deal effectively with the rapidly changing paradigms in health care and medical practice, they also must adapt their curricula and pedagogical methods to the demanding new paradigms of medical education. Their success in addressing these dual imperatives will determine whether the educational transformations currently underway will have as momentous an effect on the public's health as did those stimulated by Flexner a century ago.
TL;DR: John Black Grant was instrumental in getting China, India, and Puerto Rico to develop health systems that integrated preventive and curative care and oriented medical education to be supportive of such systems.
Abstract: John Black Grant (1890-1962) was instrumental in getting China, India, and Puerto Rico to develop health systems that integrated preventive and curative care and oriented medical education to be supportive of such systems. As these remain priority goals for all countries today, knowledge of his achievements remains of relevance. This article brings his accomplishments to the attention of the contemporary medical public.
TL;DR: It is argued that in order to understand the nature and scope of the problems facing interdisciplinary work, the authors must focus on the institutional constraints that shape how individuals frame questions, pursue investigations, develop careers, and collaborate.
Abstract: C. P. Snow’s famous Two Cultures essay has become a foil for decades of discussions over the relation between science and the humanities. The problem of the “two cultures” is often framed in terms of how the particular epistemological claims or general intellectual orientations of particular individuals on either side of this purported divide obstruct interdisciplinary dialogue or cooperation. This formulation, however, fails to consider the institutional frameworks within which such debates occur. This article examines the broader structural constraints that provide incentives, erect barriers, or otherwise shape the potential for interdisciplinary research and practice, with particular attention to work involving the life sciences. It argues that in order to understand the nature and scope of the problems facing interdisciplinary work, we must focus on the institutional constraints that shape how individuals frame questions, pursue investigations, develop careers, and collaborate.
TL;DR: This chapter presents a comprehensive overview of evidence-based medicine, suggesting that medical research should be conscientiously and judiciously applied to patients.
Abstract: Publisher Summary This chapter presents a comprehensive overview of evidence-based medicine (EBM). The top five levels of evidence that are usually considered in EBM consist of study designs that provide systematic clinical observation and that are borrowed from the scientific methods of epidemiology. It is found that randomized trials rank higher on the hierarchy of evidence and systematic reviews of randomized trials rank higher still. While EBM was originally intended to be an approach to clinical decision making carried out by individual physicians, the movement has been forced to adapt to deal with a variety of practical constraints. The initial formulation of EBM seemed to require an almost algorithmic approach to decision making according to which an individual physician assesses the evidence and then applies it to the particular case. The later versions of EBM arguably deal with the need for individualized care, as well as the importance of incorporating patient values, by suggesting that medical research should be conscientiously and judiciously applied to patients.
TL;DR: As the world watched the Fukushima reactors release radionuclides into the ocean and atmosphere, the warnings of Alice Stewart about radiation risk and the reassurances of Sir Richard Doll assumed renewed relevance.
Abstract: As the world watched the Fukushima reactors release radionuclides into the ocean and atmosphere, the warnings of Dr. Alice Stewart about radiation risk and the reassurances of Sir Richard Doll assumed renewed relevance. Doll and Stewart, pioneer cancer epidemiologists who made major contributions in the 1950s-he by demonstrating the link between lung cancer and smoking, she by discovering that fetal X-rays double the chance of a childhood cancer-were locked into opposition about low-dose radiation risk. When she went public with the discovery that radiation at a fraction of the dose "known" to be dangerous could kill a child, her reputation plummeted, whereas Doll, foremost among her detractors, was knighted and lauded as "the world's most distinguished medical epidemiologist" for his work. Their lives and careers, so closely intertwined, took contrary courses, he becoming "more of the establishment" (as he said), while she became more oppositional. When it was discovered, after his death, that he'd been taking large sums of money from industries whose chemicals he was clearing of cancer risk, his reputation remained unscathed; it is now enshrined in the "Authorized Biography" (2009) commissioned by the Wellcome Institute, along with Doll's denigration of Stewart as an "embittered" woman and biased scientist. Stewart lived long enough to see radiation science move her way, to see international committees affirm, in the 1990s, that there is no threshold beneath which radiation ceases to be dangerous; recent evidence from Chernobyl is bearing out her warnings. But a look at the making and breaking of these reputations reveals the power of status, position, and image to shape scientific "knowledge" and social policy.
TL;DR: At the beginning of the 21st century, fibromyalgia syndrome (FM) has become a diagnostic category that includes extremely large numbers of people, predominantly women, and there are competing etiological theories and therapies.
Abstract: At the beginning of the 21st century, fibromyalgia syndrome (FM) has become a diagnostic category that includes extremely large numbers of people, predominantly women. Yet only a few decades ago, FM (and its predecessor fibrositis) was of little interest or concern to either physicians or the general public. What, then, were the origins of the FM diagnosis, and why did its boundaries expand so rapidly during and after the 1980s? The answers to such questions are complex. Broad social and intellectual currents, internal developments within medicine, the appearance of a self-conscious women's movement, and the rise of an increasingly important pharmaceutical industry all converged to elevate the importance of FM. Yet the diagnosis has remained highly contested, and there are competing etiological theories and therapies.
TL;DR: The current guidelines of evidence-based medicine presuppose that clinical research and clinical practice should advance from rigorous scientific tests as they generate reliable, value-free knowledge, but this invites a more prominent role for value-laden considerations in evaluating clinical research.
Abstract: The current guidelines of evidence-based medicine (EBM) presuppose that clinical research and clinical practice should advance from rigorous scientific tests as they generate reliable, value-free knowledge. Under this presupposition, hypotheses postulated by doctors and patients in the process of their decision making are preferably tested in randomized clinical trials (RCTs), and in systematic reviews and meta-analyses summarizing outcomes from multiple RCTs. Since testing under this scheme is predominantly focused on the criteria of generality and precision achieved through methodological rigor, at the cost of the criterion of realism, translating test results to clinical practice is often problematic. Choices concerning which methodological criteria should have priority are inevitable, however, as clinical trials, and scientific research in general, cannot meet all relevant criteria at the same time. Since these choices may be informed by considerations external to science, we must acknowledge that science cannot be value-free in a strict sense, and this invites a more prominent role for value-laden considerations in evaluating clinical research. The urgency for this becomes even more apparent when we consider the important yet implicit role of scientific theories in EBM, which may also be subjected to methodological evaluation and for which selectiveness in methodological focus is likewise inevitable.
TL;DR: The history of premedical education is reviewed, some recent critiques of pre medical education are described, a newer program for premedicaleducation evolving at the University of Illinois at Chicago is discussed, and some suggestions for the future are offered.
Abstract: The Flexner Report established guidelines for medical education and made the university the obligate home for medical education. Flexner mandated specific elements necessary for university-based premedical education. With the exception of the MCAT, much less attention has been paid to premedical education and its integration into the scope of medical education than to education within the confines of the medical school. This article reviews the history of premedical education, describes some recent critiques of premedical education, discusses a newer program for premedical education evolving at the University of Illinois at Chicago, and offers some suggestions for the future.
TL;DR: The case studies of two women separated by a century who sought ovarian transplantation are presented, and a sense of wholeness on the individual, the familial, and the cultural levels are examined, due to its ability to enable a recipient to naturally conceive and experience pregnancy.
Abstract: Scholars have shown that organ transplantation may transform ideas about one's body, with recipients feeling that they are receiving not just a body part but also a part of the donor's identity. This article focuses on a different way in which organ transplantation shapes recipient identity: the idea of becoming whole. We present the case studies of two women separated by a century (one in 1902 and the other in 2004) who sought ovarian transplantation, and examine how ovarian transplantation can engender a sense of wholeness on the individual, the familial, and the cultural levels, due to its ability to enable a recipient to naturally conceive and experience pregnancy.
TL;DR: Examination of distinctive aspects of medical care experienced by a 55-year-old hospitalized for quintuple coronary artery bypass surgery who was also a senior physician-administrator (chief of gastroenterology) at the same hospital describes eight distinctive aspect of administrator-physicians as patients.
Abstract: This article examines distinctive aspects of medical care experienced by a 55-year-old hospitalized for quintuple coronary artery bypass surgery who was also a senior physician-administrator (chief of gastroenterology) at the same hospital. The article describes eight distinctive aspects of administrator-physicians as patients, including special patient treatment; exalted patient expectations by hospital personnel; patient suppression of emotions; patient denial; self-doctoring; job stress contributing to disease; self-sacrifice to achieve better health; and rational medical decisions when not under stress. Health-care workers should recognize how these distinctive aspects of medical care and behavior affect administrator-physicians as patients, in order to mitigate their negative effects, potentiate their positive effects, and optimize the care of these patients.
TL;DR: The role of genomics is explored with the help of two examples, namely the renaissance of Paleolithic diets and of Pleistocene parks, to argue that an understanding of the world in ecocentric terms requires new partnerships and mutually beneficial forms of collaboration and convergence between life sciences, social sciences, and the humanities.
Abstract: Views of ourselves in relationship to the rest of the biosphere are changing. Theocentric and anthropocentric perspectives are giving way to more ecocentric views on the history, present, and future of humankind. Novel sciences, such as genomics, have deepened and broadened our understanding of the process of anthropogenesis, the coming into being of humans. Genomics suggests that early human history must be regarded as a complex narrative of evolving ecosystems, in which human evolution both influenced and was influenced by the evolution of companion species. During the agricultural revolution, human beings designed small-scale artificial ecosystems or evolutionary "Arks," in which networks of plants, animals, and microorganisms coevolved. Currently, our attitude towards this process seems subject to a paradoxical reversal. The boundaries of the Ark have dramatically broadened, and genomics is not only being used to increase our understanding of our ecological past, but may also help us to conserve, reconstruct, or even revivify species and ecosystems to whose degradation or (near) extinction we have contributed. This article explores the role of genomics in the elaboration of a more ecocentric view of ourselves with the help of two examples, namely the renaissance of Paleolithic diets and of Pleistocene parks. It argues that an understanding of the world in ecocentric terms requires new partnerships and mutually beneficial forms of collaboration and convergence between life sciences, social sciences, and the humanities.