Health and illness from an anthroposophical viewpoint. Lecture at the Summer Academy, '92 Lucerne

Health and disease are only understood when man is not solely perceived as a physical, but also as a living, a psychic and a spiritual being. The scientific perception of physis has to be complemented by a likely scientific notion of the immaterial in man (life, soul, spirit). To this goal a human science is required like "Anthroposophy" to which I.P.V. Troxler from Lucerne (1780-1860) aspired and which was finally founded by R. Steiner (1861-1925). A really human medicine will only be regained by such an extension of modern medicine by humanities.     

Historical note on the discovery of cutaneous leishmaniasis transmission by Phlebotomus]

Compared to the past, modern dentistry offers a wide range of treatment options to the public. These options are more likely to be appreciated and accepted when we take the feelings of our patients into account. Dr. T. J. Murray, a former dean of Dalhousie University's medical school, says: "I believe it is just as important now, in the era of scientific medicine and dentistry, to practise the art of our profession as it ever was. Our professions were always a balance of caring and healing. In modern times, the concepts and approaches to healing have had a scientific underpinning, but they have not supplanted the need for humanistic care. In fact, many persons have problems and illnesses that are not amenable to scientific treatment or cure, and the approach is for caring, understanding, explanation, reassurance, and 'being there' for the patient."     

Documentary basis for research on the transfer of Islamic medical science to the European West

The last decades of the twentieth century are witness of increased interest in the study of scientific heritage in the Islamic world. The already established opinion of Islamic science as only intermediary between classical Greece and Latin West is seriously challenged. The reason for this are original sources from which the historians of our century have extracted solid evidence of high level of originality achieved by Muslim scientists in the past. Through their work in Bagdad, Buhara, Samarkand, Reyy, Kairo, Maraga, Damascus, Kordova they have shown that Islamic sciences including medicine had theoretical and practical answers to the problems characteristic of their times. Throughout its History Bosnia and Herzegovina itself has been exposed to various cultural influences from the West as well as from the Islamic East. When we try to study the history of medicine and health profession generally, we have to take into account the early Arabic sources of which short survey is given in this paper. With this in mind, one can make one preliminary conclusion at least; Islamic medicine has reached respectable level of practical and theoretical achievements while the volume of books and number of people engaged in its practice produced series of biographies and bibliographies as clear proof of its growth and level it has attained.     

Not a page-turner, but a very intellectually-challenging book.

Reviews the book, How the mind works by S. Pinker (1998). How the mind works provides an excellent example of what I consider a very good, thought-provoking scientific book. It is true that I often put the book down, sometimes for long periods. But during those down times I still continued to read, in the sense described earlier. That is, I continued to consider the thoughts and issues raised by Pinker, often discussing them with colleagues, in an attempt to decide for myself where I stood on the issues. I found that I agreed with some of Pinker's views while disagreeing with others. However, I will not recount my opinions here, because I expect a different reader would have very different opinions for the reasons described above. Instead, I will highlight the characteristics of Pinker's book that make it such a non-page-turner. In my view, the strengths of the book are rooted in three characteristics: (a) the perspective, (b) the subject matter, and (c) the writing style. The combination of interesting and relevant issues, an engaging writing style, and a strong stance on every issue make the book very challenging intellectually. I was not comfortable moving on to some new issue before I had formed an opinion on the previous one. Often this required me to talk with colleagues and at the end of the title. Perhaps it would not reflect the extend the debate beyond the book and into the faculty conviction with which Pinker holds his opinions, but it lounge. At other times it pushed me to simply take some would better reflect the challenge to readers to form their time to reflect on the issues. Perhaps the highest accolade own opinions. that can be given to a scientific book is that it forces one to think and form opinions. How the mind works is clearly deserving of that accolade. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bridge between scientific medicine and complementary medicine--utopia?

In this keynote presentation on a complex and controversial subject, I attempt to answer the following questions: 1. What is scientific medicine, what is alternative medicine? 2. Why is there in our days an increasing trend in the population towards concepts and methods of alternative (complementary) medicine? 3. Why are many scientific physicians defensive, sceptical and opposed to alternative medicine? 4. Are traditional and alternative medicine fundamentally irreconcilable worlds? The author believes that complementary medicine is beneficial and justified especially in private practice, above all in the many patients suffering from psychosomatic, psychovegetative, neurotic, depressive, functional disorders, with feelings of ill-health and often with marked subjective symptoms but in which no severe organic disease is present. In these types of patients alternative methods are often 'more gentle' and cost-effective. The doctor's personality, his empathy, his willingness to communicate are decisive factors for their effectiveness. Certain methods of complementary medicine should be increasingly integrated into our hospitals and be learnt and critically assessed locally by the scientific physicians. Scientific medicine is and remains the indispensable solid foundation for correctly indicating the use of alternative therapeutic methods.     

Comments on Gould, PAIN, 74 (1998) 341-343

Journal policies and requirements of funding agencies on financial disclosure of authors and grant applicants have divided editors and scientists who disagree on whether such policies can improve the integrity of science or manage conflicts of interest. Those opposed to such disclosure policies argue that financial interest is one of many interests held by scientists, is the least scientifically dangerous, and should not be singled out. Those who favor open reporting of financial interests argue that full disclosure removes the suspicion that something of relevance to objectivity is being hidden and allows readers to form their own opinions on whether a conflict of interest exists and what relevance that has to the study. The authors believe that the scientific community and the public will be best served by open publication of financial disclosures for readers and reviewers to evaluate.     

Quality of neurological care. Balancing cost control and ethics

As the quality of neurological care becomes a mutual objective of physicians, patients, and health planners, increased demands on cost savings will create conflicts that could threaten the ethical basis of medical practice. Physicians will see increasing ethical conflicts between their fiduciary duties to make treatment decisions in the best interest of their patients and their justice-based duties to conserve societal resources. These conflicts can be best mitigated if physicians maintain their orientation as patient advocates but practice cost-conscious clinical behaviors that consider the cost-effectiveness of tests and treatments and do not squander society's finite resources by ordering medical tests and treatments of zero or marginal utility. Health system planners should resolve their conflicting objectives of quality and cost control by rigorously defining and measuring quality through physician leadership and by implementing cost-control measures that enhance the quality of medical care. Managed care organizations voluntarily should forsake financially successful but blatantly unethical cost-saving schemes, such as gag clauses and end-of-year kickback payments to physicians, because these schemes diminish patients' trust in physicians and degrade the integrity of the patient-physician relationship. State and federal laws should prudently regulate these unethical cost-saving schemes to the same extent as they have for the harmful conflicts in fee-for-service medicine.     

Policies, practices, and attitudes of North American medical journal editors

OBJECTIVE: To describe U.S. and Canadian medical journals, their editors, and policies that affect the dissemination of medical information. DESIGN: Mailed survey. PARTICIPANTS: Senior editors of all 269 leading medical journals published at least quarterly in the United States and Canada, of whom 221 (82%) responded. MAIN MEASURES: The questionnaire asked about characteristics of journal editors and their journals and about journals' policies toward peer review, conflicts of interest, prepublication discussions with the press, and pharmaceutical advertisements. RESULTS: The editors were overwhelmingly men (96%), middle-aged (mean age 61 years), and trained as physicians (82%). Although 98% claimed that their journals were "peer-reviewed," the editors differed in how they defined a "peer" and in the number of peers they deemed optimal for review. Sixty-three percent thought journals should check on reviewers' potential conflicts of interest, but only a minority supported masking authors' names and affiliations (46%), checking reviewers' financial conflicts of interest (40%), or revealing reviewers' names to authors (8%). The respondents advocated discussion of scientific findings with the press (84%), but only in accord with the Ingelfinger rule, i.e., after publication of the article (77%). Fifty-seven percent of the editors agreed that journals have a responsibility to ensure the truthfulness of pharmaceutical advertisements, and 40% favored subjecting advertisements to the same rigorous peer review as scientific articles. CONCLUSIONS: The responding editors were relatively homogeneous demographically and professionally, and they tended to support the editorial status quo. There was little sentiment in favor of tampering with the current peer-review system (however defined) or the Ingelfinger rule, but a surprisingly large percentage of the respondents favored more stringent review of drug advertisements.     

The crisis of virtue: arming for the cultural wars and Pellegrino at the limes

Edmund Pellegrino's work has been crucial to the renaissance of interest in the philosophy of medicine and the philosophical grounding of medical ethics that has framed the contemporary field of bioethics in the expectation, of the rational justification of a universal content-full morality. However, this attempt at rational justification has failed, leaving a plurality of bioethics and the inability to secure the canonical account of virtue and character which Pellegrino has sought. This failure is integral to a Western Christian error regarding the nature of virtue.     

Hermeneutics, authenticity and the aims of psychology.

The contribution hermeneutic philosophy can make to reflection on issues in psychology is shown through a critique of the "positive psychology" movements inaugurated in the special issue of the American Psychologist edited by M. Seligman and M. Csikszentmihalyi in 2000. Drawing on the broad historical sense advocated by hermeneutics, it is shown that the conceptions of the good life defended by the contributors to the special issue might turn out to be limited to the rather narrow range of questionable and shallow ideals of contemporary Western consumerist economy. In particular, the attempt made by S. E. Taylor, et al (2000) to show that "positive illusions" are conducive to a good life is shown to rest on dubious conceptions about what is genuinely worthwhile in life. As an alternative to the somewhat arid conception of human existence presupposed by the authors contributing to the special issue, M. Heidegger's (1962) conception of authentic existence is put forward as a hermeneutically inspired basis for rethinking what constitutes the richest and most fulfilling life for humans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Homeopathy: a field of work for the veterinarian

It is generally known that Homeopathy and other so-called alternative methods of treatment have recently been gaining acceptance. The profession of lay animal practitioner is no longer a rarity in Switzerland. For some, alternative medicine is one phenomenon among others in a saturated health market and thrives on the fact that classical medicine does not yet extend to all areas. For others, the search for alternatives corresponds to a justified demand by the practitioners and denotes an extension of the medical disciplines. The Workshop for Veterinary Acupuncture and Homeopathy (AGVAH) was founded several years ago by veterinarians in Switzerland. It represents the professional interests of its members and upholds their right to practice these forms of therapy. The ensuing debate between classical and alternative medicine questions not only the basis of Homeopathy and similar forms of medicine, but also that of scientific thought. The realization that any scientific approach has its limits can open a door to deeper understanding of traditional occidental medicine.     

Scientific journals and their authors' financial interests: a pilot study

BACKGROUND: The credibility of modern science is grounded on the perception of the objectivity of its scientists, but that credibility can be undermined by financial conflicts of interest. The US Public Health Service and the National Science Foundation issued regulations effective October 1, 1995, regarding the disclosure of financial interests in the submission of grant proposals. Several scientific journals have also established pertinent policies for authors and editors. The objectives of this study were: (1) to select a set of published articles and observe the degree to which a sample of authors hold a financial interest in areas related to their research that are reportable under current standards, and (2) to examine the hypothesis that significant numbers of authors of articles in life science and biomedical journals have verifiable financial interests that might be important for journal editors and readers to know. This paper measures the frequency of selected financial interests held among lead authors of certain types of scientific publications and assesses disclosure practices of authors and journals. METHOD: These objectives were applied to a pilot study of Massachusetts academic scientists who were cited as first or last author in at least one article published in 1992 in 14 leading journals of cell or molecular biology and medicine. We created a database of every original article published in 1992 by 14 leading life science and biomedical journals, supplemented by data sets consisting of (1) Massachusetts biotechnology firms, including their officers and scientific advisory boards, and (2) scientists listed as inventors on patents or patent applications registered with the World Intellectual Property Organization. RESULTS: We examined 1,105 university authors (first and last cited) from Massachusetts institutions whose 789 articles, published in 1992, appeared in 14 scientific and medical journals. Authors are said to 'possess a financial interest' if they are listed as inventors in a patent or patent application closely related to their published work; serve on a scientific advisory board of a biotechnology company; or are officers, directors, or major shareholders (beneficial owner of 10% or more of stock issued) in a firm that has commercial interests related to their research. Applying the criteria to the reference population of journals and Massachusetts academic authors, we measured the following frequencies for lead authors: 0.20 for serving on a scientific advisory board; 0.07 for being an officer, director, or major shareholder in a biotechnology firm, and 0.22 for being listed as an inventor in a related patent or patent application. The joint frequency of articles in the journals reviewed with a lead author that meets one of the three conditions is 0.34. CONCLUSIONS: One of every three articles in our sample has at least one Massachusetts-based author with a financial interest, and 15% of the authors in our sample have a financial interest relevant to one of their publications. For the year 1992, the rate of published voluntary disclosures of financial interest (as defined in our study) is virtually zero, but relatively few scientific and biomedical journals at that time required any such disclosure to journal editors and reviewers. Further research is needed to determine the effectiveness of mandatory disclosure requirements by some journals.     

The politics of reproductive hazards in the workplace: class, gender, and the history of occupational lead exposure

Over the past two decades, several U.S. companies have sought to bar women from jobs that expose them to potential reproductive hazards, justifying these exclusionary policies by their professed concerns for the well-being of unborn children and potential liability. Although recent court cases have stimulated academic interest in this issue, a historical review of the public health and medical literature reveals that this debate is not new. To understand the logic behind the emergence of "fetal protection" policies, one must examine the scientific history of occupational teratogens and the socio-political and economic forces that have driven scientific research in this field. Using lead as an example, the author argues that research on the reproductive hazards of employment has historically emphasized the risks to women and downplayed the risks to men. This results in environmental health policies that do not uphold the ultimate goal of occupational safety for all workers, but rather reinforce the systemic segregation of men and women in the workplace. Although the political struggle over exclusionary policies has a feminist orientation, it also has important class dimensions and ultimately must be viewed within the broader context of American capitalist production.     

Consumer-professional collaboration for evaluation in neighborhood mental health programs

Neighborhood mental health programs are challenged with the scientific and fiscal necessity of evaluating their services. Since most such programs are joint endeavors of neighborhood residents (usually a consumer board) and nonneighborhood professionals, such evaluative efforts require the sanction and collaboration of both groups to be maximally effective. However, the authors point out that collaboration is often strained by lack of trust and conflicts of interest. Study design may fail to consider neighborhood values, with the result that the provision of services is impeded, consumers are frightened or coerced, the role of paraprofessionals is threatened, and the consumer board's responsibilities to the neighborhood are ignored. The authors discuss those four issues and suggest ways of resolving them.     

Maintaining integrity through clinical supervision

This article suggests that there is a relationship between successfully maintaining integrity in nursing and the practical provision of opportunities for shared reflection offered by good clinical supervision. In order to establish this case, I will first give some definitions and then proceed to consider how these ideas relate conceptually. The article makes no attempt to offer empirical research as confirmation, but provides a conceptual and moral argument making use of anecdotes for purposes of clarification and illumination. It is the author's belief that, if it is understood and implemented properly, clinical supervision offers a radical challenge to nursing's existing culture. If nurses are interested in the survival of the profession, it is perhaps a challenge that has to be addressed.     

The process of mental health consultation: A systematic look within the context of community psychology.

The process of mental health consultation has been generally defined in terms of the techniques which the psychologist uses, "the how" of the consultant's role. The content, "the what" of this process is now being considered. The issues raised are partly based on the analysis of all consultation - contacts (N-56) collected during the first nine operational months of a project serving a sample population previously not reached by traditional clinical settings. Specifically this paper discusses the way in which a record-keeping method, devised specifically to account for "what" happens during a consultation, yields findings clarifying, complementing and at times diverging from what has been impressionistically reported to be content of the consultation process: a focus on psychopathology and intrapsychic conflicts of the consultee's charges. This pilot project in its attempt to systematically record all consultant's activities, has methodological implications for valid functional definitions of the mental health consultant within the context of community psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The historiography of psychology of Italy.

The article outlines the studies conducted in Italy on the history of psychology since the 1970s, with particular attention to those elaborated in the 1990s. Reference is made to the institutions, authors, congresses, and other initiatives that in the course of 3 decades have promoted the growth of the history of psychology, and a review is presented of the principal research themes undertaken by scholars. An attempt has been made to identify the principal historiographic tendencies and to illustrate the passage from a sort of "positivistic" historiography to an orientation that could be considered multi-factorial or one of complexity, attentive to both the internal and the external components of the scientific enterprise, although with a propensity for the history of ideas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identification of class I genes in cartilaginous fish, the most ancient group of vertebrates displaying an adaptive immune response

Sharks are members of the most primitive class of vertebrates (Chondrichthyes) shown to have an adaptive immune system. Suprisingly, however, class I genes have not been identified unambiguously in this taxon, and absence of class I loci or a failure to express class I genes might explain some of the relatively "weak" adaptive immune responses documented in cartilaginous fish. We report here the isolation of three unique cDNA clones from two different species of sharks that encode bona fide class I proteins. These clones exhibit different sequence and expression profiles indicating that they are likely to represent both classical and nonclassical class I lineages. In addition, our preliminary analysis suggests that there may be transfer of gene segments among shark class I genes over evolutionary time. The cloning of shark class I genes completes the identification of molecules that define the adaptive immune system (including Ig, TCR, and MHC class II proteins) in this taxon. Thus, simple models invoking a total absence of certain molecular hallmarks of the immune system to account for poor immune responsiveness in cartilaginous fish should be abandoned.     

A triptych on affective science: Response to the commentary.

Reply by the current authors to the comments made by Jaak Panksepps (see record 2009-02352-007), James.A. Russell (see record 2009-02352-008) and Louise Sundararajan (see record 2009-02352-009) on the original article by Peter Zachar (see record 2007-10982-007). I consider the utility of the concept of natural kind, and explore difficulties in applying it reliably. I examine categorical and dimensional approaches to affect with respect to both scientific realism and nominalist approaches to classification. I agree that eliminativist analogies are beneficial but argue that they cannot fully account for the relationship between folk and scientific psychology. I also claim that neither Panksepp's nor Russell's models are incommensurable with Sundararajn's deeper approach to affective science. I suggest that Panksepp's conclusions about the structure of primary affect may be incompatible with the dimensional model, which illustrates the limits of translational work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)