In this groundbreaking book, psychiatrist and ethicist MonaGupta analyzes the basic assumptions of Evidence-based medicine (EBM), and critically examines their applicability to psychiatry. Highlighting ethical tensions between psychiatry and EBM, she asks the controversial question - should psychiatrists practice evidence-based medicine at all?
Many western industrialized countries are currently suffering from a crisis in health human resources, one that involves a debate over the recruitment and licensing of foreign-trained doctors and nurses. The intense public policy interest in foreign-trained medical personnel, however, is not new. During the 1960s, western countries revised their immigration policies to focus on highly-trained professionals. During the following decade, hundreds of thousands of health care practitioners migrated from poorer jurisdictions to western industrialized countries to solve what were then deemed (...) to be national doctor and nursing 'shortages' in the developed world. Migration plummeted in the 1980s and 1990s only to re-emerge in the last decade as an important debate in global health care policy and ethics. This paper will examine the historical antecedents to this ethical debate. It will trace the early articulation of the idea of a 'brain drain', one that emerged from the loss of NHS doctors to other western jurisdictions in the 1950s and 1960s. Only over time did the discussion turn to the 'manpower' losses of 'third world countries', but the inability to track physician migration, amongst other variables, muted any concerted ethical debate. By contrast, the last decade's literature has witnessed a dramatically different ethical framework, informed by globalization, the rise of South Africa as a source donor country, and the ongoing catastrophe of the AIDS epidemic. Unlike the literature of the early 1970s, recent scholarship has focussed on a new framework of global ethics. (shrink)
Philosophy of medicine encompasses a broad range of methodological approaches and theoretical perspectives—from the uses of statistical reasoning and probability theory in epidemiology and evidence-based medicine to questions about how to recognize the uniqueness of individual patients in medical humanities, person-centered care, and values-based practice; and from debates about causal ontology to questions of how to cultivate epistemic and moral virtue in practice. Apart from being different ways of thinking about medical practices, do these different philosophical approaches have anything in (...) common? Are they committed to incompatible assumptions about the nature of science and its relationship to experience, value, and the art of medicine, or are different approaches nonetheless complementary? The chapter examines the questions these different approaches and perspectives raise and considers why so many theorists of medicine seek to find a “base” or “center” for medicine—as though there is, or should be, some general conceptual thread linking the things we call “usual clinical practice” in the real world. It further considers whether there are alternative approaches to the philosophy of medicine, which do not embody this philosophical assumption; and it suggests that a key tool for evaluating approaches must be their ability to contribute something of genuine value to clinical medicine. (shrink)
Evidence-based psychiatry (EBP) has arisen through the application of evidence-based medicine (EBM) to psychiatry. However, there may be aspects of psychiatric disorders and treatments that do not conform well to the assumptions of EBM. This paper reviews the ongoing debate about evidence-based psychiatry and investigates the applicability, to psychiatry, of two basic methodological features of EBM: prognostic homogeneity of clinical trial groups and quantification of trial outcomes. This paper argues that EBM may not be the best way to pursue psychiatric (...) knowledge given the particular features of psychiatric disorders and their treatments. As a result, psychiatry may have to develop its own standards for rigour and validity. This paper concludes that EBM has had a powerful influence on how psychiatry investigates and understands mental disorders. Psychiatry could influence EBM in return, reshaping it in ways that are more clinically useful and congruent with patients’ needs. (shrink)
In most areas of medicine, the physician's primary task is to diagnose the patient's presenting problem by correctly identifying the underlying pathology causing that problem. Diagnoses are established through a process of correlating the information obtained from an interview with the patient about his history of illness and circumstances, with additional evidence of the underlying disease derived from physical examination findings and/or the results of laboratory investigations and diagnostic imaging. In contemporary health care, various movements that call for a shift (...) in clinical care away from underlying disease pathology toward understanding people and their experience of disease are receiving growing... (shrink)
Evidence-based medicine (EBM) made its first appearance in the medical lexicon in 1990 and since then has enjoyed widespread support from within the medical profession, including among psychiatrists. Proponents of evidence-based psychiatry (EBP) point to its ability to demonstrate the efficacy of various psychiatric treatments, promising improved mental health outcomes and more efficient use of healthcare resources as a result. Policymakers and insurers have embraced EBP in hopes that these goals will be realized. However, the question of whether EBM is (...) even applicable to psychiatry remains largely unaddressed, even though it is an urgent one, given the various corporate, professional, and governmental pressures .. (shrink)
In her paper, “Evidence-based medicine in context: A pragmatist approach to psychiatric practice,” Jorid Moen sets out to advance the debate about role of evidence-based medicine in psychiatric practice. She views this debate as dichotomous and unproductive. It is dichotomous in the sense that EBM is linked to foundationalist theories of knowledge, whereas critiques of EBM are often based in anti-foundationalist theory. It is unproductive because neither position offers a way forward. Moen draws on the philosophical tradition of pragmatism in (...) hopes that ‘opposing positions of EBM might be brought to agree that the different perspectives they represent are both relevant and important for psychiatric. (shrink)
In his paper, A Logic in Madness, Aaron Hauptman describes the evolving clinical picture of Mr. A, a patient with Asperger’s syndrome who presents with symptoms consistent with a major depressive episode. In his case discussion, Hauptman describes the difficulties, both conceptual and practical, faced by the clinical team in trying to help this man recover from his depression. Among these he identifies: ‘the ethics of mandated treatment, definitions of mental illness, rationality in the context of psychiatric disorders, and the (...) limitations on patient autonomy in a psychiatric inpatient setting’. In this response to Hauptman’s paper, I discuss the first and last concerns with emphasis on... (shrink)
Gupta effectively probes the methodological and ethical presuppostions of Evidence Based Medicine, and its more contestable application to psychiatry. She concludes with an endorsement of a very modest reformulation of it as one guide to practice among many.
This book offers a novel account of the relationship of experience to knowledge. The account builds on the intuitive idea that our ordinary perceptual judgments are not autonomous, that an interdependence obtains between our view of the world and our perceptual judgments. Anil Gupta shows in this important study that this interdependence is the key to a satisfactory account of experience. He uses tools from logic and the philosophy of language to argue that his account of experience makes available (...) an attractive and feasible empiricism. (shrink)
This volume reprints eight of Anil Gupta's essays, some with additional material. The essays bring a refreshing new perspective to central issues in philosophical logic, philosophy of language, and epistemology.
_An Introduction to Indian Philosophy_ offers a profound yet accessible survey of the development of India’s philosophical tradition. Beginning with the formation of Brahmanical, Jaina, Materialist, and Buddhist traditions, Bina Gupta guides the reader through the classical schools of Indian thought, culminating in a look at how these traditions inform Indian philosophy and society in modern times. Offering translations from source texts and clear explanations of philosophical terms, this text provides a rigorous overview of Indian philosophical contributions to epistemology, (...) metaphysics, philosophy of language, and ethics. This is a must-read for anyone seeking a reliable and illuminating introduction to Indian philosophy. (shrink)
Leah Andress,1 Anjali Gupta,2 Nida Siddiqi,3 Kwaku Marfo2,3 1University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Department of Pharmacy Practice, Buffalo, 2Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine Department of Abdominal Organ Transplant Program, Bronx, 3Montefiore Medical Center, Department of Pharmacy, Bronx, NY, USA: Rabbit anti-thymocyte globulin has proven benefit as induction therapy in renal transplant recipients, achieving reduced acute rejection rates and better short-term allograft function, with slightly higher rates of complications such (...) as infections and malignancy. Compared with other agents, the most benefit from rATG induction has been observed in renal transplant recipients at high immunologic risk for rejection. However, in special populations, such as pediatrics, the elderly, and hepatitis C-positive and human immunodeficiency virus-positive renal transplant recipients, additional information is needed to delineate the absolute benefit of rATG induction compared with other induction agents. Selection of rATG as the choice of induction therapy in renal transplant recipients should be guided by a cost-effective approach in balancing efficacy, safety, and cost. This review summarizes the published literature on efficacy, safety, and cost of rATG induction in renal transplantation. Keywords: anti-thymocyte globulin, renal transplantation, induction therapy. (shrink)
Eastern Philosophy represents one of the most ancient intellectual traditions of human culture, yet it is generally ignored by Western philosophers. Today more than ever, the need for understanding in a global community should be stressed as the scope, scale, and complexity of social changes increase. Bina Gupta strives to obtain a harmonious balance between the two traditions in her book Ethical Questions: East and West. Both ancient and modern sources such as the Buddha, Aristotle, the Upanishads, Simone de (...) Beauvoir, Kant, and Alasdair MacIntyre are used to illustrate the varying traditions. (shrink)
Owing to the growing academic and practitioner’s interest in the field of Corporate Social Responsibility, there is a need to do a comprehensive assessment and synthesis of research activities. This article addresses this need and examines the academic literature on Corporate Social Responsibility and Performance using a paradigmatic and methodological lens. The objective of this article is fourfold. First, it examines the status of CSR research from its beginning especially after 1970 to year 2008 in leading academic journals and reports (...) to assess the focus areas of research on CSR so far. Second, it analyzes the research paradigms adopted in these research articles using the Operations Research Paradigm framework. Third, it compares and contrasts various kinds of research articles, methodologies, and research designs used in various researches in literature. Finally, it uncovers the implications of this study and directions for future research. (shrink)
Corporate Social Responsibility (CSR) programs are increasingly popular corporate marketing strategies. This paper argues that CSR programs can fall along a continuum between two endpoints: Institutionalized programs and Promotional programs. This classification is based on an exploratory study examining the variance of four responses from the consumer stakeholder group toward these two categories of CSR. Institutionalized CSR programs are argued to be most effective at increasing customer loyalty, enhancing attitude toward the company, and decreasing consumer skepticism. Promotional CSR programs are (...) argued to be more effective at generating purchase intent. Ethical and managerial implications of these preliminary findings are discussed. (shrink)
We argue that distinct conditionals—conditionals that are governed by different logics—are needed to formalize the rules of Truth Introduction and Truth Elimination. We show that revision theory, when enriched with the new conditionals, yields an attractive theory of truth. We go on to compare this theory with one recently proposed by Hartry Field.
In November–December 2006, a four-part documentary, A Child against All Odds, aired on BBC television, presented by a renowned British infertility specialist, physician Robert Winston. The series portrayed the reproductive journeys of several couples who apparently had very low chances of biologically conceiving their own children. The series had all the ingredients of a medical thriller, with individuals, couples, and reproductive body parts (their own and donors’) crossing national boundaries and traveling thousands of miles in what Marcia Inhorn (2002) calls (...) a “quest for conception.” Whether it is “mail order” conception facilitated by courier services or actual persons traveling, a growing number of .. (shrink)
This article focuses on the transformation of the female reproductive body with the use of assisted reproduction technologies under neo-liberal economic globalisation, wherein the ideology of trade without borders is central, as well as under liberal feminist ideals, wherein the right to self-determination is central. Two aspects of the body in western medicine—the fragmented body and the commodified body, and the integral relation between these two—are highlighted. This is done in order to analyse the implications of local and global transactions (...) in women’s reproductive body parts for their right to self-determination and individual agency and what this means for their embodiment. We conclude by exploring whether women can become embodied subjects by exercising their proprietary right to their bodies through directing technology to achieve their own goals, while at the same time being fragmented into parts and losing their personhood and bodily integrity. (shrink)
The article discusses the meaning of consciousness and presents a collective consciousness view of business organizations and their development. It proposes an integrative hierarchical framework of three levels of organizational consciousness: material, social and spiritual. The concepts of excellence, ethical and moral temperament of organizations at different levels of consciousness are also discussed. The article describes the features of social and spiritually conscious business organizations, taking some examples from secondary sources. Overall, it is an attempt to link the ideals of (...) human evolution with the potential behaviour of business corporations. (shrink)