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  1.  1
    Editor's Introduction.Baer Neal - 2017 - Perspectives in Biology and Medicine 59 (4):445-447.
    The soda wars have taken a new turn. No longer is it a battle between Coke and Pepsi to see who wins in a blind taste test. Today's soda war is between the consumer and the gigantic multinational beverage companies whose sales are plummeting. Evidence is pointing to sodas as one of the major contributors to obesity, and taxes are being slapped on what many are now calling "liquid candy."Sugar-sweetened beverages and their purveyors have been around for over a century, (...)
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  2.  1
    Physicians Can Impact Patient Health.Baer Neal - 2017 - Perspectives in Biology and Medicine 59 (4):465-470.
    If physicians and health practitioners could do one thing to markedly improve the health of their patients, what could that be? Counsel them to reduce or stop drinking sugar-sweetened beverages.The science is clear: sodas, juice drinks, iced teas, and vitamin, sports, and energy drinks provide the largest source of empty or non-nutritional calories in the American diet and accounted for an astonishing 46% of all added sugars consumed in 2010. Sodas top the list of all sugar-sweetened beverages consumed, with the (...)
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  3.  1
    The Research Optimist's Defense.Daniel Benjamin & Jonathan Kimmelman - 2017 - Perspectives in Biology and Medicine 59 (4):491-506.
    Clinical researchers are commonly accused of being overconfident and overly optimistic. They are charged with overestimating their ability to recruit patients to trials and to end trials on time. They are also accused of overestimating effect sizes in power calculations, of overestimating the promise of new interventions, and of conveying this pronounced optimism to human research subjects. More broadly, medical scientists are accused of underestimating timelines for the maturation of research programs, or overstating the potential of their research to deliver (...)
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  4.  1
    Public Health Approaches and the Human Enhancement Debate.Abram Brummett - 2017 - Perspectives in Biology and Medicine 59 (4):536-546.
    Cognitive enhancement refers to any technology that raises some aspect of cognition beyond the species-typical level. It is often considered distinct from and less controversial than cognitive therapy, which raises the cognition of a deficient individual to the species-typical level. The debate over CE is a result of the excitement surrounding the potential of neuroscience to one day enable us to enhance our own cognition in significant ways. Some of the aspects of cognition targeted by enhancement and therapeutic technologies include (...)
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  5.  1
    Libera Me, Domine: Christian Roots of Palliative Care.Anne Ashley Davenport - 2017 - Perspectives in Biology and Medicine 59 (4):507-516.
    According to Father Patrick Verspieren, a Roman Catholic priest and member of the Society of Jesus, the chief duty of the palliative care-giver is to suspend all preconceptions of the incurably ill patient's journey to life's end: "To accompany a dying patient is not to walk ahead of him, or to show him the right path, or to impose an itinerary on him, or even to presume to know what direction he will take. Rather, it consists in walking at the (...)
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  6. Virtue Ethics in Monetized Medicine.Arthur W. Frank - 2017 - Perspectives in Biology and Medicine 59 (4):576-580.
    During Abraham Nussbaum's first year of medical school, he participated in a white coat ceremony and was invested, literally, with a white coat that is symbolic of entry into the medical profession. He was also given a book, an anthology of writings on medicine that Nussbaum describes as having a "wistful quality" and being "engaging but reverential" ; the dust jacket featured a Norman Rockwell painting. He later went to a second-hand bookstore and traded the anthology for Abraham Verghese's 1994 (...)
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  7.  2
    The Need for Uncertainty: A Case for Prognostic Silence.Paul K. J. Han - 2017 - Perspectives in Biology and Medicine 59 (4):567-575.
    No fact in human nature is more characteristic than its willingness to live on a chance. The existence of the chance makes the difference between a life of which the keynote is resignation and a life of which the keynote is hope.Powerful forces are promoting the ideal of prognostic disclosure in endof-life care. Advances in the science of prognostication—ranging from increasingly accurate clinical prediction models to new genomic risk factors—are expanding the supply of prognostic information. Meanwhile, the growing palliative medicine (...)
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  8.  1
    Beware Dichotomies.Charles J. Kowalski & Adam J. Mrdjenovich - 2017 - Perspectives in Biology and Medicine 59 (4):517-535.
    That dichotomization is, at least under certain circumstances, a bad idea is not news. A well-known, early example is the biblical story of King Solomon, who used the absurdity of the procedure to help adjudicate a dispute between two women who each claimed to be the mother of a contested child. Solomon reasoned that his proposal to split the child into two, giving half to each woman, would be abhorrent to the real mother, and when one of the women objected (...)
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  9.  1
    Reassessing Diagrams of Cardiac Mechanics: From Otto Frank and Ernest Starling to Hiroyuki Suga.Johann-Peter Kuhtz-Buschbeck, Reidar K. Lie, Jochen Schaefer & Nicolaus Wilder - 2017 - Perspectives in Biology and Medicine 59 (4):471-490.
    The main topic of this article is Otto Frank's forgotten notion of the pressure-volume diagram of the cardiac ventricle as a means to assess the external mechanical work of the heart. Developed by Frank at the end of the 19th century, this idea was reenvisioned as pressure-volume area about 70 to 80 years later by Hiroyuki Suga. This notion now serves as a perspective for defining cardiac contractility and thus enabling the controlled clinical application of cardiac assist devices. We begin (...)
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  10.  1
    Taxing Soda: Strategies for Dealing with the Obesity and Diabetes Epidemic.Maa John - 2017 - Perspectives in Biology and Medicine 59 (4):448-464.
    Obesity is one of the most common health problems facing children and society today. Since 1960, the obesity rate among adults has risen to 34% in the United States, and morbid obesity is up six-fold. In 1980, only 14% of adult Americans were obese, but this figure had skyrocketed to 31% by 2000. Two out of three Americans today are overweight or obese, and one in 20 suffers from extreme obesity. In 2012, Reuters reported that obesity in America added $190 (...)
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  11.  1
    Situating Social Differences in Health and Illness Practices.Merrild Camilla Hoffmann, Vedsted Peter & Andersen Rikke Sand - 2017 - Perspectives in Biology and Medicine 59 (4):547-561.
    In most countries in the global north, social differences in health status and disease prevalence and outcomes are persistent and growing. This is also the case in the welfare states of Scandinavia. In Denmark, the empirical point of departure for this article, income inequality is relatively low and social mobility is generally considered to be high. One of the ideals of the Danish welfare state is that all citizens have free and open access to the tax-funded health-care system. All Danish (...)
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  12.  2
    Facing Death.Franklin G. Miller - 2017 - Perspectives in Biology and Medicine 59 (4):581-586.
    Something has changed in America with respect to facing death. As I write this review of When Breath Becomes Air by Paul Kalanithi, it is number one on the New York Times nonfiction bestseller's list; number 10 is Being Mortal by Atul Gawande, on the list for 62 weeks. A few years ago, Christopher Hitchens's Mortality, a remarkable narrative of his living in the face of dying from esophageal cancer, also was a bestseller. While denial of death was thought to (...)
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  13.  2
    Dear Dr. Peabody.Daniel P. Sulmasy - 2017 - Perspectives in Biology and Medicine 59 (4):562-566.
    Francis W. Peabody, MDDepartment of MedicineBoston City Hospital and Harvard Medical SchoolBoston, MassachusettsMarch 19, 2017Dear Dr. Peabody,Thank you for giving us the opportunity to review your manuscript "The Care of the Patient." It has been carefully considered by the editors and two external reviewers. We regret to inform you that it cannot be considered further for publication in the Prestigious Journal of Medicine.Chief among our reasons is that it is overly long. Opinion pieces—especially non-data driven articles about topics like ethics—should (...)
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  14.  8
    Self-Regulation of Science: What Can We Still Learn From Asilomar?Carole R. Baskin, Robert A. Gatter, Mark J. Campbell, James M. Dubois & Allison C. Waits - 2017 - Perspectives in Biology and Medicine 59 (3):364-381.
    Ethical decision-making in public health rarely involves simply avoiding a bad choice in favor of a good choice. Instead, it requires policymakers to strike a balance among conflicting goals that are all good—goals such as the health of populations and individuals, knowledge gained through scientific research, autonomy, social justice, and the efficient use of limited resources. This balance can be elusive, and perfect examples are the legal instruments governing dual-use research, a term describing scientific endeavors meant to produce beneficial knowledge (...)
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  15.  1
    Root Metaphor and Bioethics.Tod Chambers - 2017 - Perspectives in Biology and Medicine 59 (3):311-325.
    It is pictures rather than propositions, metaphors rather than statements, which determine most of our philosophical convictions. Bioethics has been particularly attentive to the role of metaphors in the discourse on moral issues in medicine. In The Physician’s Covenant, William May discusses how the various metaphors of the physician influence the manner in which we analyze problems in clinical ethics. Meaghan O’Keefe and colleagues have argued that particular metaphors dominate and in turn mediate the representation of genetic modification to the (...)
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  16.  1
    A Safer Place.Jack Conrad - 2017 - Perspectives in Biology and Medicine 59 (3):413-418.
    When you’re on call as a chaplain, you live on the edge. One side is simple, a Bible or a quick prayer. But the other side.... My pager went off: “Ten-year-old stabbed in head with a screwdriver.” The pager blinked. I saw the doors spring open in the ER. The stretcher vaulted through the door as the EMTs wasted no time. The 10-year-old girl appeared then disappeared from sight, a squid-like creature sprouting plastic tubes instead of tentacles. She was swallowed (...)
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  17.  2
    Doctors Without Borders.Sophie Delaunay - 2017 - Perspectives in Biology and Medicine 59 (3):437-444.
    Doctors Without Borders/Médecins Sans Frontières is among the most emblematic nongovernmental organizations in the field of medical humanitarian assistance. Since its creation in 1971 in the wake of the Biafran War, MSF has grown to be admired for its outstanding boldness and often disliked for its fierce arrogance. Although best known publicly as a large organization that operates in the world’s most ravaged places and that is supported by millions of individual donors, internal staff and field workers typically identify with (...)
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  18.  11
    Epistemology, Ethics, and Progress in Precision Medicine.Spencer Phillips Hey & Brianna Barsanti-Innes - 2017 - Perspectives in Biology and Medicine 59 (3):293-310.
    One of the central goals of precision medicine is to dissolve the long-standing tension between the population-level data provided by traditional randomized controlled trials and the physician’s need to prescribe therapies for their individual patient. The RCT can tell the physician that therapy A is, on average, more effective than therapy B for a population of patients, P, but this does not tell her whether A is more effective for the particular patient, p1, in front of her. However, by leveraging (...)
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  19.  1
    "The News is Not Altogether Comforting": Fiction and the Diagnostic Moment.Annemarie Goldstein Jutel - 2017 - Perspectives in Biology and Medicine 59 (3):399-412.
    The diagnostic moment is a moment replete with drama. As Suzanne Fleischmann has written, hearing the announcement of a serious diagnosis draws an indelible line to demarcate before and after, which will be evermore imposed on an individual’s narrative construction of her life story. We can imagine this moment, considering with apprehension the “what if?” as we attend our doctor’s appointments for the verdict on what ails us. Belief in its transformative power is impressive. That we can imagine it is (...)
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  20.  1
    Towards an Empirically Informed Account of Phronesis in Medicine.Ben Kotzee, Alexis Paton & Mervyn Conroy - 2017 - Perspectives in Biology and Medicine 59 (3):337-350.
    In medical ethics, a large body of work exists on the virtues that enable good medical practice. Medical virtue ethics singles out a number of virtues of the good doctor for attention; among others, these include empathy, care, truthfulness, and justice. According to medical ethicists like Pellegrino and Thomasma, however, phronesis, or “practical wisdom,” occupies a special place among these virtues. For Pellegrino and Thomasma, phronesis is “indispensable” to good medical practice, because it coordinates all the different moral virtues that (...)
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  21.  1
    Humility Through Humiliation in Continuity Clinic.Lelkes Efrat - 2017 - Perspectives in Biology and Medicine 59 (3):419-424.
    I hated my outpatient primary care clinic during residency. Every Wednesday at noon, I scrambled to finish my inpatient work in the hospital, to raggedly see my patients, to sign out my unfinished errands to the covering residents, and to leave the children’s hospital, heading north up the dilapidated thoroughfare to the federally qualified health center where my residency clinic was held. The noise of the street, the honking of the cars, the shouts of the pedestrians, the extremes of cold (...)
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  22.  1
    Hippocrates' First Aphorism: Reflections on Ageless Principles for the Practice of Medicine.Loscalzo Joseph - 2017 - Perspectives in Biology and Medicine 59 (3):382-390.
    Hippocrates, celebrated as the Father of Medicine, emphasized the importance of observation in diagnosis and prognosis. In so doing, he argued that the observant physician could draw on both senses and logic in interpreting clinical findings for the benefit of the patient. Among his many writings is a collection of aphorisms that remain highly relevant to the practice of medicine to this day. The first of these is the best known: which can be translated as: Deceptively simple in structure, this (...)
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  23.  2
    Should a Legal Option of Physician-Assisted Death Include Those Who Are "Tired of Life"?Franklin G. Miller - 2017 - Perspectives in Biology and Medicine 59 (3):351-363.
    Recently, Canada’s National Post described in detail the death by lethal injection of a 94-year-old man, living alone, who had multiple medical problems but was not terminally ill. His son helped find a physician willing to administer lethal medication soon after his father told him he “wasn’t planning on adding another digit” to his age. The physician who complied with the request is a leading advocate for assisted death in Canada, who reportedly has been responsible for more than 30 life-terminating (...)
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  24.  2
    Trains Departing From Different Stations: Being Mortal and Dying in the 21st Century.M. Nussbaum Abraham - 2017 - Perspectives in Biology and Medicine 59 (3):425-436.
    Every July, when new resident physicians arrive at our teaching hospital, a colleague reminds them that “You now work in the train station of the gods. People coming and going all the time. You’ll need to ask spiritual questions.” He can offer this counsel annually because—whether it arrives early, as expected, or in error—every one of us is awaiting her departing train. Every few years, an experienced physician-writer offers counsel on what it means to work in these train stations, to (...)
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  25.  4
    What Hospitalists Should Know About Intersex Adults.Reis Elizabeth & W. McCarthy Matthew - 2017 - Perspectives in Biology and Medicine 59 (3):391-398.
    A 35-year-old woman presents to the hospital after a fall at home. A routine medical history and physical examination reveal that the patient identifies as intersex, and an X-ray of the left hip demonstrates profound osteopenia. The patient is admitted to the hospitalist service for further evaluation. What does it mean to identify as intersex? In the medical world, “intersex” is usually referred to as DSD, or “disorders of sex development.” Until the 1990s, physicians referred to this condition as hermaphroditism, (...)
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  26.  1
    When Patients' Values Challenge Professional Integrity: Which Way Out?Marta Spranzi - 2017 - Perspectives in Biology and Medicine 59 (3):326-336.
    An elderly patient in his early eighties is hospitalized in a long-term facility, with advanced Alzheimer disease. He is otherwise relatively strong and free from other life-threatening conditions, except for the fact that he has difficulties swallowing. After several episodes of acute aspiration pneumonia doctors prescribe “strict fast”: only hydration through an IV catheter should be administered during the night, in order to relieve the feeling of hunger, provide comfort, and stave off death. The patient is surrounded by a warm (...)
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  27.  3
    "Tailored-to-You": Public Engagement and the Political Legitimation of Precision Medicine.Alessandro Blasimme & Effy Vayena - 2017 - Perspectives in Biology and Medicine 59 (2):172-188.
    Some patients tolerate a given drug well, without adverse reactions. For others, though, an identical dose of the same medication can have toxic effects. Moreover, while a drug can be effective at relieving symptoms for some patients, it may fail to do the same for others suffering with the same disease. With such variability in treatment responses, tailoring medical interventions to individual patients has long been an aspiration of medicine. Until recently, however, medicine lacked a clear understanding of the biological (...)
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  28. Beyond Mind and Body.Howard Brody - 2017 - Perspectives in Biology and Medicine 59 (2):276-282.
    In 1979, James S. and Jean M. Goodwin and Albert V. Vogel published the first of what became a series of articles that studied current patterns of placebo use. They surveyed 60 house officers and 37 nurses in a New Mexico teaching hospital. Only five of the 1900 patients hospitalized during the study period had received a placebo. Their subjects underestimated the pain relief provided by placebos and believed that a positive placebo response showed that the pain was psychogenic and (...)
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  29.  2
    The Cosmetic Medicine Revolution, the Goals of Medicine, and Bioethics.Shahram Ahmadi Nasab Emran - 2017 - Perspectives in Biology and Medicine 59 (2):213-227.
    This article reviews the development of a new set of practices within modern medicine that can generally be called “cosmetic medicine,” practices that include cosmetic surgery, cosmetic dermatology, and cosmetic gynecology. I argue that the development of such fields indicates a fundamental change in the practice of medicine. After reviewing the possible explanations proposed for such developments, in order to indicate the social and cultural origin of the driving forces, I discuss the implications of these revolutionary changes for the perceived (...)
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  30. Bioethics' Contradiction: Everyday Ethics and the Morality System.Arthur W. Frank - 2017 - Perspectives in Biology and Medicine 59 (2):283-292.
    In one of Richard Zaner’s tales of ethics consultation practice, a moment occurs that might be comic, except for the gravity of the situation. Zaner goes to visit the parents of an infant with multiple problems who has been admitted to neonatal intensive care. He introduces himself awkwardly, and the child’s father responds: “‘Why,’ he bluntly asked, ‘are you here now?’ And with, again, exemplary frankness, he pointedly demanded, eyes narrowing in that knowing way, full of suspicion: ‘Has someone been (...)
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  31.  2
    Outcome Orientation: A Misconception of Probability That Harms Medical Research and Practice.T. Humphrey Parris & Masel Joanna - 2017 - Perspectives in Biology and Medicine 59 (2):147-155.
    We are far too willing to reject the belief that much of what we see in life is random.Uncertainty is an everyday experience in medical research and practice, but theory and methods for reasoning clearly about uncertainty were developed only recently. Confirmation bias, selective memory, and many misleading heuristics are known enemies of the insightful clinician, researcher, or citizen, but other snares worth exposing may lurk in how we reason about uncertainty in our everyday lives. Here we draw attention to (...)
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  32.  7
    Thirteen Ways of Looking at Henrietta Lacks.D. Lantos John - 2017 - Perspectives in Biology and Medicine 59 (2):228-233.
    What are we to make of Henrietta Lacks? After dying at a young age more than half a century ago, she has now become immortal twice—once biologically, and once culturally.She was first immortalized when cells from her cervical biopsy were cultured and became the first immortal cell line. The idea that this made Lacks herself immortal illustrates the dangerous temptations of genetic reductionism and literary license. Such literary license is illustrated by the title of Rebecca Skloot’s remarkable 2011 bestselling book (...)
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  33.  13
    The AMA on Euthanasia and Assisted Suicide.Steven Luper - 2017 - Perspectives in Biology and Medicine 59 (2):189-197.
    The American Medical Association opposes physician-assisted suicide on the grounds that it “would ultimately cause more harm than good,” because it is “fundamentally incompatible with the physician’s role as healer,” and because it “would be difficult or impossible to control and would pose serious societal risks”. It condemns the practice of euthanasia as conducted by physicians for these reasons as well, and adds, by way of clarifying the serious risks at hand, that “euthanasia could readily be extended to incompetent patients (...)
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  34.  5
    Transgender Patients, Hospitalists, and Ethical Care.Matthew W. McCarthy, Elizabeth Reis & Joseph J. Fins - 2017 - Perspectives in Biology and Medicine 59 (2):234-245.
    A 28-year-old female-to-male transgender patient presents to the emergency room with one day of pleuritic chest pain and shortness of breath. The patient is found to have an acute pulmonary embolus and is admitted is to the academic hospitalist teaching service for further management.The transgender population is diverse in gender identity, expression, and sexual orientation. Although estimates vary, one study suggests that 0.3% of adults identify as transgender. The U.S. National Transgender Discrimination Survey revealed that 28% of transgender adults have (...)
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  35.  1
    From Trees to Rhizomes.Rosenberg Noah - 2017 - Perspectives in Biology and Medicine 59 (2):246-252.
    The man had fallen in the hospital recovery room while attempting to put on his pants, readying himself to return home after an outpatient procedure. The case seemed so pedestrian at first. The emergency department charge nurse was annoyed; she called it a dump. “They’re sending a patient from the PACU to the ER!” she fumed. “Why can’t they take care of their own problems up there? Isn’t this a hospital?”I could relate to the gut aversion to having yet another (...)
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  36.  2
    Refusing Technology, Accepting Death: My Father's Story.Ryan-Harshman Milly - 2017 - Perspectives in Biology and Medicine 59 (2):198-205.
    In December 2004, at the age of 91, my father was told that his congestive heart failure had worsened and that his kidneys were functioning poorly. At best, the prognosis was that he had perhaps another year; at 86, my father had had a succession of three heart attacks before having surgery to place a stent in his coronary artery. The cardiologist who treated him then said he would get five or six good years from the stent, for which my (...)
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  37.  4
    Twenty-First Century "Eugenics"?: The Enduring Legacy.L. Smith Shelley - 2017 - Perspectives in Biology and Medicine 59 (2):156-171.
    In her 2001 book Building a Better Race, Wendy Kline argues that the end of World War II did not spell the demise of eugenics; instead, proponents of eugenics were flexible enough to adapt, increasingly emphasizing “positive eugenics” and social responsibility. When the earlier attempt at quarantine failed, with a leakage of “immorality” to white, middle-class women, eugenicists moved on to another public health–focused metaphor, that of preventive medicine. Emphasizing nurture as well as nature preserved the end goal of promoting (...)
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  38.  4
    The Ethics of Public Health Laws, and the Special Case of the New "Model Law".Steinberg Sharon & Jotkowitz Alan - 2017 - Perspectives in Biology and Medicine 59 (2):206-212.
    In 2012, a law against hiring models with a BMI below 18.5 was passed in Israel. In addition, every photoshopped advertisement must have a visible subtitle that indicates that the picture was photoshopped. Dr. Rachel Adatto, the initiator of the law, states that the law is “a beginning of a revolution against the anorectic beauty model ideal,” and that its aim is to prevent eating disorders that may lead to death in the aspiration to lose weight, especially among the general (...)
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  39.  1
    Reconsidering Samuel: A Mental Health Caretaker at a Ghanaian Prayer Camp.A. Taylor Lauren - 2017 - Perspectives in Biology and Medicine 59 (2):263-275.
    Since early 2014, i have studied what life is like for staff in a mental health sanatorium at a Ghanaian prayer camp. I have traveled to the camp on six occasions to observe its rhythms and routines and interview staff about their work. What follows is an informal reflection on the role of prayer camps as a source of mental health care in Ghana. The text is based on my experience conducting the research at the camp, rather than a formal (...)
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  40. Thinking Through the Pain.Keith Wailoo - 2017 - Perspectives in Biology and Medicine 59 (2):253-262.
    While researching my 2001 book on sickle cell disease, I became aware of the politics of pain. In that malady—a painful disorder associated with African Americans and characterized by frequent infections and recurring painful “crises”—the politics of pain recognition and adequate relief intersect not only with drug concerns, but also with American racial politics. One cannot understand fully the history of sickle cell patients without understanding politics on two levels: the macropolitics of race in America and the micropolitics of medicinal (...)
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