In lieu of an abstract, here is a brief excerpt of the content:George Engel’s Legacy for the Philosophy of Medicine and PsychiatryBradley Lewis (bio)KeywordsBiopsychosocial model, George Engel, pragmatism, philosophy of medicine, philosophy of psychiatryEach of the respondents to this paper raises critical and important concerns. I am grateful for the quality of their insights. David Brendel’s response, along with his recent book, Healing Psychiatry: Bridging the Science/Humanism Divide, resembles my efforts in several ways. Like Brendel, I too believe (...) that the American pragmatic philosophy can be helpful in healing the splits and divisions within psychiatry. And, like Brendel, I believe that psychiatry would benefit from what he calls the “four ps” of pragmatism. Where we differ with regard to George Engel and his biopsychosocial model seems to be less about philosophy and more about strategy. Brendel argues that Engel was too scientistic in his manifest reasoning to be considered a pragmatist. I agree with this description of Engel. But, strategically, we can go beyond Engel’s manifest reasoning to draw out the implications of Engel’s writings in a pragmatic fashion. I am not saying that Engel did this himself; I am only saying that it is very possible to reinterpret Engel along these lines.Brendel also argues that the biopsychosocial model itself needs improvement. But, just as it is possible to update Engel’s theoretical scaffold, we can also update Engel’s biopsychosocial model. Along the lines of Brendel’s concerns, we can easily revise the model so that we remember that not all problems need complex analysis and interventions. Some problems are relatively simple and can have a simple solution. We can also revise the model so we include questions of consumer participation and the provisional nature of the clinical encounter. I see nothing in the biopsychosocial model that contradicts either of these concerns. Yes, the biopsychosocial model needs to be updated, refurbished, expanded, and reimagined. That is my point in the paper.The traction of Brendel’s concerns is not can we reinterpret Engel? or can we refresh the biopsychosocial model?—of course we can. The traction of his concern seems to be “should we?” To this strategic question, Brendel’s answer is no and my answer is yes. I argue that it is a good idea to refresh and refurbish Engel and his biopsychosocial model because it helps to create a connection with an important tradition within both medicine and psychiatry: the tradition of balanced, broadminded, nuanced, patient-centered and anti-reductionistic [End Page 327] care. This tradition is important because medicine and psychiatry seem perpetually vulnerable to the temptations of reductionist approaches and to what Engel, and Nassir Ghaemi more recently, call “dogmatism” (Engel 1977, 130; Ghaemi, 2003, 301). Whether reductionism and dogmatism take the form of biopsychiatry, or psychoanalysis, or antipsychiatry, or cognitive-behavioral therapy, the problems of dogmatism are the same.I am sure Brendel would agree with this, which is why he raises pluralism to such a prominent position in his own reasoning. The difference is that Brendel believes we can better get to this kind of balanced clinical care by letting go of the past figures like Engel and moving into the bright light of the twenty-first century. Maybe so. But my thinking when I wrote the paper goes the other way around. For me, if clinical medicine and psychiatry more carefully tended to its history and tradition, it would be less likely to fall sway to the next Johnny-come-lately reductionistic model.Jeffery Spike’s memories of George Engel during the years they worked together at the University of Rochester School of Medicine provide a good sense of why Engel is an important figure to remember and to pay homage. As Spike puts it, Engel was not only a “legendary figure” with an “almost mythical diagnostic ability,” Engel “probably had more influence on the philosophy of medicine in the United States than any other person, physician, or philosopher.” Both of these accomplishments help to explain why Engel is worth remembering.Those of us in medicine and psychiatry all know mythical clinicians and teachers—the ones who seem like Michael Jordan used to seem on the basketball court, able to somehow make even... (shrink)

The book presents the outcomes of an innovative research programme in the history of science and implements a Text Act Theory which extends Speech Act Theory, in order to illustrate a new approach to texts and textual communicative acts. It examines assertives (absolute or conditional statements, forecasts, insurance, etc.), directives, declarations and enumerations, as well as different types of textual units allowing authors to perform these acts: algorithms, recipes, prescriptions, lexical templates for terminological studies and enumerative structures. The book (...) relies on the study of a broad range of documents of the past dealing with various domains: mathematics, zoology, medicine, lexicography. The documents examined come from scholarly sources from different parts of the world, such as China, Europe, India, Mesopotamia and are written in a variety of European languages as well as Chinese, Cuneiform and Sanskrit. This approach proves fruitful in both history of science and Text Act Theory. (shrink)

The history of ideas deals with the elemental unit-ideas which for Lovejoy are components of systems distinguished by their patterns. Special histories explain how a particular form of human history developed. General histories draw on special histories to document or explain social contexts. Since patterns influence philosophers, the history of ideas contributes little to the history of philosophy, a discontinuous strand within a period's continuous intellectual history. By accepting cultural pluralism, denying the monistic position (...) that there always are internal connections among all or some strands of intellectual and cultural history, both continuity and change in philosophy can be best understood. (shrink)

On April 16, 2007, Cho Seung-Hui used two semiautomatic handguns to kill 32 persons and then himself at Virginia Tech University in the largest campus shooting in U.S. history. Mr. Cho purchased his handguns from a pawnshop and a gun store in Virginia, where under state law a background check was conducted to determine whether he had any disqualifying criminal or mental health history. The paperwork for the background check was completed at the gun store, and the check (...) itself was conducted through an “instant” system facilitated by a toll-free telephone number. The entire transaction took approximately 20 minutes. At no point was Mr. Cho asked why he wished to purchase the guns. And although he had been deemed a potential danger to himself by a state magistrate in 2005 – which should have disqualified his purchase of a gun under federal law – this information never reached those conducting the background check. (shrink)

History of medicine is taught in West Germany as part of the standard course offerings for medical students and is well represented at many universities. But history of science and technology unfortunately still lacks any adequate supporting system and accordingly barely continues to survive at a few institutions of the Federal Republic. Although history of medicine serves a different function than history of science and technology, closer cooperation between these groups is possible and greatly (...) desired for the future. (shrink)

. This paper follows the journey of two small fluid units throughout the nineteenth century in Anglo-American medicine and pharmacy, explaining how the non-uniform “drop” survived while the standardized minim became obsolete. I emphasize two roles these units needed to fulfill: that of a physical measuring device, and that of a rhetorical communication device. First, I discuss the challenges unique to measuring small amounts of fluid, outlining how the modern medicine dropper developed out of an effort to resolve (...) problems with the “minimometer,” which measured minims. Second, I explain how drops, utilized in “the open drop method” of administering general anesthesia, effectively communicated a gradual process and epistemically valuable heuristic to the audience of practitioners, whose attention to individual medical outcomes was important for verifying the proper dosage. The standardized minim was never able to achieve success as the drop’s intended replacement; the non-uniform drop better served the relevant epistemic goals within the practical contexts for which these units were designed. The surprising historical trajectory of drops should cause us to question the common equivocation of “standardization” with “progress” in the history and philosophy of measurement. This study also exemplifies how examining non-standard measurement practices can be instructive for better understanding the role and function of standardization within epistemology of measurement. (shrink)

Translating ethical theories into clinical practice presents a perennial challenge to educators. While many suggestions have been put forth to bridge the theory-practice gap, none have sufficiently remedied the problem. We believe the ascendance of hospital medicine, as a dominant new force in medical education and patient care, presents a unique opportunity that could redefine the way clinical ethics is taught. The field of hospital medicine in the United States is comprised of more than 50,000 hospitalists—specialists in inpatient (...) medicine—representing the fastest growing subspecialty in the history of medicine, and its members have emerged as a dominant new force around which medical education and patient care pivot. This evolution in medical education presents a unique opportunity for the clinical ethics community. Through their proximity to patients and trainees, hospitalists have the potential to teach medical ethics in real time on the wards, but most hospitalists have not received formal training in clinical ethics. We believe it is time to strengthen the ties between hospital medicine and medical ethics, and in this article we outline how clinical ethicists might collaborate with hospitalists to identify routine issues that do not rise to the level of an “ethics consult,” but nonetheless require an intellectual grounding in normative reasoning. We use a clinical vignette to explore how this approach might enhance and broaden the scope of medical education that occurs in the inpatient setting: A patient with an intra-abdominal abscess is admitted to the academic hospitalist teaching service for drainage of the fluid, hemodynamic support, and antimicrobial therapy. During the initial encounter with the hospitalist and his team of medical students and residents, the patient reports night sweats and asks if this symptom could be due to the abscess. How should the hospitalist approach this question? (shrink)

ZusammenfassungDieser Beitrag ist Teil des Forums COVID-19: Perspektiven in den Geistes- und Sozialwissenschaften. Die Figur des Pestarztes mit der schnabelförmigen Maske ist heute die am häufigsten zitierte Bildmetapher für die Pest. Es verwundert daher nicht, dass die Pestarztmaske in der Sammlung des Deutschen Medizinhistorischen Museums in Ingolstadt zu den am meisten nachgefragten Objekten und Bildmotiven des Hauses gehört. Der Forumsbeitrag spürt der Figur des Pestarztes auf mehreren Ebenen nach: Zunächst wird anhand zeitgenössischer Text- und Bildquellen diskutiert, welche Art von Schutzkleidung (...) zu Seuchenzeiten empfohlen wurde und welche Rolle das schnabelförmige Maskenattribut dabei spielte. Anschließend wird das Ingolstädter Exemplar unter die Lupe genommen, hinsichtlich seines Materials und seiner Machart auf Authentizität und Praktikabilität hin untersucht und mit dem Exemplar des Deutschen Historischen Museums in Berlin verglichen.Das Ergebnis: Die frühesten Belege für die Verwendung dieser speziellen Art von Schutzkleidung stammen aus Italien und Südfrankreich und datieren aus der Mitte des 17. Jahrhunderts. Für Mitteleuropa gibt es keinerlei Nachweise dafür, dass zu Pestzeiten jemals eine solche Schnabelmaske in Gebrauch gewesen wäre. Und die Pestarztmasken in Ingolstadt und Berlin? Bei kritischer Betrachtung finden sich bei beiden Masken Details, die gegen eine Verwendung als Schutzkleidung sprechen. Ob es sich dabei um ältere, historisierende Nachbauten oder bewusste Fälschungen handelt, muss offen bleiben.This paper is part of Forum COVID-19: Perspectives in the Humanities and Social Sciences. The figure of the plague doctor with the beak mask has become the symbol of the plague par excellence. It’s little wonder that the plague mask in the collection of the German Museum of the History of Medicine in Ingolstadt is one of the museum’s most popular objects and motifs. This forum paper investigates the figure of the plague doctor on several levels: first, it analyses contemporary textual and image sources in regard to protective clothing used in times of plague and the respective role of the beak-like part of the mask. Then it takes a close look at the Ingolstadt specimen. By examining the mask’s materiality and fabrication, questions of its authenticity and practicability are raised. Finally, the Ingolstadt mask is compared with the specimen at the German Historical Museum in Berlin.The conclusion: the beak mask is not mentioned before the mid-seventeenth century, and then only in Italy and Southern France. There is no proof at all of its use during plague outbreaks in Middle Europe. And the specimens in Ingolstadt and Berlin? Both masks present details which suggest that they were not used as protective clothing at all. We do not know, however, if they were produced as replicas for historic reasons or as fakes for the modern art market. (shrink)

A case-study, small-group-discussion (“focal problem”) exercise in the history of medicine was designed, piloted, and evaluated in an overseas course and an on-campus elective course for medical students. Results suggest that this is a feasible approach to teaching history of medicine which can overcome some of the problems often encountered in teaching this subject in the medical curriculum.

A popular saying attributed to Aristotle states that ‘medicine begins where philosophy ends’—but this principle does not seem entirely valid for the late Middle Ages and the Renaissance, when medicine and philosophy were considered to be integral parts of the same branch of knowledge. For this reason, although today medicine and philosophy are clearly distinct disciplines, historians of ideas cannot study them entirely separately. Indeed, since the early modern era was a period of profound revision of knowledge, (...) probably only a truly interdisciplinary investigation can identify the conceptual shifts and transfers capable of reinstating medicine in its fundamental role in the development of civilisation and modern thought, in particular as a model of a rational knowledge aimed at improving the social good through a fitting interpretation of experience. This article intends to offer arguments in support of such a historiographical approach, and to illustrate certain interesting methodological ideas that emerge from a study in which the history of philosophy and history of medicine cross-pollinate. (shrink)

In order to fully understand the ethical, cultural, and political debate that moves around the papillomavirus vaccine, a bit of attention has to be paid to its history.In 2006 the first advertisements for Gardasil, the commercial name of the vaccine, started to appear in the United States. Merck pharmaceutical was the main dealer. Their “One Less” campaign was characterized by adolescent girls staring into the camera and saying, “I’m one less,” declaring their intention to be vaccinated against the human (...) papillomavirus, and to be one less victim of cervical cancer; all it would take was three injections over six months. A few months after the appearance of the advertisement, the HPV matter took another turn when Texas Governor Rick Perry decided to issue an executive order mandating vaccination of all sixth-grade girls in the state. Texas, a state with a conservative political culture and well-organized anti-vaccination movement, bypassed the legislature, overturned Perry’s order .. (shrink)

When one considers the protracted and continuing struggle of the citizens of Oregon to include physician-assisted suicide among the panoply of measures available to dying patients and the physicians who care for them, the depth and breadth of the issue becomes inescapable. The potential intractability of the dispute is illustrated by the very fact, noted in the preceding parenthetical phrase, that consensus eludes us on even the most basic of semantic points—how we are to most aptly characterize the conduct in (...) question? The case featured in this issue's The Caduceus in Court must be examined as the latest battle in a long war of attrition waged by opponents of physician-assisted suicide against the Oregon Death with Dignity Act. After briefly reviewing that history, I will then consider the details of Oregon v. Ashcroft and the implications of the litigation not only for the care of dying patients but also for the regulation of medical practice in the United States and, more broadly still, the search for resolution of serious medical disputes in a democratic society. (shrink)

My assignment today, as I understand it, is to say something about the Second International Congress of the History of Science, the only previous one held in the United Kingdom; to mention some of the great historians of science which these islands have produced; and to direct our thoughts for a few moments to the historiography of science, technology and medicine, namely the guiding ideas in the light of which one should attempt to write it. So much has (...) already been said in thanks to the city and the university in which we are now assembled that I could hardly add to it, except to express my personal sense of elation at coming on this occasion to the ‘Athens of the North’ where so many distinguished men have lived in the past, from mediaeval times onwards. (shrink)

In 1747, James Lind carried out an experiment which proved the usefulness of citrus fruit as a cure for scurvy. Nonetheless, he rejected the earlier hypothesis of Bachstrom that the absence of fresh fruit and vegetables was the only cause of the disease. I explain why it was rational for James Lind not to accept Bachstrom’s explanation. I argue that it was the urge for scientific understanding that guided Lind in his rejection and in the development of his alternative theory (...) that humidity was the primary cause of the disease. Central in this process was the search for causal mechanisms which could provide understanding of how the disease developed and which fitted in with the knowledge of the time. Given that the relevant background knowledge and statistical methods were not yet available to Lind, he was right to prefer his own explanation to that of Bachstrom. Although his explanation turned out to be wrong, and Bachstrom’s right, from a historical point of view it offered deeper causal understanding of both the development of the disease and the preventive and curative effects of fresh vegetable food. This case study illustrates how the search for causal mechanisms can not only be enlightening, but also very misleading. (shrink)

Many P4/WC practitioners and theorists privilege the school as a space for thinking and practicing philosophy for/with children. Despite its coercive nature, thinkers such as Jana Mohr Lone, David Kennedy, and Nancy Vansieleghem argue that P4C is a Trojan horse intended to reform the education system from within. I argue, however, that the Trojan horse argument requires us to internalize an incomplete and historically decontextualized understanding of public schools that in turn can reify histories of white supremacy within our CPIs (...) – a consequence that can be particularly harmful when practicing P4C with minority youth. To accurately adjudicate the value of public school classrooms for P4C – especially for those CPIs whose members are primarily Black, Latinx, Indigenous, or other youth of color — I contextualize the Trojan horse argument in the history of race and education in the United States. Through this historical analysis, I conclude that the reformist position becomes increasingly more untenable and that the material history of race and education in fact supports a pessimistic understanding of P4C in education. I end by reflecting on P4C’s need to rethink its privileging of schools as a primary site for philosophical inquiry and caution practitioners against using “social progress” as a justification for how and where they practice their craft. Instead, I encourage them to rethink how and where they practice P4C, based on the local historical and material conditions of the participants. (shrink)

This essay focuses on the structure of agency in Georg Ernst Stahl's model of organic order and the role that it plays for the difference between living and non-living beings in the discourses of medicine and natural history around 1700. Stahl calls the order of organic beings an "organism". He characterizes the "organism" through the notions of tonic movement, energy and ratio. The tonic movement is a mechanism of contraction and relaxation of organic units to direct fluids to (...) certain parts of the body; the energy represents a certain, limited potential of the living body to act spontaneously and to react if it is irritated; and the ratio expresses the logic of a processual, directed order imposed on corporeal dispositions. This ratio inheres in natural agents. However, to establish his theory of agency, Stahl first analyzes the irregular blood movements that characterize diseases. The capacity of the organic body to change these movements and to heal itself in redirecting them, leads him to the assumption that such bodies can regulate their own order and that self-regulation requires an autonomous agent. (shrink)

Although death by neurologic criteria is legally recognized throughout the United States, state laws and clinical practice vary concerning three key issues: the medical standards used to determine death by neurologic criteria, management of family objections before determination of death by neurologic criteria, and management of religious objections to declaration of death by neurologic criteria. The American Academy of Neurology and other medical stakeholder organizations involved in the determination of death by neurologic criteria have undertaken concerted action to address variation (...) in clinical practice in order to ensure the integrity of brain death determination. To complement this effort, state policymakers must revise legislation on the use of neurologic criteria to declare death. We review the legal history and current laws regarding neurologic criteria to declare death and offer proposed revisions to the Uniform Determination of Death Act and the rationale for these recommendations. (shrink)

The current financial stress in the countryside and the future of the family farm are likely to be major issues in the formulation of the 1990 Farm Bill. Medium-sized commercial family farms may be especially targeted for support. These farms are the basis of rural economies and settlement patterns in many parts of nonmetropolitan America.Two possible changes in farm policy are debt restructuring and the decoupling of farm payments from commodity production. Many medium-sized family farms continue to face substantial debt (...) problems, but most of these farms could be viable with some debt restructuring. Ccmmodity programs have become extremely expensive and encourage overproduction and the consolidation of farming resources into ever larger units. Federal farm programs may become based on need, with a sensitivity to differences in regional farming systems. Such a policy could support medium-sized family farms, slow the growth in superfarms, reduce surpluses, and reduce the overall cost of farm programs. (shrink)

In an age of rapid advances inlife-prolonging treatment, patients and caregivers areincreasingly facing tensions in making end-of-lifedecisions. An examination of the history of healthcare in the United States reveals technological,economic, and medical factors that have contributed tothe problems of terminal care and consequently to themovement of assisted suicide. The movement has itsroots in at least two fundamental perceptions andexpectations. In the age of technological medicineenergized by the profit motive, dying comes at a highprice in suffering and in personal economic (...) loss. Thefailure to provide affordable resources for terminalcare is the result of the marketplace in health care. The medical profession has been painfully slow inresponding to the challenges of terminal care, mainlybecause of the pressures of the marketplace and lackof adequate training. This has occurred at a time ofrapid advances in life-sustaining treatment and ofexpanding public awareness of personal rights underthe law. Overly aggressive treatment in the finalstages of terminal illness has enhanced anxieties overa painfully prolonged and expensive dying. Thesefactors have promoted the movement to assistedsuicide. In the U.S. debate of the issues, ethiciststend to argue abstractly without examiningadequately the context of terminal care that is thehealth care system. It is a system in dire need of areform that will remove it from the marketplace. (shrink)

The history of the Institute of Medical Ethics has been well recorded. Accounts of its origins in the London Medical Group were published in an academic paper of 2003,1 in the transcript of a Wellcome Witnesses to Twentieth Century Medicine Seminar in 20072 and in a chapter of the 2009 Cambridge World History of Medical Ethics.3 In 2013, 50 years since the inauguration of its first series of lectures and symposia, the LMG as an organisation no (...) longer exists, but its aspirations and achievements are alive and well, both in the Journal of Medical Ethics and in the IME, now exploring a new phase as a membership organisation. Other papers in this issue will discuss the history and prospects of the Journal and Institute. But the LMG, similar medical groups in all other British medical schools and the Society for the Study of Medical Ethics from which the IME derived also have a significant continuing life in the thinking and practice of many medical and healthcare professionals who participated in their activities, and then in turn on those influenced by their thinking and practice. The LMG, it could be said, is ‘no more’ an organisation ‘Now but a whole climate of opinion’.4A bottom-up evolutionThe first medical students to be involved in the LMG may not have foreseen its influence on their future careers, but many were aware of being part of something new and exciting. One of those with whom the first lecture series was planned was Margaret Lloyd . "The beginning of the LMG in 1963 was an exciting time for medical students in London. As a mature student entering St Mary's Hospital Medical School … ". (shrink)

This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as law (...) and medicine, truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (shrink)

Precision medicine is emerging as a scientific bandwagon within the contemporary biomedical sciences in the United States. PM brings together concepts and tools from genomics and bioinformatics to develop better diagnostics and therapies based on individualized information. Developing countries like China and Brazil have also begun pursuing PM projects, motivated by a desire to claim genomic sovereignty over its population. In spite of commonalities, institutional arrangements produced by the history of genomics research in China and Brazil are ushering (...) PM along different trajectories. In the Chinese case, we identify a strong state-backed push for PM combined with a dynamic network of international academic and private actors along the lines of networked technonationalism that has made large-scale, speculative PM projects possible. The Brazilian case is characterized by an institutional void at the federal level in which PM is driven by domestic academic actors in universities in the regional level, resulting in smaller scale, needs-driven PM projects. Through these cases, this paper shows how a scientific bandwagon adapts to national histories and institutions. Through this peripheral translation of the scientific bandwagon, the global infrastructure of biomedical knowledge has the potential to be transformed. (shrink)