The Pneumatist school of medicine has the distinction of being the only medical school in antiquity named for a belief in a part of a human being. Unlike the Herophileans or the Asclepiadeans, their name does not pick out the founder of the school. Unlike the Dogmatists, Empiricists, or Methodists, their name does not pick out a specific approach to medicine. Instead, the name picks out a belief: the fact that pneuma is of paramount importance, both for explaining (...) health and disease, and for determining treatments for the healthy and sick. In this paper, we re-examine what our sources say about the pneuma of the Pneumatists in order to understand what these physicians thought it was and how it shaped their views on physiology, diagnosis and treatment. (shrink)

In this article, the author explores a model of alternative medical education being pioneered at Loyola University Chicago Stritch School of Medicine. The five-year Global Health Fieldwork Fellowship track allows two students per year to complete an extra year of medical education while living and working in a free rural clinic in the jungle lowlands of Bolivia. This alternative curricular track is unique among other existing models in that it is longitudinally immersive for at least one full additional year (...) of medical education, grounded in clinical and service learning, and heavily focused upon global health and the social components of medicine. Studies have shown that both longitudinal alternative medical curricular tracks and short-term global health electives have long-term benefits upon the professional development of participants, suggesting that the GHFF is likely to do the same. The author also argues that the GHFF is an advantageous model of global health education compared to standard offerings and provides a unique curricular model by which to foster the development of social values—such as professionalism, advocacy, and social justice—that are widely considered lacking in today’s medical education. (shrink)

In many settings, and perhaps especially in low-middle income countries, training institutions do not adequately prepare their students for the ethical challenges that confront them in professional life. We conducted a survey to assess the training needs in research ethics among the faculty at the University of Zambia, School of Medicine using a structured questionnaire distributed to faculty members in January 2015. The study was approved by the University of Zambia Biomedical Research Ethics Committee. Seventy-five faculty members of various (...) ranks completed the questionnaire. It was found that 31% of the faculty had not received any research ethics training. Of those who had received training, most of them had received it through short workshops of five days or less, while only 27.7% received ethics training as a component of an academic degree and 22.2% obtained it through electronic web-based courses. While most faculty reported being well-prepared to guide their students in developing a research methods section of a research protocol, only 25.3% felt they were well-prepared to guide on ethical considerations. This study has demonstrated gaps in research ethics training among faculty members at UNZASoM. Mandatory instruction in research ethics among faculty and students is recommended. (shrink)

Medical education at the Colombian School of Medicine has undergone a reconceptualization and reorganization so as to encompasses three fundamental elements of medical practice: 1) development of general abilities and standards necessary for appropriate professional medical practice; 2) technical education which makes it possible to utilize the bases that science and technology have provided for the development and application of knowledge, and in turn, to expand this base through research and development; and 3) humanistic education to guide students into (...) ethical professional practice. (shrink)

Introduction: The high degree of religious/spiritual involvement that brings meaning and purpose to a patients’ life, especially when they are weakened by pain, is among the various reasons to consider the spiritual dimension in clinical practice. This involvement may influence medical decisions and, therefore, should be identified in the medical history of a patient.Objective: To verify the opinion of undergraduate medical students of the Paulista School of Medicine – Federal University of São Paulo regarding the use of a patient’s (...) Spirituality/Religiosity as a therapeutic resource in clinical practice.Method: Quantitative approach of the transversal analytical observational type. The sample was composed of academics’ medical program, from the first to the sixth year, regularly enrolled in 2017. Data collection was performed with a standardized questionnaire divided into three sections: sociodemographic profile; Duke University Religious Index; Spirituality/Religiosity in the clinical and academic context.Results: Participated in the survey 72% of the enrolled students, of which 61.4% had religious affiliation, 26.2% declared themselves agnostic and 12.4% atheists. All of them proposed to answer questions about the insertion of Spirituality/Religiosity in the patient care process. Through the Duke Religiosity Index, we evaluated the importance of religiosity in the student’s personal life and the pertinence of religiosity as a therapeutic insertion for medical treatment. Regarding the clinical and academic context, most participants considered relevant the proposition of didactic-pedagogical actions in medical education related to the spiritual dimension of the patient.Conclusion: We conclude, through our research, that the insertion of the Spirituality/Religiosity of the patient as a therapeutic resource in clinical practice is feasible for most undergraduate students in Medicine of the Escola Paulista de Medicina – Universidade Federal de São Paulo. The result of the research, although it shows only the opinion of medical students at a Brazilian university, indicates that Spirituality/Religiosity is already part of the contemporary medical universe. (shrink)

Introduction: We live in a society that encourages self-medication and one reason is the availability of drugs that do not require a prescription and are easily accessible, the abuse of these have important implications for the health of the general population; being the most commonly used drugs: analgesics, antibiotics, antihistamines and others. Objective: Determine the causes that induce self-medication in freshmen and fifth year of the Faculty of Medicine of the Universidad Mayor, Real y Pontificia de San Francisco Xavier (...) de Chuquisaca - Bolivia, 2012. Methodology: Quantitative and descriptive cross-sectional approach. A sample of 284 students which they apply structural survey was obtained. Results.A high percentage of students who are self-medicating themselves without.medical.supervision. Conclusions: We can say that self-medication on freshmen and fifth year of medical school at the University Of San Francisco Xavier De Chuquisaca is induced by influence of social circle (friends and parents), advertising of certain medications, access to internet and lack of time. (shrink)

The author argues that ancient Skepticism may be most suited to deal with two crises in the Age of COVID-19: both the physical or epidemiological aspects of the pandemic, and the epistemological and ethical crisis of increasing disbelief in the sciences. Following Michel Bitbol, I suggest one way to mitigate this crisis of faith may be for science to become more epistemically modest, renouncing some of its claims to describe reality as it objectively is, and adopting an “intransitive” rather than (...) a “transitive” approach to Nature. This was the attitude adopted by the Greco-Roman medical school of the Empirics, which may also be of assistance in combatting the urgent problem of Fake News. The epistemology of Skepticism and the scientific methodology of the closely related Medical Empiricism shows that an epistemically modest, non-interventionist approach to science is quite compatible with a robust and sophisticated proto-experimental scientific methodology. (shrink)

This study explores ethnic variations in animal companion attachment among 133 students enrolled in a school of veterinary medicine. The 57 White and 76 African American participants completed surveys that included background information, several questions about their animal companions, and a pet attachment questionnaire .White students had significantly higher PAQ scores than did African American students . White students also had significantly more pets and more kinds of pets and were more likely to allow pets to sleep on their (...) beds . Although keeping pets is a universal cultural phenomenon, how that attachment is expressed may vary from culture-to-culture. This study explores possible explanations and implications for these variations. (shrink)

The development of the philosophy of medicine in the Federal Republic of Germany since 1945 is presented in a thematic form. The first two decades were characterized by the evolution of an anthropological school of thought that aimed at relating physician and patient in a more personal and existential form than had hitherto been the case. In the last years, this tendency to demand deeper psychic and broader social involvement with medical problems had increased. Somatic disorders were considered to (...) be fundamentally caused by socially induced mental stress. After a brief period during which the theme of organisms in general and phenomenologically grasped living-body of human beings in particular were discussed, there followed since the mid-seventies an essential preoccupation with the methodology and epistemology of medicine. According to this trend, medicine is to be analyzed in terms of the theory of action, with its conceptual and strategic orientation towards practice and not, as generally believed, towards the standards of scientific truth. The concepts of disease, diagnosis and therapy are therefore relative and their validity is dependent on time, persons and circumstances involved. Thus, the highest criteria of utility for medical actions cannot but be the affected patient and society. (shrink)

Edmund D. Pellegrino has played a central role in shaping the fields of bioethics and the philosophy of medicine. His writings encompass original explorations of the healing relationship, the need to place humanism in the medical curriculum, the nature of the patient’s good, and the importance of a virtue-based normative ethics for health care. In this anthology, H. Tristram Engelhardt, Jr., and Fabrice Jotterand have created a rich presentation of Pellegrino’s thought and its development. Pellegrino’s work has been dedicated (...) to showing that bioethics must be understood in the context of medical humanities, and that medical humanities, in turn, must be understood in the context of the philosophy of medicine. Arguing that bioethics should not be restricted to topics such as abortion, third-party-assisted reproduction, physician-assisted suicide, or cloning, Pellegrino has instead stressed that such issues are shaped by foundational views regarding the nature of the physician-patient relationship and the goals of medicine, which are the proper focus of the philosophy of medicine. This volume includes a preface by Dr. Pellegrino and a comprehensive Introduction by the editors. Of interest to medical ethicists as well as students, scholars, and physicians, _The Philosophy of Medicine Reborn_ offers fascinating insights into the emergence of a field and the work of one of its pioneers. “After a long period of dormancy, philosophy of medicine has blossomed with new life. The single most important physician-philosopher in that rebirth has been Edmund Pellegrino. His contributions to virtue theory, the concept of beneficence, the dispute over the internal and external sources of a morality for medicine, and the role of the Hippocratic tradition are all critical. The essays collected in this volume have changed the history of the philosophy of medicine. He shows that philosophy of medicine can be done with both passion and compassion.” —_Robert M. Veatch, Kennedy Institute of Ethics, Georgetown University_ “Edmund Pellegrino's words have helped medical students, faculty, scholars and patients address the challenges they encounter in medicine and medical practice. His personal support has also been critical for many of us in developing programs in medical ethics and philosophy of medicine in our universities. Dr. Pellegrino combines the wisdom of a great physician with those of a great philosopher to produce a body of writing that will continue to inspire us all. This volume contains some of his best and most influential work.” —_Loretta Kopelman, The Brody School of Medicine, East Carolina University_ _ _ “Edmund Pellegrino has been a leading light in the philosophy of medicine for a generation. He was instrumental in the birth of bioethics, founded one of the leading journals, and provided able leadership in organizing early activities of the profession. He has served as department chairman, dean, and university president. Most recently, he chairs the President’s Council on Bioethics. In all this, first and foremost, he has been a physician. Those who are ill and suffering make a claim upon him. To respond to this claim, Pellegrino creatively brings together the worlds of science and of the humanities. For him, that is what medicine is about, making it the most scientific of the humanities and the most humane of the sciences. Fortunately for us, Pellegrino brings these worlds together in thought, as well as in practice. In this selection from his writings, Engelhardt and Jotterand have captured the heart of Pellegrino’s project, both in depth and breadth, so we can also hear that claim of the ill and so we can see what worlds must come together if we are to respond in the appropriate way.” —_George Khushf, University of South Carolina_ “Pellegrino’s work is both a treasure and important for understanding bioethics. His work in philosophy of medicine addresses the crucial questions that are so important to understanding the practice of medicine and the ethics of health care.” —_Kevin Wildes, President, Loyola University_ _ _. (shrink)

The best things in my Ufe have come to me by accident and this book results from one such accident: my having the opportunity, out of the blue, to go to work as H. Tristram Engelhardt, Jr. 's, research assistant at the Institute for the Medical Humanities in the University of Texas Medi cal Branch at Galveston, Texas, in 1974, on the recommendation of our teacher at the University of Texas at Austin, Irwin C. Lieb. During that summer Tris "lent" (...) me to Chester Bums, who has done important schol arly work over the years on the history of medical ethics. I was just finding out what bioethics was and Chester sent me to the rare book room of the Medical Branch Library to do some work on something called "medical deontology. " I discovered that this new field of bioethics had a history. This string of accidents continued, in 1975, when Warren Reich (who in 1979 made the excellent decisions to hire me to the faculty in bioethics at the Georgetown University School of Medicine and to persuade Andre Hellegers to appoint me to the Kennedy Institute of Ethics) took Tris Engelhardt's word for it that I could write on the history of modem medical ethics for Warren's major new project, the Encyclopedia of Bioethics. Warren then asked me to write on eighteenth-century British medical ethics. (shrink)

Introduction Illegal practice of medicine by medical students is a worldwide problem. In Brazil, information about this issue is scarce.Objective To describe the perception of illegal practice of medicine by medical students.Methods A cross-sectional study in a stratified random sample of 130 medical students in the 6th to 12th semesters from a private faculty of medicine in Salvador, State of Bahia, Brazil, from September to October 2011. Students responded to a standardised questionnaire about the illegal practice of (...) medicine by medical students.Results Knowing medical students who practised medical activities without supervision was reported by 86% of the respondents, and 93.8% had heard about someone who performed such practices. Medical specialties most often associated with illegal practice were general medicine and occupational health . Illegal practice of medicine was more common in peripheral cities/towns than in the State capital, Salvador City . Only 10.5% of illegal activities were reported to the authorities. Unsupervised medical practice was more often reported in the 8th–9th semester and 10th–11th semester of medical school.Conclusions Illegal practice of medicine was commonly reported by the medical students questioned. The high frequency of reported illegal practice for financial reasons highlights the need for greater availability of paid internships for medical students. Educational institutions represent the social control responsible for supervising the activities of academics. (shrink)

The author argues that ancient Skepticism may be most suited to deal with two crises in the Age of COVID-19: both the physical or epidemiological aspects of the pandemic, and the epistemological and ethical crisis of increasing disbelief in the sciences. Following Michel Bitbol, I suggest one way to mitigate this crisis of faith may be for science to become more epistemically modest, renouncing some of its claims to describe reality as it objectively is, and adopting an “intransitive” rather than (...) a “transitive” approach to Nature. This was the attitude adopted by the Greco-Roman medical school of the Empirics, which may also be of assistance in combatting the urgent problem of Fake News. The epistemology of Skepticism and the scientific methodology of the closely related Medical Empiricism shows that an epistemically modest, non-interventionist approach to science is quite compatible with a robust and sophisticated proto-experimental scientific methodology. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Intersection of Medicine and ReligionJohn C. DormoisThe practice of medicine offers a host of rewards to the practitioner. Besides the obvious intellectual satisfaction of solving a difficult diagnostic problem or the ability to make a comfortable living, I have found the greatest personal sense of moral gratification when helping [End Page 196] families negotiate the most challenging event in life: making decisions at end of life. (...) Whether the condition was a ruptured intracranial aneurysm with brain death or a patient with far advanced cancer struggling with the choice between experimental chemotherapy or choosing comfort therapy at home surrounded by family for the remaining days of life, the moral courage required to provide the best guidance was considerable. In my early years of practice I didn’t call my actions in these situations “courageous” nor were there moral “guidelines” providing a blueprint. I knew I responded with empathy and compassion and that this ability had a lot to do with being raised in a religious or spiritual home. At the same time, I suspected that some of the lack of empathy and compassion I witnessed in some of my colleagues was related to the very training programs of physicians. This essay traces the origin of my moral and ethical concerns about medical education and my intention to reinvigorate the spiritual or existential voice in medicine.An early life experience had a great deal to do with shaping my moral development. At age seven my family traveled through the West Indies. My father’s amateur radio hobby meant that at every stop we would be greeted by one of his radio contacts. One stop in particular was life changing.Port au Prince, Haiti was an unknown place to this seven year–old, but to say it was a culture shock to a boy from Kansas would be an understatement of epic proportions. It was during this visit that I experienced true poverty in its most blatant form. In downtown Port au Prince I saw limbless beggars and the deformed from polio and malnutrition. But it was the sight of the garbage dump near the center of town that changed my world forever. There, among piles of detritus, I saw children and families making their home in the dump. They had hollowed out a sort of cavern in the piles of trash that served as a place of refuge from both the rain and the sun.This experience in many ways has served as a framework and background for my life. Although seen through the eyes of a seven year–old, the picture can only be adequately understood within the context of being raised by religiously faithful parents, parents free of hypocrisy whose lives personified the best in Christian virtues and practices. These early experiences planted the seeds that would only fully blossom some 60 years later.Medical school was a demanding but exhilarating experience. Each day was a day of discovery … anatomy, physiology, pathology … all subjects opening up a whole new world to explore. Internal medicine suited me best since it was the specialty that most closely integrated all the basic sciences necessary to arrive at a diagnosis. I loved the elegance of endocrinology in particular where a given hormone mediator could cause widely different effects if present in excess or completely absent. But I was in the end drawn to cardiology since it combined complex physiology with my avocation, the love of running.There was, however, a disturbing aspect of medicine education that I observed affecting many of my classmates. Although I can vividly recall the enthusiasm that all of us shared as we donned our white coats for the first time and envisioned a future of caring for our patients, things gradually and insidiously changed over the next four years. The altruism and empathy that was so evident in the early years gradually lessened as graduation approached. I could not help being struck by this change and wondered at the time why that should happen. I had no insight then that what I had observed was a well recognized consequence of the medical school experience. I’m sure that the passage from professional training to practice in... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Institute of MedicineRuth Ellen Bulger (bio)IN 1863 the National Academy of Sciences (NAS) was established by federal charter to advise the government on scientific matters. Almost 100 years later, in 1971, the Academy created the Institute of Medicine within the NAS to focus on health-related problems and issues. Today the IOM has a program budget of about $13 million, which includes both private and government funds, and (...) is regarded as a leading center for health policy research.After briefly explaining the structure and general goals of IOM, this article describes several new or anticipated projects as well as some recently completed reports that have a strong ethical component.The IOMThe IOM's distinguished membership is made up of health care professionals of all sorts, scientists working in health-related disciplines, and lawyers, economists, and others knowledgeable in and involved with policies and activities associated with health issues. It is organized around eight working groups or divisions: Health Sciences Policy; Health Care Services; Health Promotion and Disease Prevention, including AIDS activities; International Health; Biobehavioral Sciences and Mental Disorders; the Food and Nutrition Board; the Medical Follow-up Agency; and the Health Policy Fellowship Programs. Each of these divisions is assisted by an oversight board that provides advice on its activities.It is important to know at the outset that IOM has decided that each of the divisions will include consideration of human values and ethical issues in their activities. Therefore, no separate locus was established within the IOM to deal with these matters. I am director of the Division of Health Sciences Policy, which is the only division that has made ethics a priority in its work, and it is the focus of this article.We have addressed questions of ethics, human values, social values, decision making, and priority setting in many of the division's reports. In fact, most of our reports at least raise ethical questions. In addition, a portion of the interest from endowment funds given to IOM by the Howard Hughes Medical Institute has been devoted to work in this area. [End Page 73]The division's advisory board, headed by Claude Bennett, chairman of the Department of Medicine, University of Alabama at Birmingham School of Medicine, has decided on two major priorities for the division: (1) foster an environment conducive to productive research, and (2) anticipate the impact of scientific—especially biomedical—advances on society, monitoring and considering the social and ethical factors that accompany basic scientific and technological progress. These two priorities are interdependent because the fostering of a good environment for research presupposes that the results of this research will produce beneficial effects for the society that supports the research.Upcoming StudiesSociety has been unable to establish a mechanism for discussing in a meaningful way—and possibly resolving—a number of pressing national issues with social, ethical, legal, and scientific ramifications. The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research considered several such issues and produced important reports about them. However, the commission was funded only until 1983. The Congressional Biomedical Ethics Advisory Committee was authorized in 1985 to address these contentious issues, but it was caught in the crossfire of congressional abortion politics and subsequently died. A new model is needed to attempt to develop national consensus on these complex, contentious issues.The Board on Health Sciences Policy has wrestled with this idea. Recently, it approved a proposal to establish a study committee charged with developing effective alternative methodologies for anticipating and addressing the social, legal, and ethical issues that may accompany rapid advances in biomedical science and technology. This multidisciplinary committee will be given a series of tasks: (1) to explore past experiences with some of these varying methodologies (i.e., town meetings, consensus conferences, forums, commissions, etc.); (2) to develop an agenda of issues likely to arise in the future; (3) to define and test a variety of alternative methodological approaches to these questions; (4) to evaluate strengths, weaknesses, and impact of the various approaches; and (5) to make recommendations on the process and structure by which this fact-finding, analytical, and decision-making function could be... (shrink)

Summary This paper discusses the emergence of new medical experimental specialties at the Medical School of Surgery (Escola Médico-Cirúrgica) and the Faculty of Medicine of Lisbon University (Faculdade de Medicina da Universidade de Lisboa) between 1897 and 1946, as a result of the activities of Marck Athias's (1875?1946) histophysiology research school. In 1897, Marck Athias, a Portuguese physician who had graduated from the Faculty of Medicine in Paris, founded a research school in Lisbon along the lines of Michael (...) Foster's physiology research school in England and Franz Hofmeister's physiological chemistry school in Germany. His research programme was highly innovative in Portugal. Not only did it bring together many disciples and co-workers, but it branched out and created new medical specialties within Portuguese medical science. These new disciplinary areas grew out of the study of the histology of the nervous system but eventually expanded into normal and pathological histophysiology, physiological chemistry and experimental endocrinology. The esprit de corps that existed between research school members ensured the school's success and influence in various fields social and political as well as scientific. Athias's school was strongly influenced by positivist ideals and promoted a teaching and research style that sought inspiration in Humboldt's university model, thus helping to bring about a change in the dominant scientific ethos and to modernize scientific research in Portugal during the first half of the twentieth century. (shrink)

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)

In December of 1899, Sir John Scott Burdon-Sanderson delivered an address to the Middlesex Hospital Medical Society in London on the relation between science and medicine. Commenting specifically on the future of medicine in the upcoming century, he criticized the gap between scientific research in academic settings and the practice of medicine in the clinical setting. He ends by stating that “all depends on whether you accept the proposition I have submitted to you—namely, that the science of (...) medicine, even more than the art, holds the promise of the future” (Burdon-Sanderson 1900, 255). Burdon-Sanderson’s proposition was actualized in the United States through the Flexner Report of 1910, which helped to universalize what medical education would come to look like in the country: the emphasis was placed squarely on science, rather than art (Flexner 1910). While there are still gaps between clinical practice and scientific research, there is no doubt that modern medicine is scientific medicine. There is also no doubt that scientific medicine leads to better health outcomes (Duffin 2010).However, some have argued that the emphasis of medicine as a science has left the art of medicine behind, to the detriment of modern medicine. Thomas Duffy, for instance, an internist at the Yale School of Medicine, states that the aftermath of the Flexner Report “created an excellence in science that was not balanced by a comparable excellence in clinical caring” (2011,276). Indeed, at the onset of our current century, many called for a reinvestment in the art of medicine so as to balance the emphasis on science (The Commonwealth Fund 2002; Committee on the Roles of Academic Health Centers in the 21 st Century 2003; Association of American Medical Colleges 2004). The burgeoning field of medical humanities—that is, the interdisciplinary field dedicated to demonstrating “how the arts and humanities inform and 2elevate the work of healing” (Campo 2005)—is evidence that such calls have been heard. While we surely want to celebrate scientific medicine, there are certain areas of medical practice where the art of medicine is as important, if not more important , as the science of medicine. We argue that one of those areas is the sphere of cancer care in which health professionals are asked not only to treat patients with cancer, but also to help them navigate through what is oftentimes one of the scariest, most vulnerable, and suffering-ridden times of their lives. Using concepts from the phenomenological tradition, we aim to provide philosophical clarity to situations in the medical setting in which health professionals must treat the whole person, rather than simply the person’s body, in order to provide proper patient care, thus highlighting an element of the art of medicine. We end by providing three principles that we think can help guide phenomenologically-informed cancer care. (shrink)

Herophilus, a contemporary of Euclid, practiced medicine in Alexandria in the third century B.C., and seems to have been the first Western scientist to dissect the human body. He made especially impressive contributions to many branches of anatomy and also developed influential views on many other aspects of medicine. Von Staden assembles the fragmentary evidence concerning one of the more important scientists of ancient Greece. Part 1 of the book presents the Greek and Latin texts accompanied by English (...) translation and interpretative commentary. Significant background information is given in the introductory essay preceding each chapter. Part 2 briefly sketches the major developments within the Herophilean school after Herophilus, and discusses the individual members within it. Anyone interested in the history of science, the history of medicine, or intellectual history will find this book a rich source of information about an unusual and important aspect of Greek culture. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Philosophy of George Engel and the Philosophy of MedicineJeffrey P. Spike (bio)KeywordsGeorge Engel, psychosocial medicine, medical education, medical humanities, interviewing skills, philosophy of medicine, scientific methodDoctor Brad Lewis has encouraged us to consider George Engel’s philosophy with his excellent essay on Engel and Pragmatism. As a philosopher teaching full time in a medical school, it is refreshing to have an opportunity to analyze the work of (...) two physicians at this level of reflection and abstraction. It is even more of a pleasure because I knew Dr. Engel personally while I was teaching at the University of Rochester School of Medicine. I will make some observations of the philosophy behind Dr. Engel’s work, both published and practical, that is, as reflected in his writing but also in his influence in the medical curriculum at the institution that he called home for some thirty years (as seems appropriate when considering someone’s bona fides as a pragmatist).Engel’s Philosophy and Medicine’s PhilosophyGeorge Engel’s primary philosophical concern was to fight the powerful belief (or perhaps delusion) that medicine was evolving into a pure physical science, an extension of biochemistry and cell biology, or as we would now call them, proteomics and genomics. There is little evidence that he espoused any one methodology for basic science, so much as he opposed any one methodology for medicine. So to say he was a pragmatist seems underdetermined by his words, if that is taken to mean he advocated for changing the methodological model for scientific research. Rather the question is whether his preferred medical methodology is best characterized as pragmatic, or by some other description. On that score I agree with Lewis wholeheartedly.Of course, it might be that the claim of pragmatism is not meant to suggest a change in method for basic science, but to advocate for retaining an appreciation for the whole range of approaches to knowledge, from experimental science to epidemiology, and from epidemiology to acculturation. By that definition of pragmatism, Engel was indeed a pragmatist. Interpreted this way, he wanted medicine to stop worshipping the scientific method and appreciate that there are many paths to knowledge besides through the wet lab.It might be said that there are different scientific methods for different sciences, and Engel wanted us to appreciate that the reductionist methods [End Page 315] appropriate to the sciences of the small are not necessarily methods that can be applied to all sizes of objects we study, or all levels of reality (like the psychological and social). This is the truth about the world, although I am not sure that this is what Engel meant. As Lewis notes, Engel’s writing does sometimes sound as if he worshipped at the alter of science, as if all subjects of importance can be studied scientifically. But if he believed that, he was not correct. It might be, if all the subjects of the university that Lewis mentions are important, that some will turn out to be able to be studied in academically rigorous methods that are not scientific in any of the usual meanings of the word. Consider philosophy itself, for example.To the degree that it may stretch the evidence to say that Engel would have advocated for a pragmatic scientific method, it is still the case that pragmatism as outlined by Lewis and Engel’s biopsychosocial model can both be used to help medicine understand itself and overcome the temptation to idolize science. Medicine is not a science, or at least it is not just a science; in fact, I would suggest that it never was a science, and it will never be a science. Medicine is about health and illness, and uses whatever science it can to promote health and to treat (ameliorate or cure) illness.None of this should necessarily lead us to idolize pragmatism either. If each subject has its own ideal methodology for study, then it may be that pragmatism is the preferred method for, say, clinical judgment, whereas the scientific method is the best for the ‘hard’ sciences, and logic for philosophy. Or perhaps pragmatism and inductive logic are competing models for clinical... (shrink)

This paper is a criticalexamination of the development of thephilosophy of medicine as a discipline. Ithighlights two major themes in the contemporarydebate about the philosophy of medicine: thescope of the discipline and the relation of thediscipline to its cognate disciplines. A broadview of the philosophy of medicine is defendedand the philosophy of medicine is seen as aphilosophical sub-discipline. These viewsdepend in important ways on three factors: ageneral metaphysical world view, particularunderstandings of the cognate disciplines, andthe perspective (...) from which one asks thequestions about the nature of the discipline. It is proposed that the future of thephilosophy of medicine may follow thephilosophy of science in that philosophical,sociological and historical studies may combinein a mutually enriching way to form ‘‘medicinestudies.’‘. (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)