En este texto se presenta un espacio de intercambio de conocimientos desde una perspectiva científica, técnica y jurídica, para contribuir a la protección de los recursos naturales. Debido a la importancia de establecer mecanismos para proteger la biodiversidad y posibilitar la preservación de los conocimientos asociados especialmente al uso de la flora medicinal, la Línea de Investigación en Política y Legislación, del Grupo de Estudios en Sistemas Tradicionales de Salud de la Facultad de Medicina, y la Línea de (...) Derecho Ambiental y Grupos Étnicos, del Grupo de Derechos Humanos de Jurisprudencia de la Universidad del Rosario, desarrollaron este libro a través del cual la Universidad se propone profundizar en el panorama actual de la reglamentación y política –Internacional, nacional y local—respecto a la flora medicinal y al patrimonio cultural inmaterial asociado a ésta. (shrink)

Despite centuries of colonization in the Philippines, the traditional Filipino healing system has survived. However, as modern education has continued to spread and Western medicine has grown in influence, traditional healing practices have been pushed to the margins and labeled as unscientific or mere superstition. This also suggests that unrecorded information may be lost forever. For future generations to appreciate this rich cultural heritage, cultural mapping of traditional healers in a local community is necessary. Thus, the researcher explored, identified, documented, (...) and analyzed the cultural profile of the traditional healers in a local community. Specifically, he studied the (1) background information, (2) description of the intangible cultural heritage, (3) stories/narratives associated with traditional healing, (4) significance of the practice, (5) assessment of the practice, and (6) references/supporting documentation of the traditional healers. The study was conducted in one of the local communities in the province of Quezon. The research participants were selected using inclusion criteria, and 11 traditional healers served as the key informants of the study. This study also employed qualitative research through cultural mapping, and pertinent data were obtained using participant observation, documentation, and interview guides. Qualitative content analysis was used in analyzing the gathered data. The findings revealed that the traditional healers have diverse background information, reflected in the element types, the geographical location and range of the element, and the related domains of the intangible cultural heritage. Likewise, the description of the intangible cultural heritage gave a wide array of descriptions of the history of practice, occasion/season, processes, and procedures involved, beliefs associated, settings, aims, social functions, and cultural meaning, culture bearer/s and practitioner/s of the element, mode of transmission, list of significant tangible movable heritage used associated with the element and list of significant flora/fauna used associated with the element. Meanwhile, spiritual guides and supernatural claims, healing severe cases, and being accused of malpractice or maltreatment were some of the stories/narratives associated with the element. In addition, traditional healing has historical, aesthetic, scientific, social, socio-economic, socio-political, and spiritual significance. Moreover, the assessment of practice exposed the condition/status of traditional healing, which is in danger because of the elderliness of the traditional healers and because no one is accepting the knowledge and practices. Furthermore, the constraint, threat, issue, or challenge experienced by the traditional healers is making false accusations against them. Nevertheless, traditional healers have identified several safeguarding measures in their traditional healing practice. These are transmission through informal education, identification, documentation, research, promotion, enhancement, and revitalization. Finally, sacred texts, books, pictures, prayers, and saints are the references or supporting documentation used in traditional healing. Based on the findings and conclusions, it is recommended to utilize the two research outputs: “Kaalaman at Kasanayan: Cultural Profile of Traditional Healers,” a booklet, and “Tanging Healing,” a documentary film about traditional healing for the preservation of local heritage, community development, and heritage education. (shrink)

RESUMO A alimentação é o fator que mais onera um sistema de produção animal. Assim, a utilização de diferentes estratégias de alimentação dos animais ainda é o grande desafio da nutrição animal, principalmente, levando em consideração as exigências nutricionais de diferentes categorias de ruminantes, em especial bovinos em regiões tropicais, haja vista que a sazonalidade na produção de forragens afeta diretamente a produção bovina, promovendo inadequação no atendimento das exigências nutricionais dos animais principalmente em minerais e vitaminas. Uma alimentação que (...) não atenda as exigências nutricionais dos ruminantes gera prejuízos no sistema de produção, além de, em casos mais graves, ocasionar a perda do animal. Estudos que abordam o efeito e a importância de vitaminas e minerais na nutrição bovina são escassos e necessários. Recentemente a National Research Council (NRC) apresentou novos registros das exigências nutricionais das vitaminas e minerais. Essas alterações proporcionam um impacto econômico significativo em relação à nutrição animal. Nesse sentido, objetivou-se com esta revisão trazer informações acerca de vitaminas e minerais na nutrição de bovinos em pastejo. -/- Palavras-chave: Alimentação animal; forragem; pastagem; requerimentos nutricionais; ruminantes; vitaminas lipossolúveis (Source: AGROVOC). -/- ABSTRACT Animal feed is the factor that most burdens a production system. Thus, the use of different animal feeding strategies is still the great challenge of animal nutrition, taking into account the nutritional requirements of different categories of ruminants, especially cattle in tropical regions, given that seasonality in forage production directly affects cattle production, promoting inadequacy in meeting the nutritional requirements of animals, mainly in minerals and vitamins. A diet that does not meet the nutritional requirements of ruminants generates losses in the production system, in addition to, in more serious cases, causing the loss of the animal. Studies that address the effect and importance of vitamins and minerals in bovine nutrition are scarce and necessary. Recently the National Research Council (NRC) presented new records of the nutritional requirements of vitamins and minerals. These changes provide a significant economic impact on animal nutrition. In this sense, the objective of this review was to bring information about vitamins and minerals in the nutrition of grazing cattle. -/- Keywords: Animal feeding; fat soluble vitamins; forage; nutritional requirements; pasture feeding; ruminants (Source: AGROVOC). -/- REFERÊNCIAS BIBLIOGRÁFICAS -/- 1. Cavalcanti CPL, Silva e Macedo TJ, Gois GC, Menezes VG, Monte APO, Silva AD, Silva DJM, Silva EO, Araújo GGL, Rodrigues RTS, Wischral A, Matos MHT, Queiroz MAA. Licuri oil improves feedlot performance and modifies ruminal fauna of Santa Inês ewes. Liv Sci. 2022; 265:e105093. 2. Busato KC, Chizzotti ML, Rodrigues RTS, Silva TS, Silva IF, Queiroz MAA, Silva KT, Borges JC, Gois GC. Ingestive behavior and growth performance of boer crossbred and indigenous goat kids under different feeding levels in Semiarid Region in Brazil. Trop Agric Res. 2022; 33:299-309. 3. Patton J, Dineen M, Keady TWJ, McGee M, Waters S. Developments in nutrition for pasture-based cattle and sheep systems in Ireland. Irish J Agric Food Res. 2022; 61(1):12-37. 4. McAllister TA, Stanford K, Chaves AV, Evans PR, Figueiredo, EES, Ribeiro G. Nutrition, feeding and management of beef cattle in intensive and extensive production systems. Chapter 5. In: Bazer FW, Lamb GC, Wu G, editors. Animal Agriculture. Sustainability, Challenges and Innovations. 1st ed. Elsevier Inc.: Academic Press; 2020. 5. Byrne L, Murphy RA. 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Paul SH, Usman AA, Gana IN, Manase A, Adeniyi OD, Olutoye MA. Comparative study of mineral and nutritional composition of a multifunctional flora composite formulated from seven medicinal plants and their applications to human health. Eng Techn Open Access J. 2018; 1:137-150. 30. Zhou J, Zhang J, Xue B, Yue S, Yang C, Xue B. Effects of premating calcium and phosphorus supplementation on reproduction efficiency of grazing yak heifers. Anim. 2021; 11:1-9. 31. Harder H, Khol-Parisini A, Metzler-Zebeli BU, Klevenhusen F, Zebeli Q. Treatment of grain with organic acids at 2 different dietary phosphorus levels modulates ruminal microbial community structure and fermentation patterns in vitro. J Dairy Sci. 2015; 98:8107–8120. 32. Jain RK, Mudgal V. Phosphorus deficiency influences rumen microbial activity: Review. Int J Zoo Anim Biol. 2021; 4:1-9. 33. Barreto JC, Branco AF, Santos GT, Magalhães VJA, Coneglian SMC, Teixeira S. Avaliação dos efeitos de fontes de fósforo na dieta sobre parâmetros do meio ruminal e eficiência de síntese microbiana, digestibilidade dos nutrientes e fósforo plasmático em bovinos. Rev Bras Zootec. 2009; 38:760-769. 34. Yamada S, Inaba M. Potassium metabolism and management in patients with CKD. Nutr. 2021; 13:1-19. 35. Martinsen TC, Fossmark R, Waldum HL. The phylogeny and biological function of gastric juice—Microbiological consequences of removing gastric acid. Int J Mol Sci. 2019; 20:1-22. 36. González FHD, Silva SC. Minerais e vitaminas no metabolismo animal. 1st ed. Porto Alegre: Universidade Federal do Rio Grande do Sul; 2019. 37. Melo RR, Gonçalves SLS, Baccarin FJB, Vasconcelos WA, Miranda SC. Influência de altas dosagens de cloreto de potássio no desenvolvimento de espécies em cultivo hidropônico. Pubvet. 2020; 14:1-9. 38. Araújo WAG, Rostagno HS, Albino LFT, Carvalho TA, Ribeiro Neto AC. Potássio na nutrição animal. Rev Eletr Nutr. 2010; 7:1280-1291. 39. NRC. National Research Council. Nutrient requeriments of dairy cattle. 8th ed. Washinton, DC.: The National Academy Press; 2021. 40. Palomares RA. Trace Minerals Supplementation with Great Impact on Beef Cattle Immunity and Health. Anim. 2022; 12:e2839. 41. Tariq M, Abbas G, Ahmad S, Mustafa R, Sultan H, Abdullah M, Hussain I, Arshad M, Cheema UB, Hassan SU. Effect of supplementation of minerals on the productive and reproductive performance of lactating cattle and buffalo. Pakistan J Sci. 2022; 74:e425. 42. Pagno KCA Barbosa JD, Salvarani FM, Bomjardim HA, Faial KCF, Souza RS, Gava A, Perotta JH, Barros Filho IR. Micromineral concentrations (copper, cobalt, iron, molybdenum and zinc) in the liver of dairy cows from Campos Gerais Region, Paraná state, Brazil. Pesq Vet Bras. 2023; 43:e07137. 43. Jeong H, Vacanti NM. Systemic vitamin intake impacting tissue proteomes. Nut Met. 2020; 17:1-16. 44. Spears JW, Weiss WP. Invited Review: Mineral and vitamin nutrition in ruminants. Appl Anim Sci. 2014; 30:180-191. 45. Erickson PS, Kalscheur KF. Nutrition and feeding of dairy cattle. Chapter 9. (pp. 157-180). In: Bazer FW, Lamb GC, Wu G, editors. Animal Agriculture. Sustainability, Challenges and Innovations. 1st ed. Elsevier Inc.: Academic Press; 2020. 46. Kareem MM, Jabir MS. Vitamins. Chapter 3. In: Imran M, Imran A, editors. Malnutrition. 1st ed. London, UK.: IntechOpen; 2020. 47. Akram M, Munir N, Daniyal M, Egbuna C, Găman MA, Onyekere PF, et al. Vitamins and minerals: Types, sources and their functions. Chapter 9. (pp 149–172). In: Egbuna C, Tupas GD, editors. Functional foods and nutraceuticals. Switzerland, AG.: Springer, Cham; 2020. 48. Marino CT, Medeiros SR. Minerais e vitaminas na nutrição de bovinos de corte. Chapter 6. (pp. 79-93). In. Medeiros SR, Gomes RC, Bungenstab DJ, editors. Nutrição de bovinos de corte: fundamentos e aplicações. Brasília, DF: Embrapa; 2015. 49. Hodnik JJ, Ježek J, Starič J. A review of vitamin D and its importance to the health of dairy cattle. J Dairy Res. 2020; 87:84–87. 50. Alves EM, Pedreira MS, Santana CA, Silva FF. Nutrição vitamínica de vacas leiteiras. Pubvet. 2008; 2:1-17. 51. Jiang Q, Lin L, Xie F, Jin W, Zhu W, Wang M, et al. Metagenomic insights into the microbe-mediated B and K2 vitamin biosynthesis in the gastrointestinal microbiome of ruminants. Microb. 2022; 10:1-16. 52. Magan JB, O’Callaghan TF, Zheng J, Zhang L, Mandal R, Hennessy D, et al. Effect of diet on the vitamin B profile of bovine milk-based protein ingredients. Foods. 2020; 9:1-17. 53. Pinedo LA, Berenchtein B, Selem ASMA. Estudo dos processos bioquímicos da fermentação, degradação e absorção de nutrientes dos alimentos em ruminantes. Pubvet. 2008; 2:1-10. 54. DA SILVA, Emanuel Isaque Cordeiro. Formulação e Avaliação de Suplemento Mineral Para Caprinos. Instrução Técnica Para o Produtor Rural de Pernambuco, v. 3, n. 1, p. 1-4, 2023. 55. DA SILVA, Emanuel Isaque Cordeiro. Nutrição Sobre a Reprodução e Fertilidade dos Bovinos. Emanuel Isaque Cordeiro da Silva, 2021. 56. DA SILVA, Emanuel Isaque Cordeiro. Suplementação e formulação de sal mineral e mistura múltipla para bovinos. Revista Universitária Brasileira, v. 2, n. 1, 2024. (shrink)

Catch up on the status of the more than 135 vaccines in development against the SARS-CoV-2 virus, ponder the biology and physics of free will and learn how scientists helped win the battle over evolution in US classrooms.

The study area was a small lowland river valley within a range of 4750 m length and approx. 150 m width (about 62 ha), situated in the south-east of Poland, in the middle of Sandomierz Basin (Fig. 1). Flora and the chosen most valuable plant communities of the river bed with adjacent ecotone zone were investigated in 2007. During the study 291 species of vascular plants were found. Among them 10 are protected: Batrachium peltatum, Convallaria majalis, Dactylorhiza majalis, Daphne (...) mezereum, Frangula alnus, Hedera helix, Lycopodium annotium, Nuphar lutea, Utricularia vulgaris, and Viburnum opulus. Other species were considered to be value-raising, e.g. Achillea ptarmica, Batrachium circinatum, Calla palustris, Crepis paludosa, Hottonia palustris, Hypochoeris glabra, Senecio ovatus or Valeriana dioica. The number of antropophytes with the amount of 10% is relatively low. Most valuable plant communities represent 3 types of Nature 2000 habitats: natural eutrophic lakes with Magnopotamion or Hydrocharition – code 3150, transition and quaking bogs – code 7140-1, and alluvial forests with Alnus glutinosa and Fraxinus excelsior – code 91E0-3. Human activities brought about the emergence of 3 different areas within the valley: channeled river site (K), natural river bed site (N) and agricultural field site (P). Those areas differ significantly in terms of the composition of flora, vegetation and biological diversity. Most valuable is (P) and the least is (K). The greatest potential source of danger for biodiversity is the wrong forester’s management, especially interference in the natural processes (the planned building of the extra pond) and preventing wooden biomass accumulation. (shrink)

Even in the increasingly individualized American medical system, advocates of 'personalized medicine' claim that healthcare isn't individualized enough. With the additional glamour of new biotechnologies such as genetic testing and pharmacogenetics behind it, 'Me Medicine'-- personalized or stratified medicine-- appears to its advocates as the inevitable and desirable way of the future. Drawing on an extensive evidence base, this book examines whether these claims are justified. It goes on to examine an alternative tradition rooted in communitarian ideals, that of the (...) common good as a goal in medicine. (shrink)

The success of precision medicine depends on obtaining large amounts of information about at-risk populations. However, getting consent is often difficult. Why? In this commentary I point to the differentials in social status involved. These differentials are inevitable once personal information is surrendered, but are particularly intense when the studied populations are socioeconomically or socioculturally disadvantaged and/or ethnically stigmatized groups. I suggest how the deep distrust of the latter groups can be partially justified as a lack of confidence that their (...) core values or interests will sufficiently be taken into account. Hence, the ethical challenge here lies not in avoiding status differentials, but in dealing with them appropriately. Scientists should not assume trust from others but adopt a norm of “demonstrating trustworthiness”. (shrink)

This brief paper raises a puzzle, or half-puzzle, about Flora Nwapa’s ethnic identity in light of sentences in her novel Women are Different and presents two solutions.

ABSTRACT: Abstract Most modern knowledge is not science. The physical sciences have successfully validated theories to infer they can be used universally to predict in previously unexperienced circumstances. According to the conventional conception of science such inferences are falsified by a single irregular outcome. And verification is by the scientific method which requires strict regularity of outcome and establishes cause and effect. -/- Medicine, medical research and many “soft” sciences are concerned with individual people in complex heterogeneous populations. These populations (...) cannot be tested to demonstrate strict regularity of outcome in every individual. Neither randomised controlled trials nor observational studies in medicine are science in the conventional conception. Establishing and using medical and other “soft science” theories cannot be scientific. It requires conceptually different means: requiring expert judgement applying all available evidence in the relevant available factual matrix. -/- The practice of medicine is observational. Prediction of outcomes for the individual requires professional expertise applying available medical knowledge and evidence. Expertise in any profession can only be acquired through experience. Prior cases are the fundament of knowledge and expertise in medicine. Case histories, studies and series can provide knowledge of extremely high reliability applicable to establishing reliable general theories and falsifying others. Their collation, study and analysis should be a priority in medicine. Their devaluation as evidence, the failure to apply their lessons, the devaluation of expert professional judgement and the attempt to emulate the scientific method are all historic errors in the theory and practice of modern medicine. (shrink)

In this paper, I argue that the concept of normality in medical research and clinical practice is inextricable from the concept of ambiguity. I make this argument in the context of Edmund Pellegrino's call for a renewed reflection on medicine’s basic concepts and by drawing on work in critical disability studies concerning Deafness and body integrity identity disorder. If medical practitioners and philosophers of medicine wish to improve their understanding of the meaning of medicine as well as its concrete practice, (...) I contend that they should take seriously the import and centrality of ambiguity for biomedicine. (shrink)

The issue of how to incorporate the individual's first‐hand experience of illness into broader medical understanding is a major question in medical theory and practice. In a philosophical context, phenomenology, with its emphasis on the subject's perception of phenomena as the basis for knowledge and its questioning of naturalism, seems an obvious candidate for addressing these issues. This is a review of current phenomenological approaches to medicine, looking at what has motivated this philosophical approach, the main problems it faces and (...) suggesting how it might become a useful philosophical tool within medicine, with its own individual, but interrelated, contribution to make to current medical debates. After the general background, there is a brief summary of phenomenological ideas and their current usage in a medical context. Next is a critique of four key claims within current phenomenological medical works, concerning both the role phenomenology plays and the supposedly clear divide between phenomenology and other approaches. There are significant problems within these claims, largely because they overlook the complexity of the questions they consider. Finally, there is some more in‐depth examination of phenomenology itself and the true complexity of phenomenological debate concerning subjectivity. The aim is to show that it will be both more productive and truer to phenomenology itself, if we use phenomenology as a philosophical method for explicating and gaining deeper understanding of complex and fundamental problems, which are central to medicine, rather than as providing simple, but flawed solutions. (shrink)

Our present day knowledge in the area of medicine in Ancient Egypt has been severally sourced from medical papyri several of which have been deduced and analyzed by different scholars. For educational purposes it is always imperative to consult different literature or sources in the teaching of ancient Egypt and medicine in particular. To avoid subjectivity the author has found the need to re-engage the efforts made by several scholars in adducing evidences from medical papyri. In the quest to re-engage (...) the efforts of earlier writers and commentaries on the medical papyri, we are afforded the opportunity to be informed about the need to ask further questions to enable us to construct or reconstruct both past and modern views on ancient Egyptian medical knowledge. It is this vocation the author sought to pursue in the interim, through a preliminary review, to highlight, comment and reinvigorate in the reader or researcher the need for a continuous engagement of some pertinent documentary sources on Ancient Egyptian medical knowledge for educational and research purposes. The study is based on qualitative review of published literature. The selection of those articles as sources was based on the focus of the review, in order to purposively select and comment on articles that were published based either on information from a medical papyrus or focused on medical specialization among the ancient Egyptians as well as ancient Egyptian knowledge on diseases and medicine. It was found that the Egyptians developed relatively sophisticated medical practices covering significant medical fields such as herbal medicine, gynecology and obstetrics, anatomy and physiology, mummification and even the preliminary form of surgery. These practices, perhaps, were developed as remedies for the prevailing diseases and the accidents that might have occurred during the construction of their giant pyramids. It must be stated that they were not without flaws. Also, the key issues raised from these literatures are but a few among the Egyptian medical corpus across the academic and publishing world. It should therefore afford researchers, students and readers the opportunity to continue the educational dialogue on the medical practices of the Ancient Egyptians. (shrink)

Proponents of evidence-based medicine have argued convincingly for applying this scientific method to medicine. However, the current methodological framework of the EBM movement has recently been called into question, especially in epidemiology and the philosophy of science. The debate has focused on whether the methodology of randomized controlled trials provides the best evidence available. This paper attempts to shift the focus of the debate by arguing that clinical reasoning involves a patchwork of evidential approaches and that the emphasis on evidence (...) hierarchies of methodology fails to lend credence to the common practice of corroboration in medicine. I argue that the strength of evidence lies in the evidence itself, and not the methodology used to obtain that evidence. Ultimately, when it comes to evaluating the effectiveness of medical interventions, it is the evidence obtained from the methodology rather than the methodology that should establish the strength of the evidence. (shrink)

Physicians frequently ask whether they should give patients what they want, usually when there are considerations pointing against doing so, such as medicine’s values and physicians’ obligations. It has been argued that the source of medicine’s values and physicians’ obligations lies in what has been dubbed “the internal morality of medicine”: medicine is a practice with an end and norms that are definitive of this practice and that determine what physicians ought to do qua physicians. In this paper, I defend (...) the claim that medicine requires a morality that is internal to its practice, while rejecting the prevalent characterization of this morality and offering an alternative one. My approach to the internal morality of medicine is constructivist in nature: the norms of medicine are constructed by medical professionals, other professionals, and patients, given medicine’s end of “benefitting patients in need of prima facie medical treatment and care.” I make the case that patients should be involved in the construction of medicine’s morality not only because they have knowledge that is relevant to the internal morality of medicine—namely, their own values and preferences—but also because medicine is an inherently relational enterprise: in medicine the relationship between physician and patient is a constitutive component of the craft itself. The framework I propose provides an authoritative morality for medicine, while allowing for the incorporation, into that very morality, of qualified deference to patient values. (shrink)

The connections between medicine and well-being are myriad. This paper focuses on the place of well-being in clinical medicine. It is here that different views of well-being, and their connection to concepts like “autonomy” and “authenticity”, both illuminate and are illuminated by looking closely at the kinds of interactions that routinely take place between clinicians, patients, and family members. -/- In the first part of the paper, I explore the place of well-being in a paradigmatic clinical encounter, one where a (...) competent patient interacts with a clinician. The main question here is how, or even whether, the pursuit of patient well-being – however we construe it – figures into a paradigmatic clinical encounter. In the second part of the paper, I consider what I will call a marginal clinical encounter – one where the patient is, as Agnieska Jaworska (1999) puts it, at the “margins of agency” – to theorize about the nature of well-being and to show how different theories of well-being can have dramatic consequences for clinical decision-making. (shrink)

Recent criticisms of medicine converge on fundamental questions about the aim of medicine. The main task of this paper is to propose an account of the aim of medicine. Discussing and rejecting the initially plausible proposal according to which medicine is pathocentric, the paper presents and defends the Autonomy Thesis, which holds that medicine is not pathocentric, but sanocentric, aiming to promote health with the final aim to enhance autonomy. The paper closes by considering the objection that the Autonomy Thesis (...) is overly permissive and allows many highly controversial procedures as legitimate parts of medicine. (shrink)

Part of a symposium devoted to ‘Prediction, Understanding, and Medicine’, in which Alex Broadbent argues that the nature of medicine is determined by its competences, i.e., which things it can do well. He argues that, although medicine cannot cure well, it can do a good job of enabling people not only to understand states of the human organism and of what has caused them, but also to predict future states of it. From this Broadbent concludes that medicine is (at least (...) in part) essentially a practice of understanding and predicting, not curing. In reply to this bold position, I mount two major criticisms. First, I maintain that the reasons Broadbent gives for doubting that medicine can cure provide comparable reason for doubting that medicine can provide an understanding; roughly, the best explanation of why medicine cannot reliably cure is that we still lack much understanding of health and disease. Second, I object to the claim that a practice is medical only if it facilitates understanding and prediction. Although Broadbent has brought to light certain desirable purposes of medicine that are under-appreciated, my conclusion is that he has not yet provided enough reason to think that understanding and prediction are essential to it. Instead of supposing that medicine has an essence, in fact, I suggest that its nature is best understood in terms of a property cluster. (shrink)

If one had to identify the biggest change within the philosophical tradition in the twenty-first century, it would certainly be the rapid rise of experimental philosophy to address differences in intuitions about concepts. It is, therefore, surprising that the philosophy of medicine has so far not drawn on the tools of experimental philosophy in the context of a particular conceptual debate that has overshadowed all others in the field: the long-standing dispute between so-called naturalists and normativists about the concepts of (...) health and disease. In this paper, I defend and advocate the use of empirical methods to inform and advance this and other debates within the philosophy of medicine. (shrink)

This is a volume of twelve essays concerning the fundamental tension in personalised medicine between individual choice and the common good.

As opposed to a ‘one size fits all’ approach, precision medicine uses relevant biological, medical, behavioural and environmental information about a person to further personalize their healthcare. This could mean better prediction of someone’s disease risk and more effective diagnosis and treatment if they have a condition. Big data allows for far more precision and tailoring than was ever before possible by linking together diverse datasets to reveal hitherto-unknown correlations and causal pathways. But it also raises ethical issues relating to (...) the balancing of interests, viability of anonymization, familial and group implications, as well as genetic discrimination. This article analyses these issues in light of the values of public benefit, justice, harm minimization, transparency, engagement and reflexivity and applies the deliberative balancing approach found in theEthical Framework for Big Data in Health and Research to a case study on clinical genomic data sharing. Please refer to that article for an explanation of how this framework is to be used, including a full explanation of the key values involved and the balancing approach used in the case study at the end. Our discussion is meant to be of use to those involved in the practice as well as governance and oversight of precision medicine to address ethical concerns that arise in a coherent and systematic manner. (shrink)

Amid criticism of medicine's scientific rigor and patient care, this book offers a philosophical examination of the nature and aims of medicine, and new perspectives on how these challenges can be addressed. It offers input for rethinking the agenda of medical research, healthcare delivery, and the education of healthcare personnel.

Medicine is increasingly subject to various forms of criticism. This paper focuses on dominant forms of criticism and offers a better account of their normative character. It is argued that together, these forms of criticism are comprehensive, raising questions about both medical science and medical practice. Furthermore, it is shown that these forms of criticism mainly rely on standards of evaluation that are assumed to be internal to medicine and converge on a broader question about the aim of medicine. Further (...) work making medicine’s internal norms explicit and determining the aim of medicine would not only help to clarify to what extent the criticism is justified, but also assist an informed deliberation about the future of medicine. To illustrate some of the general difficulties associated with such a task, the paper concludes by critically engaging Edmund Pellegrino’s account of the aim of medicine as well as the Hastings Center’s consensus report. (shrink)

What position on dualism does medicine require? Our understanding of that ques- tion has been dictated by holism, as defined by the biopsychosocial model, since the late twentieth century. Unfortunately, holism was characterized at the start with con- fused definitions of ‘dualism’ and ‘reductionism’, and that problem has led to a deep, unrecognized conceptual split in the medical professions. Some insist that holism is a nonreductionist approach that aligns with some form of dualism, while others insist it’s a reductionist view (...) that sets out to eradicate dualism. It’s important to consider each version. Nonreductive holism is philosophically consistent and clinically unprob- lematic. Reductive holism, however, is conceptually incoherent—yet it is the basis for the common idea that the boundary between medical and mental health disorders must be vague. When we trace that idea through to its implementation in medical practice, we find evidence that it compromises the safety of patient care in the large portion of cases where clinicians grapple with diagnosis at the boundary between psychiatry and medicine. Having established that medicine must embrace some form of nonreduc- tionism, I argue that Chalmers’ naturalistic dualism is a stronger prima facie candidate than the nonreductive alternatives. Regardless of which form of nonreductionism we prefer, some philosophical corrections are needed to give medicine a safe and coherent foundation. (shrink)

In Nwapa’s novel, Dora and Rose are both confronted with the rituals of Tunde, but engage with them in different ways. I attempt a somewhat pained contrast: Dora’s way is closer to that of the functionalist participant observer, whereas Rose’s way is closer to that of earlier armchair anthropologists who sought the origins of rituals. I also note a puzzle to do with literary realism.

The controversy around the accommodation of conscientious objections in medicine persists, especially for such contentious services as abortions. COs are typically considered in their negativ...

In this chapter, we consider ethical and philosophical aspects of trust in the practice of medicine. We focus on trust within the patient-physician relationship, trust and professionalism, and trust in Western (allopathic) institutions of medicine and medical research. Philosophical approaches to trust contain important insights into medicine as an ethical and social practice. In what follows we explain several philosophical approaches and discuss their strengths and weaknesses in this context. We also highlight some relevant empirical work in the section on (...) trust in the institutions of medicine. It is hoped that the approaches discussed here can be extended to nursing and other topics in the philosophy of medicine. (shrink)

The reemergence of the question of suicide in the medical context of physician-assisted suicide seems to me one of the most interesting and fertile facets of late modernity. Aside from the disruption which this issue may cause in the traditional juridical relationship between individuals and the state, it may also help to transform the dominant conception of subjectivity that has been erected upon modernity's medicalized order of death. To enhance this disruptive potential, I am going to examine the perspectives on (...) death offered by two contemporary writers: Zygmunt Bauman and Jean Baudrillard. Each of these writers recognizes the centrality of death to modern culture, as Heidegger did, but they also go beyond him in specifying the ways in which death maintains a presence in late modernity, despite efforts to conceal it. In particular, both of these writers recognize the important role that medicine has played in ordering the modern conception of death. After situating these two perspectives in relation to each other, and in relation to Heidegger, who will serve here as a sort of benchmark, I will return to the issue of suicide. Given the differences in their readings of the role that death and medicine play in modern culture, these post-Heideggerians take strikingly different positions on this issue. By engaging these perspectives, I intend not only to point out the tremendous potential which this issue holds for a fundamental rethinking of modern subjectivity, but also reveal some of the dangers that may beset any naive optimism about the right to die. (shrink)

This paper begins with Adam Smith’s advice to specialize and draws attention to an advantage from a misleading appearance of fixed specialization, identified in Flora Nwapa’s novel Efuru.

This paper considers two explanations for why the main character of Flora Nwapa’s novel One is Enough does not answer the question of how many times her mother-in-law has visited. One of these is a variation on the surprise exam paradox.

Cancer has garnered increasing interest among philosophers. This chapter focuses on cancer medicine and precision oncology, an influential approach to cancer which seeks to individualize treatment on the basis of genetic or molecular features of disease. It reviews a range of ontological, epistemic, and ethical questions raised by precision oncology, relating developments in cancer medicine to broader issues in the philosophy of science and medicine.

The soaring promises made by personalized genetic medicine advocates are probably loftier than those in any other medical or scientific realm today. Are they justified?

How compatible is a medical training with a future role in public office? Potentially very compatible and advantageous, particularly with regard to public policy issues, argues Dr Michael L Riordan.

In this thesis, I give a metascientific account of causality in medicine. I begin with two historical cases of causal discovery. These are the discovery of the causation of Burkitt’s lymphoma by the Epstein-Barr virus, and of the various viral causes suggested for cervical cancer. These historical cases then support a philosophical discussion of causality in medicine. This begins with an introduction to the Russo- Williamson thesis (RWT), and discussion of a range of counter-arguments against it. Despite these, I argue (...) that the RWT is historically workable, given a small number of modifications. I then expand Russo and Williamson’s account. I first develop their suggestion that causal relationships in medicine require some kind of evidence of mechanism. I begin with a number of accounts of mechanisms and produce a range of consensus features of them. I then develop this consensus position by reference to the two historical case studies with an eye to their operational competence. In particular, I suggest that it is mechanistic models and their representations which we are concerned with in medicine, rather than the mechanism as it exists in the world. -/- I then employ these mechanistic models to give an account of the sorts of evidence used in formulating and evaluating causal claims. Again, I use the two human viral oncogenesis cases to give this account. I characterise and distinguish evidence of mechanism from evidence of difference-making, and relate this to mechanistic models. I then suggest the relationship between types of evidence presents us with a means of tackling the reference-class problem. This sets the scene for the final chapter. Here, I suggest the manner in which these two different classes of evidence become integrated is also reflected in the way that developing research programmes change as their associated causal claims develop. (shrink)

The literature on conscientious objection in medicine presents two key problems that remain unresolved: Which conscientious objections in medicine are justified, if it is not feasible for individual medical practitioners to conclusively demonstrate the genuineness or reasonableness of their objections? How does one respect both medical practitioners’ claims of conscience and patients’ interests, without leaving practitioners complicit in perceived or actual wrongdoing? My aim in this paper is to offer a new framework for conscientious objections in medicine, which, by bringing (...) medical professionals’ conscientious objection into the public realm, solves the justification and complicity problems. In particular, I will argue that: an “Uber Conscientious Objection in Medicine Committee” —which includes representatives from the medical community and from other professions, as well as from various religions and from the patient population—should assess various well-known conscientious objections in medicine in terms of public reason and decide which conscientious objections should be permitted, without hearing out individual conscientious objectors; medical practitioners should advertise their conscientious objections, ahead of time, in an online database that would be easily accessible to the public, without being required, in most cases, to refer patients to non-objecting practitioners. (shrink)

Recently, a friend of one of these writers told her story of using one of a healthcare product to activate her stem cells as part of regenerative medicine. Regenerative medicine is a field of medicine that seeks to repair or replace damaged or diseased tissues and organs. This can be done through a variety of methods, including stem cell therapy, tissue engineering, and gene therapy. This is a short review article on this rapid field called regenerative medicine, in particular via (...) a new method called photobiomodulation, especially by virtue of low-intensity laser pen treatment. Hopefully it will attract more research in this interesting direction, both for laser/photobiomodulation to boost plant growth as well as in healthcare (see also: Christianto & Smarandache, 2022; Christianto, 2023). (shrink)

Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue that draws (...) both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. (shrink)

In Deep Medicine, Eric Topol argues that the development of artificial intelligence (AI) for healthcare will lead to a dramatic shift in the culture and practice of medicine. Topol claims that, rather than replacing physicians, AI could function alongside of them in order to allow them to devote more of their time to face-to-face patient care. Unfortunately, these high hopes for AI-enhanced medicine fail to appreciate a number of factors that, we believe, suggest a radically different picture for the future (...) of healthcare. Far from facilitating a return to “the golden age of doctoring”, the role of economic and institutional considerations in determining how medical AI will be used mean that it is likely to further erode therapeutic relationships and threaten professional and patient satisfaction. (shrink)

This paper aims to clarify the nature of understanding in medicine. The first part describes in more detail what it means to understand something and links a type of understanding (i.e., objectual understanding) to explanations. The second part proceeds to investigate what objectual understanding of a disease (i.e., biomedical understanding) requires by considering the case of scurvy from the history of medi- cine. The main hypothesis is that grasping a mechanistic explanation of a condi- tion is necessary for a biomedical (...) understanding of that condition. The third part of the paper argues that biomedical understanding is necessary, but not sufficient for understanding in a clinical context (i.e., clinical understanding). The hypothe- sis is that clinical understanding combines biomedical understanding of a disease or pathological condition with understanding illness, which involves some degree of personal understanding of the patient. It is argued that, in many cases, clinical understanding necessitates adopting a particular second-personal stance and using cognitive resources in addition to those involved in biomedical understanding. (shrink)

Recently, dramatic price increases by several pharmaceutical companies have provoked public outrage. These scandals raise questions both about how pharmaceutical firms should be regulated and about how pharmaceutical executives ethically ought to make pricing decisions when drug prices are largely unregulated. Though there is an extensive literature on the regulatory question, the ethical question has been largely unexplored. This article defends a Kantian approach to the ethics of pharmaceutical pricing in an unregulated market. To the extent possible, pharmaceutical companies must (...) price drugs so that those who genuinely need them can get them without financial ruin. This requirement is an ethical side constraint, like the moral prohibitions on deception and theft, that takes precedence over a business’s interest in maximizing profit. That said, the requirement’s application is sensitive to the need to recoup the costs of research and to produce a return that financially justifies the original investment. It may not be either feasible or desirable for government to attempt to enforce the ethical requirements concerning just pharmaceutical pricing. Either price regulation or subsidy could fulfill government’s obligation to protect patients from being objectionably vulnerable to pricing decisions by private companies. (shrink)

According to Aristotle, the medical art aims at health, which is a virtue of the body, and does so in an unlimited way. Consequently, medicine does not determine the extent to which health should be pursued, and “mental health” falls under medicine only via pros hen predication. Because medicine is inherently oriented to its end, it produces health in accordance with its nature and disease contrary to its nature—even when disease is good for the patient. Aristotle’s politician understands that this (...) inherent orientation can be systematically distorted, and so would see the need for something like the Hippocratic Oath. (shrink)

The idea of personalised medicine (PM) has gathered momentum recently, attracting funding and generating hopes as well as scepticism. As PM gives rise to differing interpretations, there have been several attempts to clarify the concept. In an influential paper published in this journal, Schleidgen and colleagues have proposed a precise and narrow definition of PM on the basis of a systematic literature review. Given that their conclusion is at odds with those of other recent attempts to understand PM, we consider (...) whether their systematic review gives them an edge over competing interpretations. We have found some methodological weaknesses and questionable assumptions in Schleidgen and colleagues’ attempt to provide a more specific definition of PM. Our perplexities concern the lack of criteria for assessing the epistemic strength of the definitions that they consider, as well as the logical principles used to extract a more precise definition, the narrowness of the pool from which they have drawn their empirical data, and finally their overlooking the fact that definitions depend on the context of use. We are also worried that their ethical assumption that only patients’ interests are legitimate is too simplistic and drives all other stakeholders’ interests—including those that are justifiable—underground, thus compromising any hope of a transparent and fair negotiation among a plurality of actors and interests. As an alternative to the shortcomings of attempting a semantic disciplining of the concept we propose a pragmatic approach. Rather than considering PM to be a scientific concept in need of precise demarcation, we look at it as an open and negotiable concept used in a variety of contexts including at the level of orienting research goals and policy objectives. We believe that since PM is still more an ideal than an achieved reality, a plurality of visions is to be expected and we need to pay attention to the people, reasons and interests behind these alternative conceptions. In other words, the logic and politics of PM cannot be disentangled and disagreements need to be tackled addressing the normative and strategic conflicts behind them. (shrink)

Since its introduction just over two decades ago, evidence-based medicine (EBM) has come to dominate medical practice, teaching, and policy. There are a growing number of textbooks, journals, and websites dedicated to EBM research, teaching, and evidence dissemination. EBM was most recently defined as a method that integrates best research evidence with clinical expertise and patient values and circumstances in the treatment of patients. There have been debates throughout the early 21st century about what counts as good research evidence between (...) EBM proponents and philosophical critics and even within the EBM community itself. Similar controversy arises about the relative worth of patient values and clinical expertise (and how these can be integrated). EBM has also evolved in ways that have come under scrutiny. Specifically, policymakers have used EBM research methodology to increase the relative importance of clinical guidelines that some clinicians have argued are tyrannical. Philosophers have addressed all of these controversies, and with very few exceptions have been critical of EBM. In addition most philosophical attention has been on the epistemic role of Randomization and evidence hierarchies, with relatively little attention being paid to the role of Diagnosis, expertise, patient values, and Systematic Reviews within EBM. (shrink)

Der Kugel als Grundbauform des Lebens begegnen wir im gesamten Organismenreich, angefangen von sphärischen einzelligen Lebewesen wie der Namibperle (Thiomargaritha namibiensis), einem großen marinen Bakterium, über kugelige, vielzellige Algen wie der Süßwasseralge Volvox, marinen Rippenquallen wie der Seestachelbeere (Pleurobrachia) und den frühen Entwicklungsstadien tierischer Vielzeller (Metazoa). Alle diese kugeligen Gestalten finden wir fast ausschließlich in wässrigem Milieu. An Land sind die Pflanzen hingegen generell langgestreckt. Tiere haben spätestens beim Auszug aus einer aquatischen Umgebung die Kugelform aufgegeben. Diese Beobachtung führt zur (...) Frage nach den grundlegenden Prinzipien der Bauplanevolution im Zusammenhang mit dem Landgang der Tiere und Pflanzen. Beim Landgang konnte auf bereits im aquatischen Milieu entwickelte Grundformen zurückgriffen werden. Bei den Pflanzen waren es die von Algen bekannten Zellfäden, aus denen die bipolare Langform hervorging. Mit dem einen Ende dem mineralischen Untergrund verhaftet und mit dem anderen in die Atmosphäre reichend, schufen sie die Grundlagen für terrestrische Tiere. Der Schritt ans Land vollzog sich bei Tieren mehrfach und ging von einer größeren Zahl von Bauplänen aus. Wie die evolutionäre Entwicklungsbiologie (EvoDevo) nahelegt, gingen diese auf kleine Abwandlungen in der Embryonalentwicklung zurück, die in kurzen Zeiträumen große Entwicklungsschritte (Makrosprünge) möglich machen. Entsprechend rasch konnten sich die Tiere auch an terrestrische Bedingungen anpassen. (shrink)

Precision medicine functions by grouping patients along genetic, molecular, and related ‘-omics’ factors. This stratification relies on large, growing databases of patient-volunteered information. Both private companies and government bodies incentivize patients to volunteer this genetic information appealing to the creation of collaborative patient partnerships and the concept of empowerment. This paper aims to address two related questions: (1) what is the actual nature of patient participation in precision medicine research? And (2) is this participation in precision medicine research really that (...) empowering for the average patient? I contend that firstly, the nature of this participation is best conceived of as merely contributory. Contributory participation, as it will be shown, falls short of collaboration. The partnership created by participation in precision medicine research is not one of sharing values, equal say in decisions, or shared benefit. Secondly, I contend that there are important caveats to claims that patient participation in precision medicine is empowering. Empowerment is hindered by the type of participation, the practical use or actionability of genetic data, genetic literacy, the cost of precision drugs for patients that qualify for them, and bioethical considerations of informed consent. (shrink)

Inflammation is said to be a healthy component of the body's immune system's reaction. Inflammation is characterised by four key symptoms: pain, redness, heat or warmth and swelling. As secondary metabolites, plants may produce a wide range of phytochemical compounds, which possess anti-inflammatory characteristics. Herbal remedies are important therapies for a wide range of ailments all over the world. There are around 7,500 species of medicinal plants, including representatives from over 17,000 flowering plant species. Even though synthetic chemistry has (...) developed its expectations, the use of natural ingredients in the manufacture of drugs used in contemporary medicine is unparalleled. By interfering with the biology of inflammation, anti-inflammatory medications may assist to minimising tissue damage and increase patient comfort. Because of the bulky figure of species reachable for study, the effective development of novel naturally taking place anti-inflammatory drugs is mostly dependent on a multidisciplinary approach to discovering new chemicals. Despite the statistic that many review papers have been produced in this field, the conventional of them simply examined the issue from an area perspective. Several non-steroidal anti-inflammatory drugs have been shown to reduce inflammation and pain by decreasing the isoform of the cyclooxygenase enzyme's digestion of arachidonic acid, hence lowering prostaglandin production. Non-steroidal anti-inflammatory drugs have a host of harmful effects. There are, however, medicinal herbs with anti-inflammatory pharmacological properties that have few or no negative effects. (shrink)

The cashew nut is essential for physical and emotional well-being. It is an energetic diet and the best food medication for many illnesses. Nuts protects from malignant growth, coronary illness, circulatory strain, and various degenerative infirmities connected to aging. It can be used for several medicinal purposes. Every part of cashew has some important medicinal properties. Cashew kernel contains proteins, carbohydrates, vitamins, and fats which help gain energy. Cashew nuts are used for many purposes like blood sugar, weight (...) loss, cancer, cold and flu, aging, urinary disorders, digestive disorders, and bone relaxation. In comparing cashew with other nuts, Cashew kernels have good properties, including proteins, carbohydrates, fibers, and minerals, then almond, hazelnut, and walnuts. Cashew kernels contain the highest number of proteins (21%) when compared with Almonds (20.8%), Hazelnuts (15.6%), and Macadamia Nuts (60.9%). Cashew contain large amount of carbohydrate (22%) compared to other nuts like almonds, walnuts, etc. There are some strong benefits of Cashew for health. They boost the immune system, act as an antioxidant, remove gallstones, and beneficial for anemia. They are good sources of healthy fats that are necessary for our body to absorb fat-soluble vitamins. Its bark is known as the antihypertensive and glucose-lowering part. It has beneficial effect on the eyes and skin. This is rich in vitamin C, so it can be used for skin problems like acne, flawless freckles, skin lines and protects from aging. (shrink)