With the shortage of physicians and surgeons and increase in demand worldwide due to situations such as the COVID-19 pandemic, there is a growing interest in finding solutions to help address the problem. A solution to this problem would be to use neurotechnology to provide them augmented cognition, senses and action for optimal diagnosis and treatment. Consequently, doing so can negatively impact them and others. We argue that applying neurotechnology for human enhancement in physicians and surgeons can cause (...) injustices, and harm to them and patients. In this paper, we will first describe the augmentations and neurotechnologies that can be used to achieve the relevant augmentations for physicians and surgeons. We will then review selected ethical concerns discussed within literature, discuss the neuroengineering behind using neurotechnology for augmentation purposes, then conclude with an analysis on outcomes and ethical issues of implementing human augmentation via neurotechnology in medical and surgical practice. (shrink)

A model policy for conscientious objection in medicine.

Joshua Mezrich is a practicing transplant surgeon who draws on his experiences, and those of his patients, to provide a "here's where we're at" moment in the story of transplant medicine. In so doing, he explains what it is like to practice while telling the stories of his patients, donors, and the pioneering surgeons who persisted in the face of failure to make what Mezrich does a work of healing. Written for a popular audience, When Death Becomes Life is (...) perhaps the most accessible work yet on the modern history of organ transplantation and what the current "standard of care" actually looks like. Indeed, it rounds out a "trinity" of quality books about the transplant experience, this one from the surgeon's... (shrink)

A good surgeon knows how to perform a surgery; a good architect knows how to design a house. We value their know-how. We ordinarily look for it. What makes it so valuable? A natural response is that know-how is valuable because it explains success. A surgeon’s know-how explains their success at performing a surgery. And an architect’s know-how explains their success at designing houses that stand up. We value know-how because of its special explanatory link to success. But in virtue (...) of what is know-how explanatorily linked to success? This essay provides a novel argument for the thesis that know-how’s special link to success is to be explained at least in part in terms of its being, or involving, a doxastic attitude that is epistemically alike propositional knowledge. It is argued that the role played by know-how in explaining intentional success shows that the epistemic differences between know-how and knowledge, if any, are less than usually thought; and that "revisionary intellectualism", the view that know-how is true belief that might well fall short of knowledge, is not really a stable position. If its explanatory link to success is what makes know-how valuable, an upshot of my argument is that the value of know-how is due, to a considerable extent, to its being, or involving, a kind of propositional knowledge. (shrink)

Dear Editors, -/- I found the content of your editorials to be highly intriguing [1,2]. Scientific journals are witnessing a growing prevalence of publications related to artificial intelligence (AI). Three letters to the editor were recently published in your journal [3-5]. The renowned journal Nature has dedicated approximately 25 publications solely to the subject of ChatGPT. Moreover, a quick search on Pubmed using the term "ChatGPT" yields around 900 articles, with the vast majority originating in 2023. These statistics underscore the (...) substantial interest of the scientific community in this area. -/- AI, especially the ChatGPT tool and the recent Bard, have faced criticism and been portrayed as significant adversaries of science. It is evident that many authors or researchers, who may not be well-versed in writing, can greatly benefit from these tools, as mentioned earlier. Without taking a contrarian stance, one should consider the potential advantages of such technologies for researchers in less privileged regions, where access to new technologies is limited, and local or regional challenges abound [6]. AI cannot be confounded with other technologies, as it specifically focuses on replicating human-like intelligence and decision-making processes, rather than simply automating tasks or improving performance based on data patterns. -/- The translation into English poses challenges due to the dominance of English in worldwide publications, with over 95% of articles being published in this language, and even reaching 98% in some fields. Although this manuscript was partially translated using AI, it can still benefit researchers from non-native English regions. Even simple tasks like text editing can be problematic for researchers in underprivileged areas. AI can play a crucial role in the evolution of online lectures and classes, providing valuable support for African maxillofacial surgeons who lack the luxury of taking breaks from work to update their knowledge, as they may be the only available option [7]. One of the remarkable features of AI is its ability to discover knowledge gaps. The use of simple tools like reference organizers is rapidly evolving and can become automated or semi-automated through AI. However, we must carefully consider whether we should refrain from relying too heavily on AI in certain cases, as this could be seen as a significant regression. -/- On the other hand, we must be cautious about freely allowing AI tools to circulate in scientific journals and books without proper regulation [8]. Currently, accurately identifying texts generated by AI is challenging, and their effectiveness remains relatively low, at less than 30%. This means that only about 30 out of every 100 texts can be confidently classified as AI-generated. The technology must advance further to increase detection accuracy or at least raise suspicion. Academic journals no longer view authors acknowledging artificial intelligence tools as co-authors in their research favorably. This is crucial to prevent certain unscrupulous individuals, such as "false prophets," charlatans, and flat-earthers, from infiltrating the realm of science, potentially impeding the progress of serious research conducted by professionals dedicated to advancing humanity through science. -/- It is essential to keep in mind that AI does not generate anything novel. Human authors can not be fully substituted [9]. In research involving groundbreaking concepts, innovations, case reports, or technical notes, the use of AI tends to be less frequent due to its lack of capability in creating innovative outcomes. On the other hand, reviews, whether narrative, systematic, or scoping, are based on existing publications. To address potential fraudulent practices, editors, reviewers, and journals themselves should exercise greater vigilance and apply more stringent filters for this type of publication. -/- An article from over a decade ago already discussed the professions most susceptible to replacement by computerization [10]. Maxillofacial surgeons, physicians, dentists, and psychologists are among the professions that are less likely to be displaced. This position can be attributed to the significant level of patient-professional interaction, the development of specific manual skills over time, and the ability to make adaptable decisions during procedures. These intricacies pose formidable challenges for AI to grasp, regardless of its level of advancement. -/- We should maintain a composed yet vigilant stance at this juncture. Just as Portuguese navigators feared encountering serpents and sea monsters when they ventured into uncharted waters, the uncertainty and novelty of AI can evoke apprehension in us all. Nonetheless, we must embrace the benefits that AI can offer while imposing strict regulations and appropriate penalties to prevent any potential abuses carried out "in the name of science." -/- Sincerely yours,. (shrink)

Lung cancer is still a detrimental problem for physicians and surgeons. Because of having no standard treatment and poor survival, enforces us to find new approaches for its eradication. However, we have a so long way to this purpose. Genetic and cell researches to find out its real etiology and pathway are developing. But today, patients with lung cancer are waiting for some treatment methods which ease and give hope themselves immediately. Surgery is the most hopeful way for radical (...) solution of lung cancer. Recently, new anesthetic and surgical technics give us some important advantages that were very frightfully before. In this issue, we aimed to emphasize the new researches, interventions and experimental studies about pulmonary carcinoma. All authors worked hard for this purpose. I appreciate all of them and the editor in chief Prof. Murat Sucu. I hope all articles will help us thinking and researching lung cancer in all ways. -/- Prof. A. Feridun Işık. (shrink)

Qualitative evidence concerning the relationship between QoL and a wide range of disabilities suggests that subjective judgments regarding other people’s QoL are wrong more often than not and that such judgments by medical practitioners in particular can be biased. Guided by their desire to do good and avoid harm, surgeons often rely on "the eyeball test" to decide whether a patient will or will not benefit from surgery. But the eyeball test can easily harbor a range of implicit judgments (...) and biases against patients with disabilities, including erroneous assumptions about QoL. We critique the use of the "eyeball" test and offer suggestions to reduce bias and ensure that patients’ values are more consistently prioritized in surgical decision-making. (shrink)

Important achievements were obtained in the fields of mathematics, medicine, chemistry, astronomy, physics, optics, mechanics, zoology, botanic, mineralogy, geography and etc. in the Turkish-Islamic world between the ninth and thirteenth centuries. According to the leading historians of science, scholars living in different parts of the TurkishIslamic world not only surpassed their Greek and Byzantine predecessors. They also paved the way for development of these fields of science for following centuries. It is possible to mention many physicians that left non-erasable marks (...) in the medicine history among these distinguished scholars. One of these names is an Andalusian surgeon-physician called Abul-Qāsim alZahrāwī. He is known for his solid and unique contributions to the surgical world and regarded as the founder of surgery in the TurkishIslamic world. al-Zahrāwī wrote many books. One of these books, called al-Taṣrīf (The Method of Medicine) regarded as a medical encyclopedia has reached until today. The book attracted more attention in the European countries than in the Turkish-Islamic world and had an impact on Europe. Different chapters from the book were translated into languages such as Hebrew, French, English and especially Latin. al-Zahrāwī’s scientific heritage has also been discussed with all its aspects in Russia where scientists in the Turkish-Islamic world have especially been studied. Even though it was translated at a later period than Avicenna’s al-Qānūn fī al-Ṭibb (The Canon of Medicine), al-Taṣrīf was translated into Russian. The aim of this study is to identify Russian studies on Zahrawi and his main work, al-Taṣrīf -within the framework of available opportunitiesand to present prominent ones among these. In conclusion, this article also aims to contribute to the Turkish literature on al-Zahrāwī and al-Taṣrīf. Therefore, the author wishes to assist the relevant ongoing studies and the ones to be conducted in the future in terms of bibliography and material index. (shrink)

It is often noted that if someone has a tertiary degree in a scientific field who promotes an anti-science-establishment, antiscience, or pseudoscience agenda, they are very often engineers, dentists, surgeons or medical practitioners. While this does not mean that all members of these professions or disciplines are antiscience, of course, the higher frequency of pseudoscience among them is indicative of what I call the “deductivist mindset” regarding science itself. Opposing this is the “inductivist mindset”, a view that has been (...) deprecated among philosophers since Popper. Roughly, the deductivist mindset tends to see problems as questions that can be resolved by deduction from known theory or principle, while the inductivist sees problems as questions to be resolved by discovery. These form cognitive poles, which nobody ever purely instantiates, but a cognitive tendency to be a deductivist may explain why some people find results that conflict with prior theoretical commitments, whether scientific or not, unacceptable. The deductivist tends to be a cognitive conservative, where the inductivist tends to be a cognitive progressive, and the conservative mindset leads to a ressentiment about modernism, and hence about certain scientific results, more often, or so I shall argue in this chapter. (shrink)

Under which conditions are we epistemically justied to believe that what other people tell us is true? Traditionally, the answer has either been reductionist or anti-reductionist: Either our justication reduces to non-testimonial reasons, or we have a presumptive, though defeasible, right to believe what we are told. However, different cases pull in different directions. Intuitively, someone asking for the time is subject to different epistemic standards than a surgeon consulting a colleague before a dangerous operation. Following this line of thought, (...) this paper develops an account of testimonial justication that captures our reductionist as well as our anti-reductionist intuitions. It is argued that the speaker’s commitment to an epistemic norm, as well as the hearer’s understanding of that norm, gives the hearer a presumptive right to believe what she is told. However, this justication doesn’t apply to situations with high practical risks. Here, the hearer needs reductive reasons to believe that her interlocutor is especially qualied to give her the desired information. (shrink)

Objective: The present study aims to determine the number and position of the nutrient foramina (NF) of the human femur, tibia, and fibula and to observe the size, direction, and obliquity of the nutrient foramina. Methods: We observed 265 adult human, lower limb long bones in the Department of Anatomy of the Gaziantep University. The nutrient foramina were identified with naked eyes, and the obliquity was determined with a hypodermic needle. Gauge 20 and 24 needles were used for size determination. (...) Shape was observed with the naked eye and classified into oval and round types. The nutrient foramina location was determined by dividing total bone length into three segments, and the locations were validated by calculating foraminal index (FI). Results: Results showed that 79% of the long bones had a single nutrient foramen. More than 96% of the nutrient foramina were directed away from the knees. A total of 87% of the femoral foramina were located in the middle third, 72% of the tibial foramina were located in the proximal third, and 98% of the fibular nutrient foramina were located in the middle third of the specimens. Overall, no foramina were found on the distal third of the studied bones. Conclusion: Our study findings are in accordance to the findings from several research studies. The assessment of pathological conditions associated with the findings of foramen nutricium in our study may help clinicians and surgeons in planning treatments for applications to be performed in this region. However, it is thought that literature will be a source for basic and clinical sciences by providing reference values. (shrink)

Objectives: The most principal nutrition source of a bone is nutrient arteries. They are important at every stage of bone development. A nutrient artery enters a bone through the nutrient foramen, the largest hole on the outer surface of the bone. The foramen is important both morphologically and clinically. -/- Methods: A total of 414 adult human dry bones were investigated in this study to identify topographic and morphological features of nutrient foramina in the scapula, clavicle, humerus, radius and ulna. (...) Nutrient foramina were examined with a hand lens. Their dimensions and directions were determined with a 21-gauge needle, and thus major foramina were detected. Positions of nutrient foramina were noted according to surfaces of the bones, and to segments separated as proximal, middle and distal by calculating foraminal index. -/- Results: A single nutrient foramen was found in 71% of our samples. We observed that 94.2% of foramina in the clavicle, 89.3% of foramina in the humerus, 51.3% of foramina in the radius, and 67.7% of foramina in the ulna were located in the middle 1/3 segment of the bones. -/- Conclusion: Our findings were in line with the data in the literature. On account of pathologies associated with the nutrient foramen, our findings may be helpful for surgeons to design applications performed in the region. In addition, we think that our data by contributing to the literature may be a resource for clinicians due to the importance of the nutrient foramen for surgical procedures. (shrink)

The mythical bronze creature Talos (Greek: Τάλως) was worshiped initially as the god of light or the sun in the Hellenic Island of Crete. He is supposed to have lived in the peak Kouloukona of the Tallaia Mountains in the Gerontospelio cave. His relation towards bronze and fire and his continuous voyage circling the island of Crete most probably introduces the concept of the change of the four seasons. The sun was considered in the area of the South-East Mediterranean nations (...) as just judge, a guardian who monitors and judges from above all the actions of the commoners, a controller for the faithful application of laws in Crete [1]. Hesychios in his Lexicon notes that talos means sun and that the name Tallaios was initially attributed to Zeus [2]. The birth of the Olympian gods forged a new Pantheon and nomenclature forcing some of the old gods to fell into lower deities. This happened to Talos who soon became a mythical hero [1]. According to Apollodorus, the bronze creature was forged by the magnificent constructor Hephaestus as a gift to the mythical King Minoa to help him guard the island [3]. Although the verb “peritrohazo” (Greek: περιτροχαζω) was used, meaning a movement in a steady orbit (track), some depictions image him as a winged being. To protect the island, he was throwing rocks into unknown ships or in the case of a foreign landing he was burning with fire or with his flamed bronze body the intruders. He was holding copper plates with the laws of the island and his circle allowed him to pass all island sores three times daily [1,4-6]. Plato, speaks of him as a real person, suggesting he was the brother of King Rhadamanthys, thus a son of Zeus [5]. Talos may be considered as the token of the Cretan power, a symbol of technological development in the field of metalworking in prehistoric and Minoan times. An animated, programmed gigantic android to enforce its will. A primitive robot for basic actions having a power source, fire and ichor (Greek: ιχώρ) the sacred fluid in the vessels of the gods. The first manufactured being with his individual intelligence, a primary concept of artificial intelligence (AI) [7]. -/- Homer was the first to introduce the term automata (Greek: αυτόματα), to describe ingenious machines built by the supreme blacksmith god of invention and technology, God of metal and fire, Hephaestus, manufactured devices “acting of one’s own will” as the Hellenic word indicates [8]. Eons later, the humanoid automaton the “Automa cavaliere” (English: Automaton knight) appeared in the court of the nobleman and Duke of Milan Ludovico Maria Sforza. It was the year 1495, when Leonardo da Vinci presented his robotic knight, an innovative construction operated by a series of pulleys and cables, presenting though no individual mind. Although it was manufactured by a highly intelligent polymath, it could only be operated through an outer intelligence [9]. Advancements made during the Fourth Industrial Revolution allowed modern technology to manufacture intelligent machines to aid the field of invasive surgery. One of those most sophisticated devises is the da Vince Surgical Tower. -/- Launched in the setting of the 21st century, the DaVinci System is one of the most commonly employed tools/systems, which has prevailed in the field of robotic-assisted surgery [10]. One could claim that it practically reshaped the concept of surgery, providing doctors with immense capabilities, aiming towards the optimal post-operative outcome. Through visual augmentation, high resolution 3D video, enhanced precision and reduced complication rates [11] the DaVinci Si and the latest DaVinci Xi system have been implemented in a variety of surgeries, including but not limited to general, urologic, gynecologic, thoracic and even cardiac procedures; valve and coronary artery bypass graft operations [12,13]. Da Vinci is cleared globally for cardiosurgery and came in vogue to fulfill the dream of cardiac surgeons to operate in closet chest. It offers in patients the same benefits as those that open chest incision surgery procedures do [14]. -/- The more recent DaVinci Xi model was introduced to counteract commonly known drawbacks of the Si system, such as the inability to simultaneously manipulate the different abdominal quadrants [10]. It consists of four boom mounted robotic arms along with a mobile platform and a master console. The latter with the adaptable intraocular distance, the cushioned headrest, the modifiable arm bars and the flexible finger loops, is meticulously designed to meet the surgeon´s “demands” [12]. Every robotic arm has three degrees of freedom, which combined with the EndoWrist technology to imitate the delicate motion of the surgeon´s hand, acquires an extra seven degrees of freedom. Evidently, the combination of the user-friendly interface, the high-quality 3D intraoperative images, the multiple joints and sensors, as well as the surgeon himself, who can learn to handle the DaVinci Xi Surgical System in a relatively short period of time, has established the model in the surgical armamentarium, paving the way towards a continuously progressive future of minimally invasive and robotic surgery (Figure 1) [12]. -/- History testifies that the nomination of the AI surgical tower as da Vinci was wrongfully given to commemorate a majestic historical figure. It is clear that the mythical creature Talos which was fabricated by the ingenious god Hephaestus was the first true automaton in the line of AI origins. (shrink)

At the age of 70 years, Professor Chris Nwamuo is still breaking new grounds in the Theatre, Media and Communication disciplines, not only in the University of Calabar, but also in Cross River University of Technology (CRUTECH) in Cross River State Nigeria, Abia State University in Abia State, Nigeria and many other state, national and international higher institutions of learning. He is tireless in research, clinical in project supervision, stern in the resolution of academic knots and committed to teaching students (...) both at the graduate and undergraduate levels. One would imagine that despite the ever busy schedule of this prolific scholar, including his attendance to family affairs, he still has the time to write out his findings, thoughts and perspectives in the very field that he has worked for more than three decades. One of his most recent works is his book “The Dynamics of International Communication” published in 2016. Communication is the human nutrient that grows a healthy relationship among people and nations of the world. When absent or not properly handled, communication effects result to rumor, grapevines, conflict or in internationally severe cases, war. ‘Communication’ as a term is surrounded by mysteries of comprehension but Nwamuo has attempted an unraveling throughout his years of academic surgeon in the field. Ike (2005:40) define communication as the process by which people share information, ideas and feelings using spoken and written words, body language, personal mannerism and style, the physical environment or anything that adds meaning to a message. Iyorza (2015:11) views communication as the transmission of information, idea or beliefs from the encoder to the decoder with the aim of achieving a common ground of understanding, promoting a course or reacting to given stimuli in the communication encounter. Both definitions share a common characteristic: information or ideas sharing or transmission. (shrink)

Purpose: The objective of this study is to determine the importance of supplementary medical ethics course for resident physicians. In this study, we assessed the current state of their knowledge of medical ethics and aimed to improve and deepen their understanding of clinical scenarios to increase their awareness of the link between the practice of medicine and ethical issues. Methods: The course was held for groups of 10-12 people for 3 days a week for a total of 6 hours. Tests (...) given prior to and following completion of the course were used to assess the effectiveness of a medical ethics training course in which 120 resident physicians completed. The evaluation was made on the basis of the same pre-and post-tests (14 scenarios) and direct observation of participants. Result and Discussion: The average age was 28.23 ± 4.08 and 25% were female and 75% were male. Of the participants, 68.3% were training to be internists, 24.2% were training to be surgeons, and 7.5% were training in laboratory medicine. There was a significant statistical difference between the mean total scores of both tests (p=0.00). After completing the course, residents took into account the medical ethical principles while discussing ethical decisions. Conclusion: After finishing the course, participants defended their responses in regard to issues of medical ethics more carefully and articulated their thoughts more clearly. Our experience demonstrated that the trainees benefited from a structured curriculum in medical ethics. We believe that the development and implementation of our course may serve as a case study for training resident physicians in medical ethics. (shrink)

Transoral laser microsurgery applies to the piecemeal removal of malignant tumours of the upper aerodigestive tract using the CO2 laser under the operating microscope. This method of surgery is being increasingly popularised as a single modality treatment of choice in early laryngeal cancers (T1 and T2) and occasionally in the more advanced forms of the disease (T3 and T4), predomi- nantly within the supraglottis. Thomas Kuhn, the American physicist turned philosopher and historian of science, coined the phrase ‘paradigm shift’ in (...) his groundbreaking book The Structure of Scientific Revolutions. He argued that the arrival of the new and often incompatible idea forms the core of a new paradigm, the birth of an entirely new way of thinking. This article discusses whether Steiner and col- leagues truly brought about a paradigm shift in oncological surgery. By rejecting the principle of en block resection and by replacing it with the belief that not only is it oncologically safe to cut through the substance of the tumour but in doing so one can actually achieve better results, Steiner was able to truly revolutionise the man- agement of laryngeal cancer. Even though within this article the repercussions of his insight are limited to the upper aerodigestive tract oncological surgery, his willingness to question other peoples’ dogma makes his contribution truly a genuine paradigm shift. (shrink)

Medicine, like law, is a pragmatic, probabilistic activity. Both require that decisions be made on the basis of available evidence, within a limited time. In contrast to law, medicine, particularly evidence-based medicine as it is currently practiced, aspires to a scientific standard of proof, one that is more certain than the standards of proof courts apply in civil and criminal proceedings. But medicine, as Dr. William Osler put it, is an "art of probabilities," or at best, a "science of uncertainty." (...) One can better practice medicine by using other evidentiary standards in addition to the "scientific." To employ only the scientific standard of proof is inappropriate, if not impossible; furthermore, as this review will show, its application in medicine is fraught with bias. Evidence is information. It supports or undermines a proposition, whether a hypothesis in science, a diagnosis in medicine, or a fact or point in question in a legal investigation. In medicine, physicians marshal evidence to make decisions on how to best prevent, diagnose, and treat disease, and improve health. In law, courts decide the facts and render justice. Judges and juries assess evidence to establish liability, to settle custody and medical issues, and to determine a defendant's guilt or innocence. (shrink)

This exchange of correspondence with a critic provides helpful explanations of aspects of the paper "On Evidence, Medical and Legal" by the same authors.