Kant and Medicine - the Philosopher as Anthropologist, Physician and Patient. It remains uncertain whether the student Immanuel Kant (1724-1804) truly wanted to become a physician or only said this in order to please a sponsor. Due to his narrow chest and other typical weaknesses of a scholar he considered himself a hypochondriac and cautiously kept his distance from dangerous illnesses, especially those of the mind. He inspired his students - including Herder, Herz, Lenz and Hoffmann - far less (...) with logic and metaphysics than with exciting findings about far away countries, their alien inhabitants and the health dangers lurking in exotic parts of the world. He called for philosophical treatment of physical illnesses beyond the limited "veterinary" approach of medicine. He claimed the responsibility of the philosophy faculty for forensic questions. Kant developed original ideas about the seat of the soul, which led to the construction of a first model of the brain including functioning synapses. He was unable to overcome reservations about smallpox vaccination because he feared a change in the germ line. He wanted to see "how long the stuff would last" and during his later decades used all the classic dietetics to successfully extend his life. These sex res non-naturales continue to play a significant role in the prevention of widespread diseases today. Then an "electric revolution of the air strata" took its toll on him. Towards the end, his confidants were to look at him like a child, who, however, left posterity an extensive work with deep insights into his thinking, the Opus postumum. (shrink)

Papaya is a tropical fruit with a green cover, yellow pulp, and a taste between mango and cantaloupe, having commercial importance because of its high nutritive and medicinal value. The process of sorting papaya fruit based on maturely is one of the processes that greatly determine the mature of papaya fruit that will be sold to consumers. The manual grading of papaya fruit based on human visual perception is time-consuming and destructive. The objective of this paper is to the (...) status classification of papaya fruits if it's mature or partially matured or unmatured. A deep learning technique that was extensively applied to image recognition was used. The trained model achieved an accuracy of 100% on a held-out test set, demonstrating the feasibility of this approach. Classification model of VGG16 achieved a 100% accuracy and 112 seconds of training time. (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. Relative bioavailability of trace minerals in production animal nutrition: A review. Anim. 2022; 12:e1981. 6. Arthington JD, Ranches J. Trace mineral nutrition of grazing beef cattle. Anim. 2021; 11:e2767. 7. Silva NCD, Martins TLT, Borges I. Efeito dos microminerais na alimentação de ruminantes. Ci Anim. 2017; 27:75-98. 8. Tufarelli V, Ragni M, Laudadio V. Feeding forage in poultry: A promising alternative for the future of production systems. Agric. 2018; 8:1-10. 9. Elgersma A, Søegaard K, Jensen SK. Fatty acids, α-tocopherol, β-carotene, and lutein contents in forage legumes, forbs, and a grass–clover mixture. J Agric Food Chem. 2013; 61:11913–11920. 10. Collet SG, Demeda MA, Taffarel GV, Taffarel L, Girardini LK, Nesi CNH, et al. Efeito de um suplemento mineral traço e vitaminas A e E injetáveis sobre a produção e composição de leite em vacas Holandesas. Rev Ci Agrovet. 2017; 16:463-472. 11. Silva NCD, Martins TLT, Borges I. Macrominerais: Deficiências E Interações Com A Produção E Nutrição De Ruminantes. Scient Agr Paranaensis. 2018; 17:263-271. 12. Danieli B, Schogor ALB. Uso de aditivos na nutrição de ruminantes: revisão. Vet Zootec. 2020; 27:1-13. 13. Goff JP. Invited review: Mineral absorption mechanisms, mineral interactions that affect acid–base and antioxidant status, and diet considerations to improve mineral status. J Dairy Sci. 2018; 101:2763–2813. 14. NRC. National Research Council. Nutrient requirements of beef cattle. 8th ed.Washington, DC.: The National Academy Press; 2016. 15. Silva LFC, Valadares Filho SC, Engle TE, Rotta PP, Marcondes MI, Silva FAZ, et al. Macrominerals and trace element requirements for beef cattle. Plus One. 2015; 10:e0144464. 16. Miranda MMF, Ferrarezi Junior E, Cavichioli FA. Boas práticas agropecuárias: Os benefícios da suplementação alimentar em ruminantes. Int Tec. 2021; 18:455-465. 17. Bhanderi BM, Goswami A, Garg MR, Samanta S. 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Commun Soil Sci Plant An. 2020; 51:2001-2021. 23. Byrne L, Murphy RA. Relative bioavailability of trace minerals in production animal nutrition: A review. Anim. 2022. 12:e1981. 24. Valentim JK, Mendes JP, Przybulinski BB, Serpa FC, Barbosa DK, Castilho VAR, et al. Fatores nutricionais aplicados à reprodução de ruminantes. Rev Uniciên. 2019; 23:77-82. 25. Martins KPF, Fonseca TRS, Silva ES, Munhoz TCP, Dias, GHS, Glauco JN, et al. Bócio em bovino. Pesq Vet Bras. 2018; 38:1030-1037. 26. González-Montaña JR, Escalera-Valente F, Alonso AJ, Lomillos JM, Robles R, Alonso ME. Relationship between vitamin B12 and cobalt metabolism in domestic ruminant: An update. Anim. 2020; 10:e1855; 27. Ventura RA, Cuzzuol GD, Silva TB, Malegoni ACS, Roque LZ, OLiveira SFC, et al. Deficiência de cobalto em bovinos: Revisão. Pubvet. 2021; 15:1-4. 28. Lopes HOS. Suplementação de Baixo Custo para Bovinos Mineral e Alimentar. 1st ed. Brasília, DF: Embrapa Cerrados; 1998. 29. 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)

Venomous snakebite is a neglected tropical disease and disease of poverty, affecting hundreds of thousands of people annually. The only effective medical intervention for snakebite is antivenom, produced primarily using captive venomous snakes as a source of venom. This paper analyzes snakes’ welfare at venom labs within this global health context. I recommend significant changes to improve the welfare of captive snakes, particularly in light of recent ethological research and attention on snakes. These recommendations are broadly consequentialist, aiming to (...) improve the lives of the snakes and ensure that people have increased access to affordable antivenom. (shrink)

Tropical cyclones and their pertinent natural hazards can cause destructive damage to people and properties. Vietnam, located in the Northwest Pacific basin, is highly vulnerable to tropical cyclones due to its geography (i.e., a long coastline and narrow width). In this paper, we discuss how the negative consequences of tropical cyclones on Vietnam can be exacerbated by climate change and how forests, either in the mountainous or in the coastal regions, play crucial roles in safeguarding the country (...) from tropical cyclones and their pertinent hazards (e.g., landslides and flood). Despite the importance of forests, their protection values are undermined, leading to continuous deforestation of natural forests for socio-economic development. We suggest the social transitions towards eco-surplus culture through more proactive and transparent communication of the destructive outcomes of tropical cyclones and the protection roles of forests in the current climate change era. (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)

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)

Many countries in Africa, and more generally those in the Global South with tropical areas, are plagued by illnesses that the wealthier parts of the world (mainly ‘the West’) neither suffer from nor put systematic effort into preventing, treating or curing. What does an ethic with a recognizably African pedigree entail for the ways various agents ought to respond to such diseases? As many readers will know, a characteristically African ethic prescribes weighty duties to aid on the part of (...) those in a position to do so, and it therefore entails that there should have been much more contribution from the Western, ‘developed’ world. However, what else does it prescribe, say, on the part of sub-Saharan governments and the African Union, and are they in fact doing it? I particularly seek to answer these questions here, by using the 2013-16 Ebola crisis in West Africa to illustrate what should have happened but what by and large did not. (shrink)

Tropical grasses are fast growing and often used for phytoremediation. Three different types of tropical grasses: Vetiver (V. zizanoides), Imperata (I. cylindrical) and Pennisetum (P. purpureum) tested in different growth media of spiked heavy metal contents under the glasshouse environment of RimbaIlmu for 60-day. The growth performance, metals tolerance and phyto-assessment of cadmium (Cd), lead (Pb), zinc (Zn) and copper (Cu) in shoots and roots were assessed using flame atomic absorption spectrometry (FAAS).Tolerance index (TI), translocation factor (TF), biological (...) accumulation coefficient (BAC), biological concentration factor (BCF), and uptake efficacy was applied to evaluate the metal translocation ability among all three grasses. All three grasses showed significantly higher (p<0.05) accumulation of the total heavy metals in the spiked metal treatment compared with other tested treatments. Vetiver accumulated remarkably higher total concentration of Cd (93.08 ± 3.81 mg/kg) and Zn (1284.00 ± 234.83 mg/kg) than both Imperata and Pennisetum. The overall trend of heavy metals accumulation for all three grasses followed the order of Zn>Pb>Cd>Cu. The results of study suggested that both Imperata and Pennisetum are commendable and potential phytoextractors for Zn as well as phytostabilizers for Cd, Pb and Cu, respectively. (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)

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)

● Much more relevant than the simplicity or complexity of a method of measuring the houses is whether such a division remains true to the physics of the sky (i.e. whether it makes any sense at all). ● Because astrology has no central institution to decide what is valid and what is not, we believe that the least astrologists should do is to respect the truths confirmed by science. Physics teaches that we cannot separate time from space or space from (...) time, for they stand in an unbreakable or indissoluble relationship which we call continuum , a plane made up of four dimensions (i.e. the three of space plus the one of time) regarded as spacetime, and that time is not absolute but relative (dependent on frames of reference). ● Astrology — which is not horoscopism but one of the consequences of physics — appeals to different methods of measuring segments of our horizon known as houses, sectors, or regions and has classified them into space-based measurements and time-based measurements (according to which of the two concepts decides the subdivision of the diurnal arc) , but said classification is impertinent according to the reality that governs us. ● One that can be confirmed to be compatible with our reality is to be employed at all times for all types of charts, that is to say, one that is truly or essentially spacetime-based without, at the same time, presenting any of the errors characteristic of other house systems . We will see that only one will be compatible with relativity, for while the others would have us believe that time is absolute, the Placidus method of house measurement will show us that it is relative. ● The difference lies in the ability of a method to recognise the different ascensional times of not only the twelve segments of our ecliptic at different latitudes but also of each degree of said circumference simultaneously and uninterruptedly, that is, temporally simultaneously and spatially uninterruptedly during their trajectories from the horizon (ASC) to the midheaven (MC). We concluded, based on the house cusp analysis, that only the Placidean formula can carry out this promise, that is, make it possible to measure the lengths of time under said conditions. ● While the Alcabitius and Koch measurements of time assign fictional speeds — i.e. times of oblique ascension — to all degrees contained between the horizon (ASC) and the midheaven (MC), Placidus takes care to measure the speeds or true times for all. The measurement most Newtonian of all the methods of house division, Regiomontanus, in turn, clings to space at the expense of time, the reason for which it cannot reflect the true positions of the planets in spacetime (ignores the relationship between space and time). ● During the demonstrational process, we take the opportunity of pointing out that velocity (special relativity) and gravity (general relativity) do not constitute the only — two — primary forms of time dilation. The tilt of a reference frame relative to another (that of Earth relative to the plane of our ecliptic, although velocity remains a variable, whereas gravity, in turn, a possibility we will explore in the appendices) constitutes the third form. ● We encourage any physicist and/or astronomer to corroborate our observations with their own tools. For our part, we have employed the astrological/astronomical software Solar Fire Gold, although the astrographs come from the astrological/astronomical software Janus. (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.

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)

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

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 (...) class='Hi'>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)

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)

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)

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)

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)

O presente estudo tem por objetivo discutir a recepção do platonismo na produção lírica de Raul de Leoni (1895-1926). Atualmente, o nome de Leoni é majoritariamente ausente da matriz curricular do ensino de poesia brasileira; sua figura foi praticamente esquecida nos círculos acadêmicos. Não obstante essa lacuna, seu único livro publicado, intitulado Luz mediterrânea (1922), gozou de grande reconhecimento e prestígio entre poetas e críticos do período, dentre eles Alceu Amoroso Lima, Ribeiro Couto e Múcio Leão. A fim de melhor (...) explorar sua obra, o artigo se divide em dois momentos: na primeira seção, aborda-se o lugar da poesia de Leoni e suas peculiaridades; enquanto, na segunda seção, analisam-se os elementos clássicos constituintes de sua produção, demonstrando de que modo o poeta faz uso habilidoso de concepções geralmente atribuídas a Platão. Palavras-chave: Raul de Leoni, Poesia brasileira, Estudos Clássicos, Platonismo no Brasil. (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)

Abstract -/- Rationale, aims and objectives: Irregularity limits human ability to know, understand and predict. A better understanding of irregularity may improve the reliability of knowledge. -/- Method: Irregularity and its consequences for knowledge are considered. -/- Results: Reliable predictive empirical knowledge of the physical world has always been obtained by observation of regularities, without needing science or theory. Prediction from observational knowledge can remain reliable despite some theories based on it proving false. A naïve theory of irregularity is outlined. (...) Reducing irregularity and/or increasing regularity can increase the reliability of knowledge. Beyond long experience and specialization, improvements include implementing supporting knowledge systems of libraries of appropriately classified prior cases and clinical histories and education about expertise, intuition and professional judgement. -/- Conclusions: A consequence of irregularity and complexity is that classical reductionist science cannot provide reliable predictions of the behaviour of complex systems found in nature, including of the human body. Expertise, expert judgement and their exercise appear overarching. Diagnosis involves predicting the past will recur in the current patient applying expertise and intuition from knowledge and experience of previous cases and probabilistic medical theory. Treatment decisions are an educated guess about the future (prognosis). Benefits of the improvements suggested here are likely in fields where paucity of feedback for practitioners limits development of reliable expert diagnostic intuition. Further analysis, definition and classification of irregularity is appropriate. Observing and recording irregularities are initial steps in developing irregularity theory to improve the reliability and extent of knowledge, albeit some forms of irregularity present inherent difficulties. (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)

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)

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)

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)

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...

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)

Tropical grasses are fast growing and often used for phytoremediation. Three different types of tropical grasses: Vetiver (V. zizanoides), Imperata (I. cylindrical) and Pennisetum (P. purpureum) tested in different growth media of spiked heavy metal contents under the glasshouse environment of RimbaIlmu for 60-day. The growth performance, metals tolerance and phyto-assessment of cadmium (Cd), lead (Pb), zinc (Zn) and copper (Cu) in shoots and roots were assessed using flame atomic absorption spectrometry (FAAS).Tolerance index (TI), translocation factor (TF), biological (...) accumulation coefficient (BAC), biological concentration factor (BCF), and uptake efficacy was applied to evaluate the metal translocation ability among all three grasses. All three grasses showed significantly higher (pPb> Cd >Cu. The results of study suggested that both Imperata and Pennisetum are commendable and potential phytoextractors for Zn as well as phytostabilizers for Cd, Pb and Cu, respectively. (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)

Sources of soil contamination can exist in various types of conditions including in the form of semifluids. In this study, 3 different types of tropical plants, Acacia (Acacia mangium Willd), Mucuna (Mucuna bracteata DC. ex Kurz) and Vetiver (Vetiveria zizanioides L. Nash), were tested under different levels of soil-leachate conditions. The relative growth rate, metal tolerance, and phytoassessment of cadmium (Cd) and lead (Pb) accumulation in the roots and shoots were determined using flame atomic absorption spectrometry. Tolerance index, translocation (...) factor, metal accumulation ratio, and percentage metal efficacy were applied to assess the metal translocation ability among all the 3 types of plants. Significantly higher (P < .05) accumulation of Cd and Pb was exhibited in the roots and shoots of all 3 plants growing under the soil-leachate conditions. However, negative growth performance and plant withering were observed in both Acacia and Mucuna with increased application of higher soil-leachate levels. Vetiver accumulated remarkably higher total concentration of Cd (116.16-141.51 mg/kg) and Pb (156.37-365.27 mg/kg) compared with both Acacia and Mucuna. The overall accumulation trend of Cd and Pb in the 3 plants growing under the soil-leachate conditions was in the order of Vetiver > Acacia > Mucuna. The findings of the study suggest that Vetiver has great potential as Cd and Pb phytoremediator in soil-leachate conditions. (shrink)

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)

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)

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.

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)

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?

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 purpose of this chapter is to describe what we see as several important new directions for philosophy of medicine. This recent work (i) takes existing discussions in important and promising new directions, (ii) identifies areas that have not received sufficient and deserved attention to date, and/or (iii) brings together philosophy of medicine with other areas of philosophy (including bioethics, philosophy of psychiatry, and social epistemology). To this end, the next part focuses on what we call the “epistemological (...) turn” in recent work in the philosophy of medicine; the third part addresses new developments in medical research that raise interesting questions for philosophy of medicine; the fourth part is a discussion of philosophical issues within the practice of diagnosis; the fifth part focuses on the recent developments in psychiatric classification and scientific and ethical issues therein, and the final part focuses on the objectivity of medical research. (shrink)

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.

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)

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 (...) class='Hi'>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)

The rise of personalised medicine can be seen as an extension of individualism and as a threat to the common good.

Even though the evidence‐based medicine movement (EBM) labels mechanisms a low quality form of evidence, consideration of the mechanisms on which medicine relies, and the distinct roles that mechanisms might play in clinical practice, offers a number of insights into EBM itself. In this paper, I examine the connections between EBM and mechanisms from several angles. I diagnose what went wrong in two examples where mechanistic reasoning failed to generate accurate predictions for how a dysfunctional mechanism would respond (...) to intervention. I then use these examples to explain why we should expect this kind of mechanistic reasoning to fail in systematic ways, by situating these failures in terms of evolved complexity of the causal system(s) in question. I argue that there is still a different role in which mechanisms continue to figure as evidence in EBM: namely, in guiding the application of population‐level recommendations to individual patients. Thus, even though the evidence‐based movement rejects one role in which mechanistic reasoning serves as evidence, there are other evidentiary roles for mechanistic reasoning. This renders plausible the claims of some critics of evidencebased medicine who point to the ineliminable role of clinical experience. Clearly specifying the ways in which mechanisms and mechanistic reasoning can be involved in clinical practice frames the discussion about EBM and clinical experience in more fruitful terms. (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)

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)