McMaster's pioneer in evidence-based medicine now spreading his message in England.

Dr. David Sackett, formerly of McMaster University and now at Oxford University in England, is considered one of the pioneers of the evidence-based medicine movement. This article looks at his colleagues'' assessment of Sackett''s contributions to medicine and at Sackett''s own views on his lengthy career.     

Lessons my $3101 cat taught me about universal health care

Dr. Brian Goldman describes how his cat''s experience with veterinary medicine has helped shape his views about Canada''s health care system.     

Making sense of shadows: Dr. James Third and the introduction of x-rays, 1896 to 1902.

The discovery of x-rays was announced by German physicist Wilhelm Conrad Röntgen in December 1895. This review of the introduction of the use of x-rays in Kingston, Ont., shows the rapidity of their adoption in Canadian medicine. By February 1896 "x-ray photographs" were being taken by Captain John Cochrane of the Royal Military College of Canada in Kingston. Initially a scientific and popular curiosity, the new rays were quickly applied to medicine, and by the fall of 1896 the Kingston General Hospital had acquired its own x-ray apparatus. The hospital superintendent, Dr. James Third, became a leading practitioner and promoter of radiographic diagnosis and radiation therapy. He published, in 1902, the first comprehensive review of the diagnostic and therapeutic uses of x-rays by a Canadian physician. Third''s writings reveal his technical knowledge, his organized approach to the application of radiography to clinical medicine and his cautious attitude. Like other physicians who have witnessed the introduction of new diagnostic techniques, Third feared that the new technology would usurp the physician''s clinical skills.     

Archival data on wild food plants used in Poland in 1948

Background

The author reports on the plants, rituals and spells used against worms and the so-called scantu (fright) in some areas of Sicily. The work is based on ethnobotanical research carried out, prevalently, between 2002-2006, in some areas of Eastern, South-Eastern, North-Central and South-Central Sicily.

Methods

This research is based on dialogue. Senior 'healers' were contacted; furthermore, doctors, teachers, farmers and in general 'experts' with herbs and 'magic' rituals. Information was collected about the way the plants of folk medicine are prepared. The interviewees were also invited to recite prayers and spells against helminthiasis.

Results

The author has highlighted the importance of how, in some parts of Sicily, some ailments like helminthiasis and other correlated pathologies like scantu are 'treated' and, especially within the rural social classes, by folk medicine remedies, herbal practises, particular prayers, rituals and spells.

Conclusion

As regards health/illness, it should be noted that in the last ten years conventional medicine has provided very satisfactory results even resolving potentially mortal pathologies. However, in certain social classes, there is no real collaboration between conventional and folk medicine; so for some senior citizens, the 'healer' with his rituals and empirical and magical herbs is still the person to turn to for the 'cure' of particular ailments. Interest in these practises from ancestral heritage in an advanced country like Italy, is only relevant if the aim is to recoup a cultural identity which is already in decline. It is significant to report a piece: on 14 October 2007 the news on a well-known national Italian TV channel reported an interview with a 94 year-old man from Arbatax (Sardinia) referred to as a 'healer' because both his townspeople and others from all over the world go to him for his cures. He is not paid except in kind and has been known to cure St. Anthony's fire, burns, scalding and marine fungal infections, by smearing his saliva over the infected part and reciting 'special words'.     

The future of genomic medicine is here

A report on the 6th annual Future of Genomic Medicine conference, held at the Scripps Seaside Forum, La Jolla, CA, USA, March 7-8, 2013.On his flight over to San Diego to lead the Future of Genomic Medicine (FoGM) conference, Dr Eric Topol (Scripps Translational Science Institute, USA) used a heart monitor device attached to his smartphone to diagnose a distressed passenger with atrial fibrillation. Already, mobile technologies such as this one are beginning to transform medicine, and genome sequencing, with its rapidly decreasing costs, is no exception. As we get closer to mini-sequencers and what George Church (Harvard Medical School, USA) termed ''wearable sequencing'', a future of genomically informed medicine becomes possible. The FoGM conference integrated the patient-oriented perspective of genomic medicine, along with cutting-edge technologies and data integration, and developing methods and models in the aim of clinical utility.     

The road to Wisconsin

In this article Lynne Sears Williams of Calgary describes her family''s decision to leave for the US, where her husband, Dr. Jim Williams, will pursue his career in family medicine. The decision was not made easily, she writes, but eventually a love for Canada was outweighed by her husband''s desire to practise medicine without the financial and other constraints facing physicians in Canada.     

The Oslerian Tradition and Changing Medical Education: A Reappraisal

Although only 21 of Sir William Osler''s 45 years in academic medicine were spent in US medical schools (1884 to 1905), he played a major role in shaping modern medical education in this country. The integration of scholarship with patient care, together with the science and art of medicine, was central to Osler''s teaching and writing throughout his career. A classic generalist and a charismatic clinical teacher, he taught by example and was as concerned with the ideals of medicine as with its science and knowledge.Many changes have reshaped the content, process and concerns of American medical education since Osler''s time. Subspecialization and balkanization of medical education and practice have become dominant. Many of the important issues in medicine today do not fit neatly into the domain of any of the established specialties or medical organizations. There is now an urgent need to promote generalist attitudes in medicine, and the Oslerian tradition has much to offer in approaching today''s problems in medical education and practice.     

Brain and Mind

In the last few years great progress has been made in many fields of knowledge. Technology has moved forward with rapid strides, and with the appearance of self-regulating systems it has moved to a new stage. Significant progress has been achieved in physics and biology; new branches of medicine have been formulated and are being developed; and substantial changes have also been noted in a sphere of particular relevance and importance for each of us, in psychology, the science of man's mental life and the laws of his behavior.     

Do you have any regrets about entering medicine?

Do today''s students have any second thoughts about their decision to pursue a career in medicine? Gabriel Leung, who graduates in June from the University of Western Ontario, considers the problems and dilemmas that have confronted him and his classmates during their short careers and muses on the uncertain future today''s physicians face.     

Dr. Max King: the sad life and early death of Mackenzie King's physician brother

While researching her best-selling biography, Mrs. King: The Life and Times of Isabel Mackenzie King, CMAJ contributing editor Charlotte Gray discovered a wealth of information about Dr. Dougal Macdougall (Max) King. Although he never became as famous as his older brother Mackenzie, Gray presents a convincing argument that Dr. Max King''s life and early death speak volumes about medicine and the medical profession at the turn of the century. She also argues that Mackenzie King''s own life would have been much different had his brother not died at the too young age of 42. Gray''s book was nominated for the Viacom Award, which honours the best nonfiction book published annually in Canada.     

What's so special about Osler?

Sir William Osler was an outstanding figure in American and British Medicine during the early years of this century. Over fifty years after his death, his name is still remembered and honored, whereas other leaders who were equally important in the eyes of their contemporaries have been relegated to the realm of history. This brief review attempts to discover what special qualities have kept Osler''s memory vivid. No single characteristic of his skill, science, or personality seems in itself to explain his continuing reputation. Rather, a combination of his eminence in several different medical schools, his presence at a time of revolution in medical teaching and thought, his authorship of one of the most successful medical textbooks, and an enthusiastic claque of ex-students and colleagues seem to have combined to maintain his memory as a leader of medicine.     

Age as a Criterion for Setting Priorities in Health Care? A Survey of the German Public View

Although the German health care system has budget constraints similar to many other countries worldwide, a discussion on prioritization has not gained the attention of the public yet. To probe the acceptance of priority setting in medicine, a quantitative survey representative for the German public (n = 2031) was conducted. Here we focus on the results for age, a highly disputed criterion for prioritizing medical services. This criterion was investigated using different types of questionnaire items, from abstract age-related questions to health care scenarios, and discrete choice settings, all performed within the same sample. Several explanatory variables were included to account for differences in preference; in particular, interviewee''s own age but also his or her sex, socioeconomic status, and health status. There is little evidence that the German public accepts age as a criterion to prioritize health care services.     

Chronobiology: a frontier in biology and medicine

On the occasion of Franz Halberg's 70th birthday, some of his many achievements are reviewed. We provide a historical background to the development of chronobiology; offer insight into the current state of this new science; and sketch the promise of this discipline for health care and cure. As a tribute to Franz Halberg, in an era of fast-growing technology, an attempt is made to describe his perspective of tomorrow's medicine and biology. The many students he trained throughout his productive career face the challenge of deserving the trust he placed in them and of further implementing his vision. A leader in social pediatrics put it aptly: it will take several generations of researchers to study and master his life's work.     

Autonomy,Natality and Freedom: A Liberal Re‐examination of Habermas in the Enhancement Debate

Jurgen Habermas has argued that carrying out pre‐natal germline enhancements would be inimical to the future child's autonomy. In this article, I suggest that many of the objections that have been made against Habermas' arguments by liberals in the enhancement debate misconstrue his claims. To explain why, I begin by explaining how Habermas' view of personal autonomy confers particular importance to the agent's embodiment and social environment. In view of this, I explain that it is possible to draw two arguments against germline enhancements from Habermas' thought. I call these arguments ‘the argument from negative freedom’ and ‘the argument from natality’. Although I argue that many of the common liberal objections to Habermas are not applicable when his arguments are properly understood, I go on to suggest ways in which supporters of enhancement might appropriately respond to Habermas' arguments.     

HOMEOPATHY AND EXTRAORDINARY CLAIMS – A RESPONSE TO SMITH'S UTILITARIAN ARGUMENT

Kevin Smith's utilitarian argument against homeopathy 1 is flawed because he did not review and refute the relevant basic science literature on ultra‐high dilutions. He also failed to appreciate that allopathic medicine is based on a deductive‐nomothetic method and that homeopathic medicine is based on an inductive‐idiographic method, and thus that the implications for clinical research are very different. His misunderstanding of provings and of the holism of homeopathic medicine also demonstrated his failure to understand the history, philosophy and method of homeopathy. Finally, I questioned the value of introducing ethical judgment into an ongoing scientific debate.     

The Williams' legacy: A critical reappraisal of his nine predictions about the evolution of senescence

Williams' evolutionary theory of senescence based on antagonistic pleiotropy has become a landmark in evolutionary biology, and more recently in biogerontology and evolutionary medicine. In his original article, Williams launched a set of nine “testable deductions” from his theory. Although some of these predictions have been repeatedly discussed, most have been overlooked and no systematic evaluation of the whole set of Williams' original predictions has been performed. For the sixtieth anniversary of the publication of the Williams' article, we provide an updated evaluation of all these predictions. We present the pros and cons of each prediction based on recent accumulation of both theoretical and empirical studies performed in the laboratory and in the wild. From our viewpoint, six predictions are mostly supported by our current knowledge at least under some conditions (although Williams' theory cannot thoroughly explain why for some of them). Three predictions, all involving the timing of senescence, are not supported. Our critical review of Williams' predictions highlights the importance of William's contribution and clearly demonstrates that, 60 years after its publication, his article does not show any sign of senescence.     

抑郁症治疗的循证医学研究进展

循证医学是近年来国际上临床医学领域迅速发展起来的新学科,已成为当前国际医学研究中的热点之一,是指对病人的诊 断、治疗、预防、康复和其他决策应建立在当前最佳临床研究证据,是遵循证据的临床医学,强调收集最佳证据。其理念的科学性 和有效性迅速渗透到医学领域的众多学科,循证精神卫生也相继提出并发展。抑郁症是由各种原因引起的以抑郁为主要症状的 一组心境障碍或情感性障碍,近几年能够有效运用循证医学方法为治疗抑郁症寻找最佳临床证据,制定循证诊疗指南成为了临 床医生的迫切要求。本文就抑郁症治疗方面的循证医学研究进展做一综述。     

Sizing‐up the Competition: Factors Modulating Male Display Behavior During Mate Competition

When competing for mates, males of many species use cues from their rivals to evaluate their chances of success. Signaling behavior is a vital component of male–male contests and courtship, and may inform males of a rival's quality or intentions. We used eastern fence lizards (Sceloporus undulatus) to investigate how the time a male spent signaling during mate competition is influenced by his quality, his rival's quality relative to his own, and the value of a contested female. Furthermore, we examined how a male's behavioral response to a competitor's signals would be mediated by his relative quality. We simulated natural encounters by allowing two males to compete over a single female in the laboratory. We measured the time males spent performing two types of displays (pushups and shudders) and categorized male behavioral responses to rival pushup and shudder displays. Time spent signaling was not related to a male's absolute quality (body and head size, condition, and badge sizes), or his quality relative to that of his rival, although males did spend more time performing pushups when competing over females in better condition. Male behavior was also influenced by his rival's signals, such that males of relatively lower quality than their opponents were more likely to aggressively respond to rival pushups and shudders. We discuss these results with respect to the evolution and function of signaling behavior in courtship and male–male contests.