Analysis of Your Professional Liability Insurance Policy

The most important lessons for the physician to learn in regard to his professional liability insurance coverage are the following:1. The physician should carefully read his professional liability policy and should secure the educated aid of his attorney and his insurance broker, if they are conversant with this field.2. He should particularly read the definition of coverage and carefully survey the exclusion clauses which may deny him coverage under certain circumstances.3. If the physician is in partnership or in a group, he should be certain that he has contingent partnership coverage.4. The physician should accept coverage only from an insurance carrier of sufficient size and stability that he can be sure his coverage will be guaranteed for “latent liability” claims as the years go along—certainly for his lifetime.5. The insurance carrier offering the professional liability policy should be prepared to offer coverages up to at least $100,000/$300,000.6. The physician should be assured that the insurance carrier has claims-handling personnel and legal counsel who are experienced and expert in the professional liability field and who are locally available for service.7. The physician is best protected by a local or state group program, next best by a national group program, and last, by individual coverage.8. The physician should look with suspicion on a cancellation clause in which his policy may be summarily cancelled on brief notice.9. The physician should not buy professional liability insurance on the basis of price alone; adequacy of coverage and service and a good insurance company for his protection should be the deciding factors.     

The Philosophical Origins of Mitchell's Chemiosmotic Concepts

Mitchell's formulation of the chemiosmotic theory of oxidative phosphorylation in 1961 lacked any experimental support for its three central postulates. The path by which Mitchell reached this theory is explored. A major factor was the role of Mitchell's philosophical system conceived in his student days at Cambridge. This system appears to have become a tacit influence on his work in the sense that Polanyi understood all knowledge to be generated by an interaction between tacit and explicit knowing. Early in his life Mitchell had evolved a simple philosophy based on fluctoids, fluctids and statids which was developed in a thesis submitted for the z at the University of Cambridge, England. This aspect of his work was rejected by the examiners and became a tacit element in his intellectual development. It is argued from his various publications that this philosophy can be traced as an underlying theme behind much of Mitchell's theoretical writing in the 50's leading, through his notion of vectorial metabolism, to the formulation and amplification of the chemiosmotic theory in the sixties. This philosophy formed the basis for Mitchell of his understanding of biological systems and gave him his unique approach to cell biology. This revised version was published online in July 2006 with corrections to the Cover Date.     

The medium of signs: nominalism, language and the philosophy of mind in the early thought of Dugald Stewart

In 1792 Dugald Stewart published Elements of the philosophy of the human mind. In its section on abstraction he declared himself to be a nominalist. Although a few scholars have made brief reference to this position, no sustained attention has been given to the central role that it played within Stewart's early philosophy of mind. It is therefore the purpose of this essay to unpack Stewart's nominalism and the intellectual context that fostered it. In the first three sections I aver that his nominalism emanated from his belief that objects of the mind--qualities, ideas and words--were signs that bore no necessary relation to the external objects that they were meant to represent. More specifically, it was these signs that were arranged into systems of thought by the 'operations of the mind'. The next three sections suggest that his treatment of words as signs most probably originated in his views on language and medicine and that his nominalistic philosophy of mind could also be extended to systems that sought to classify the natural world. I conclude by suggesting several avenues of enquiry that could be pursued by future scholars interested in excavating Stewart's thought.     

Types Distinct from Our Own: Franz Boas on Jewish Identity and Assimiliation

Boas's published writings on assimilation were deeply influenced by his German Jewish background. In particular, his unwillingness to recognize Jewish cultural identity as a reality was central to his persistent emphasis on human plasticity and his insistence that people not be "classified" in groups. In support of this argument, 19th-century German and German Jewish history is reviewed, focusing on the relation between Kultur ideology and anti-Semitism. It is suggested that this approach to Boas's statements offers fresh perspective on some of the apparent confusion in his ideas about culture and assimilation.     

A Critique of Rob Lovering's Criticism of the Substance View

In his article, The Substance View: a critique, Rob Lovering argues that the substance view – according to which the human embryo is a person entitled to human rights – leads to such implausible implications that this view should be abandoned. In this article I respond to his criticism by arguing that either his arguments fail because the proponents of the substance view are not obligated to hold positions which may be considered absurd, or because the positions which they are assumed to be obligated to hold, are not absurd at all.     

Philip R. White (1901–1968)—a tribute

The groundbreaking research carried out by Philip R. White in the 1930s and 1940s played a critical early role in the development of modern plant biotechnology and the production of biotech crops. He gained instant fame and became a historical figure early in his career by becoming the first person to attain unlimited growth of cultured plant tissues. White was one of the best known and most influential figures of his generation in plant cell culture research. His tireless and lifelong efforts to promote the use of plant cell culture systems inspired a generation of scientists and stimulated much scientific activity. White was not only a brilliant and visionary scientist but also a highly principled man who spoke courageously about the great moral and political issues of his day. He was admired as much for his science as for his humanity. His belief that plant cell culture research was not well represented at national and international meetings, and his deeply held conviction that science had to be international and without borders in order to be of service to humankind led to the founding of the International Association for Plant Biotechnology in 1963, currently the largest forum for the international plant biotechnology community. This tribute honors and celebrates Philip R. White for his inspiring science, for his kind and generous mentoring of young scientists, for his advocacy of plant cell culture research and its applications, for his promotion of international scientific exchange and cooperation, and for his leadership in the founding of the International Association for Plant Biotechnology.     

Informed Consent in California: Latent Liability Without `Negligence'

Informed consent is a legal obligation due from a physician to his patient, an obligation which may not be met by the physician''s skillful treatment of his patient. It may only be met by the treating physician obtaining from his patient knowing authorization for carrying out the intended medical procedure. The physician is required to disclose whatever would be material to his patient''s decision, including the nature and purpose of the procedure, and the risks and alternatives. The disclosures should be made by the physician to his patient, and not through use of consent forms which are not particular to individual patients. To minimize any subsequent claim by the patient that there was a lack of adequate disclosures, the physician should record in the patient''s chart the circumstances of the patient''s consent, and should not rely on the patient''s unreliable ability to recall those circumstances.     

REFLECTION ON EUTHANASIA: WESTERN AND AFRICAN NTOMBA PERSPECTIVES ON THE DEATH OF A CHIEF

Largely, the concept of energy or vital force, as first analysed by Placide Tempels in Bantu Philosophy , permeates most African ontology systems, worldviews and life views. The Ntomba Chief is chosen because of his above average vital force. This puts him in the position of intermediary between the Supreme Being, the ancestors, and his subordinates. The waning of his energy is incompatible with his position because his energy is that of his tribe. When installed, he takes an oath that, when this happens, he has to accept mohilo , the 'hastening of death'. In the Chief's case, the hastening of death is not intended to relieve his pain, as it would be with other creatures. The Chief's dying a natural death would result in the loss of the entire community's vital force. Therefore, he has to be killed ritually to avoid that risk. That the Chief agrees to be killed – via a form of advanced directive – poses an ethical dilemma for a Western observer. From the Ntomba perspective, however, where the energy is being, and being is energy, it is the only way to preserve and protect the community's raison d'être .     

OPERATIONS IN UPPER EXTREMITY AMPUTEES

The surgeon is obligated to prepare the patient mentally as well as physically for amputation. Acceptance of his loss by the patient, his family and contemporaries is important in his adjustment to his environment. He must provide the best stump possible, direct the postoperative shrinking and conditioning of the stump, prescribe the prosthetic device best suited to the needs of the individual, make sure it fits and functions, and that the patient is instructed in its maximum use.There are definite indications for ablation of a part. All possible length in the upper extremity should be preserved.Amputation in children with congenital deformities should usually be postponed until demanded by the family. The growth centers should be preserved if feasible. Congenital upper extremity amputees should ordinarily be fitted within the first two years.Neuromata, spurs, redundant tissue, scars, and phantom pain should generally be treated by other than surgical methods. Revisions, including cineplasty, should be undertaken only after careful study and when there are clear indications that benefit to patient will ensue.     

Obituary Fumio Oosawa 1922–2019

Prof. Fumio Oosawa passed away in Nagoya on March 4, 2019, at the age of 96. As two of his former students we, like a great many scientists both in Japan and around the world, were much inspired and influenced by him. We have, at the request of the journal, penned this note to describe some of his major scientific contributions and also provide the readers of Biophysical Reviews with an idea of the remarkable personality and character traits that he displayed throughout his life. Fumio Oosawa (or Oosawa-san as he preferred to be called) was a physicist who initially entered the area of biophysics through studies in the field of condensed matter phenomena. Although a remarkable human being, he was, first and foremost, one of the leading scientists of his generation, making many original contributions that could, by any measure, be described as scientific breakthroughs. Therefore, before providing a short biography of his life in and around science, we thought it most appropriate to begin this Letter by first summarizing his major scientific contributions.     

Vincenzo Malacarne (1744-1816): a researcher in neurophysiology between anatomophysiology and electrical physiology of the human brain

Since his first years at Turin until the last years of his life at Padua, Vincenzo Malacarne devoted most of his time to the examination of the structures and the various parts of which the cerebellum and the human brain are composed. He is rightly considered as one of the first to have correctly described the anatomy of the cerebellum, as well in the field of human anatomy and comparative anatomy. However, his work cannot be reduced to these studies. He worked out a cerebral physiology, with organic and intellectual phenomena in mind, established on an anatomopsychic parallelism. This parallelism is itself founded on a rational and mathematical criterion: the number of lamellae contained in the cerebellum. A letter written by him in 1792 and addressed to Abbot Denina was recently found by the present author in November 2005 at the Academy of Sciences of Turin. Malacarne exposed his project of studying the animal electricity put forward by Galvani within the cerebral organ. May it be that Malacarne had in mind the physiology of his time while trying to record an electric activity within the brain?     

Studies of the Influence of Diet on Clearing-Factor Lipase (CFL) and Blood Lipid Levels of a Patient with Hyperlipidemia

A 30-year-old man was studied who had hyperlipidemia of a hereditary nature which was at first thought to be refractory to changes in diet. It was subsequently shown that the lipemia was adequately controlled by diet. The patient had no defect in his ability to produce clearing-factor lipase (CFL) following heparin injection, his chylomicra were not refractory to CFL, and his plasma showed no more than ordinary inhibitory activity against CFL. Under dietary conditions which resulted in a high degree of lipemia, much of the CFL was rendered inactive by adsorption on the chylomicra. The results suggest that the role of CFL in patients with hyperlipidemia may be minor.     

The DNA supercoiling-sensitive expression of the Salmonella typhimurium his operon requires the his attenuator and is modulated by anaerobiosis and by osmolarity

Bacterial cells possess a subset of genes whose expression correlates with changes in DNA supercoiling brought about by anaerobic growth and by growth at high osmolarity. It has been shown previously that expression of the histidine biosynthetic operon of Salmonella typhimurium is derepressed by relaxation of supercoiled DNA. Here, we confirm that a his::MudJ operon fusion in S. typhimurium can be induced by treatment with the DNA gyrase inhibitor novobiocin in a dose-dependent manner, and show that the level of derepression is higher in stationary phase than in mid-exponential phase cultures. Furthermore, expression of his is repressed by anaerobiosis and by osmolarity, two environmental parameters which increase the negative supercoiling of bacterial DNA. Novobiocin induction of his is also repressed by growing the cells either at high osmolarity or anaerobically. Both environmental repression and novobiocin induction of his require the his attenuator. In addition, derepression of his expression by novobiocin and its repression by anaerobiosis or osmolarity are independent of the stringent response gene, relA.     

The plaintiff's attorney and obstetrics

This paper was presented before a meeting of plaintiffs' attorneys, including those who specialize in malpractice actions against physicians-the National Association of Claimants' Compensation Attorneys (NACCA). Doctor Eastman is known internationally for his contribution in the field of obstetrics. In recent years his interests have led him into the field of forensic obstetrics, a complex and difficult subject. Some of these problems are explored by Dr. Eastman in this paper and his comments will be of interest to physicians and attorneys. It is to be hoped that NACCA members benefited by this accurate and scientific presentation.     

Gastric and duodenal ulcer; the surgeon's approach

A surgeon must have a clear conception of the indications for operation for either gastric or duodenal ulcer. He must realize that his indications must be modified by his operative mortality. The operation he carries out must be determined by several factors. It is the author's opinion that the various types of distal partial gastrectomy are those most likely to succeed and to produce the fewest undesirable postoperative sequelae.     

Linnaeus's natural and artificial arrangements of plants

Linnaeus's artificial and natural arrangements of plants are examined using a Spearman rank coefficient (which is explained) on his presentations of his own and others' arrangements in the Classes plantarum and elsewhere. There is little alteration in his successive artificial arrangements. In contrast, between 1751 and 1764 his natural arrangements changed considerably, partly in the sequences of genera within orders but mostly by rearrangement of the orders. Comparison with Cesalpino's and Ray's natural arrangements, using the longest-recognized natural groups as signposts, suggests that Linnaeus in his latest natural arrangement (1764) approximated more closely to Ray's. Examination of Linnaeus's successive treatments of certain groups (palms, Zingiberaceae, Hydrocharis-Stratiotes-Vallisneria) and of Giseke's exposition of Linnaeus's lectures on natural groups (1792) shows that Linnaeus was much influenced by habitus and vegetative characters as well as those of the fructification. He recognized orders consisting of a chain of genera linked successively by overall affinity and without any single diagnostic character. Where possible, he preferred characters of the fructification and his ‘secret’ consulting of the habitus is explained as secondary to such characters. It is suggested that in his latest arrangement he approximated more to a scala naturae, as he probably did in zoology about the same time. Within his artificial arrangements Linnaeus kept to sequences of genera as natural as possible. He realized that some groups in his natural arrangements were still artificial, and his aphorism that all genera and species are natural, classes and orders part natural and part artificial, refers to his and others' practice until the natural system could be completed. It is not a statement of the essential natures of these ranks. Linnaeus's distinction in practice between natural and artificial arrangements was less clear-cut than Sachs believed. Linnaeus's rejection of the ancient tree/herb division was empirical, not a reasoned repudiation of an a priori grouping. The tree/herb division could be upheld in his day as obviously natural, not merely accepted on authority.     

What about R.A. Fisher's statement of the "too good" data of J.G. Mendel's Pisum paper?

Mendel was accused by Fisher that his observed data, which corresponded to expectations, were too good to be true, and, further, that Mendel, growing only 10 plants per offspring, disregarded in his genotypical analysis the loss of recessives by assuming a ratio of 1:2 instead of 1.1126:1.8874. In contrast, it is proposed here that all chi-square statistics of genetic segregations fall short because the variance of genetic segregations is smaller and not of a binomial type as assumed. Furthermore, this variance and the corresponding chi-square statistics are not homogeneous in different segregation types. Consequently, it is not possible to summarize the different chi-square statistics as Fisher did. It is only in this way that he was able to obtain his unrealistic result (a probability of "seven times in 100,000 cases"). Regarding Fisher's second accusation, it should be taken into account that Mendel selected his 10 plants from offspring with a finite and not an infinite number of entities. Although this number is different from offspring to offspring, the average number is about 30. This means that the loss of recessives must be calculated by using a hypergeometric and not a binomial model as Fisher did. Consequently, the real deviation from the 1:2 ratio can be disregarded.     

Gastric and Duodenal Ulcer—A Surgeon's Approach

A surgeon must have a clear conception of the indications for operation for either gastric or duodenal ulcer. He must realize that his indications must be modified by his operative mortality. The operation he carries out must be determined by several factors. It is the author''s opinion that the various types of distal partial gastrectomy are those most likely to succeed and to produce the fewest undesirable postoperative sequelae.     

Neuroscience was not even a word: an interview with Floyd Bloom

Floyd Bloom says that he grew up, surrounded by doctors and pills, in a drug store in Dallas, where his father and uncles were pharmacists. He is a natural storyteller, readily recalling the people and events that have shaped his career. His narrative skills were apparent as early as high school, where he was encouraged, partially on the basis of aptitude tests, to pursue a career in journalism or public relations, and to stay away from hard subjects like math and science. In college, he majored in German literature, although he pursued premedical studies in accordance with his father's wishes. During his medical school and residency experiences in St. Louis, he recounts, he always attempted to carry in his mind an organized way of explaining his academic and clinical activities to the professors and attending physicians that might quiz him. His subsequent research into the central nervous system similarly benefited from his ability not only to anticipate and formulate questions, the answers to which often required the development of new methods, technologies, and alliances, but also to place his findings in novel contexts where they could be conceptually appreciated and utilized. The prospect of telling good scientific stories was one of the factors that later drew Bloom to the position of Editor-in-Chief of Science magazine (1995-2000). While there, he was instrumental in widening the contexts in which the magazine presents science, and in shaping the ways that scientific information is electronically disseminated across the globe. Currently on sabbatical from Scripps, Floyd Bloom continues to explore, as CEO of a startup company in La Jolla, the entrepreneurial contexts in which his own research can be applied.