Meaning, Medicine, and the "Placebo Effect"

Meaning, Medicine, and the "Placebo Effect" Daniel Moerman Cambridge: Cambridge University Press, 2002. xiii. 172 pp.     

Decision making in the NICU--strategies,statistics, and "satisficing"

As science progresses, new issues in bioethics grab the headlines, but in neonatal medicine communication and decision making for sick and premature infants is as important today as it was thirty years ago. Decisions have to be made and made well, despite suboptimal time, data, or knowledge. To this end, the authors propose good communication and a cooperative model as key to interpreting the best interest standard in a way that respects parental rights and responsibility and allows best interest to be decided from an amalgam of medical facts and human values.     

蕲州地区的蕲艾、青蒿、黄花蒿与茵陈的考订

<正> 蕲州是我国中药材主要产地之一,是湖北省蕲春县的一个集镇,,是我国中医药大师李时珍的家乡。该地区生长的菊科蒿属植物Artemisia Linn。颇多,其中入药的有十余种,并在李时珍《本草纲目》中曾有记载。这里仅对该地区常见入药的蕲艾、青蒿、黄花蒿与茵陈结合《本草纲目》记载的材料作初步的考订。     

"Sweeping up after the parade": professional, ethical, and patient care implications of "turfing"

"Turfing" denotes a patient transfer or triage from one physician to another when the care of that patient feels more troublesome than it is worth. A widespread phenomenon in medical training programs, turfing appears to allocate patient care to meet physicians' rather than patients' needs. Although turfing reportedly causes inter-physician discord and inter-specialty stereotyping, its deeper consequences are poorly understood. Turfing is an interpersonal conflict masquerading as a medical issue. After examining turfing alongside other patient-related slang, I analyze the distinction between "the turf," a person, and "to turf," a practice. Several explanatory models from medical practice are explored in order to illuminate turfing's implications for medical professionalism, ethics, and patient care. I suggest that a physician's medical specialty or practice type--that is, professional culture--may link to that physician's degree of altruism. If so, then what it means fundamentally to be a physician might vary across medical specialties. Such a link calls for a new notion of cultural competence, one that physicians may apply not to patients but to each other.     

Body size, body proportions, and mobility in the Tyrolean "Iceman"

Body mass and structural properties of the femoral and tibial midshafts of the "Iceman," a late Neolithic (5,200 BP) mummy found in the Tyrolean Alps, are determined from computed tomographic scans of his body, and compared with those of a sample of 139 males spanning the European early Upper Paleolithic through the Bronze Age. Two methods, based on femoral head breadth and estimated stature/bi-iliac (pelvic) breath, yield identical body-mass estimates of 61 kg for the Iceman. In combination with his estimated stature of 158 cm, this indicates a short but relatively wide or stocky body compared to our total sample. His femur is about average in strength compared to our late Neolithic (Eneolithic) males, but his tibia is well above average. His femur also shows adaptations for his relatively broad body (mediolateral strengthening), while his tibia shows adaptations for high mobility over rough terrain (anteroposterior strengthening). In many respects, his tibia more closely resembles those of European Mesolithic rather than Neolithic males, which may reflect a more mobile lifestyle than was characteristic of most Neolithic males, perhaps related to a pastoral subsistence strategy. There are indications that mobility in general declined between the European Mesolithic and late Neolithic, and that body size and shape may have become more variable throughout the continent following the Upper Paleolithic.     

Science, Art, or Application—the "Karma" of Restoration Ecology

The present state of restoration ecology is far away from Bradshaw’s “acid test for ecology.” The conclusions drawn from the series of papers in this issue and from the Jena workshop suggest some directions in which the field may progress. More attention must be paid to the degraded state, which should be evaluated by its specific features and carefully analyzed before any restoration plan is laid down. Restoration goals have to be realistic, which includes the appreciation of globally changing conditions, resulting in a paradigm‐shift toward “forward‐restoration.” Basically, the transition from the degraded state conditions to the target state is a kind of succession that is manipulated by the application of goal‐orientated and system‐specific disturbances. Whenever possible, restorationists should step back and make use of naturally occurring succession, which requires a sophisticated restoration strategy, involving flexible management responses, multiple alternative target states, robust measurements for the restoration progress, and careful long‐term monitoring. The unique feature of restoration ecology is the involvement of socioeconomic decisions, and conceptual frameworks for ecological restoration have to implement the specific links to natural succession. To bridge the gap between ecological theory and on the ground restoration, it is essential that restoration practice is translated into the vocabulary and thinking of basic ecology. If all these aspects are integrated, ecological restoration as an application—and restoration ecology as an applied science—may develop into an acid test for our understanding of interactions between people and their environment, rather than for pure ecology.     

Men Who Are Called "Women" in Toba-Batak: Marriage, Fundamental Sex-Role Differences, and the Suitability of the Gloss "Wife-Receiver"

This article gives brief accounts of affinal relations, marriage, gender roles, and long-term lineage relationships among Toba Bataks of Samosir, north Sumatra, Indonesia. Ethnographic data, presented in tandem with data on the Kachin and similar cultures, are used to call into question the use of the term "wife-taker" as opposed to "wife-receiver," as it is generally employed with reference to the groom, his family, and lineage-mates, in glossing a major conceptual category of Southeast Asian hinterland societies that have preferred matrilateral cross-cousin marriage. It is argued that "wife-taker" is more distorting of Batak practice and of their system of values than "wife-receiver."     

Hypertriglyceridemia, the coronary heart disease risk marker "solved"

Both epidemiological and intervention studies have shown that hypertriglyceridemia is a significant cardiovascular risk factor. The large variation of the triglyceride values is explained by the influence of several modifying factors, which are difficult to standardise. Therefore hypertriglyceridemia should be considered rather as risk marker, than risk factor. The measurement of the apolipoprotein CIII level, which is a more stable parameter of the triglyceride rich lipid particles, is now becoming more widespread. This parameter is also able to substitute the assessment of the small dense LDL form that has a controversial significance. The clinical benefit of reduction of triglyceride concentration and the accompanying increase of HDL cholesterol level by fibrates, in the prevention of the coronary heart disease (CHD) events, have been demonstrated in several prospective, placebo-controlled trials. The VA-HIT study, enrolling the largest number of patients, has shown that fibrates have another effect, presumably influencing the insulin resistance independently of lipid levels that is also able to reduce the CHD events.     

A history of noma,the "Face of Poverty"

Noma (necrotizing ulcerative stomatitis, stomatitis gangrenosa, or cancrum oris) is a devastating orofacial gangrene that occurs mainly among children. The disease has a global yearly incidence of 140,000 cases and a mortality rate of approximately 90 percent. Patients who survive noma generally suffer from its sequelae, including serious facial disfigurement, trismus, oral incontinence, and speech problems. The medical history of noma indicates that the disease was already known in classical and medieval civilizations in Europe. In the sixteenth and seventeenth centuries, Dutch chirurgeons clearly described noma as a clinical entity and realized that the popular name "water canker" was not sufficient, because this quickly spreading ulceration in the faces of children was different from "cancer." In the eighteenth century, awareness that noma is related to poverty, malnutrition, and preceding diseases such as measles increased in northwestern Europe. In the first half of the nineteenth century, extensive surgical procedures were described for the treatment of the sequelae of noma. At the end of that century, noma gradually disappeared in the Western world because of economic progress, which gave the poorest in society the opportunity to feed their children sufficiently. Only in the twentieth century were effective drugs (sulfonamides and penicillin) against noma developed, as well as adequate surgical treatment for the sequelae of noma. These modes of treatment remain inaccessible for the many present-day victims of noma because of their extreme poverty. The only truly effective approach to the problem of noma throughout the world is prevention, namely, combating the extreme poverty with measures that lead to economic progress. In the meantime, medical doctors in the Western world should not forget their own history and ignore this global health problem; rather, they should face "the face of poverty" with the eyes of mercy and concern suited to their profession.