A pluralist challenge to “integrative medicine”: Feyerabend and Popper on the cognitive value of alternative medicine

This paper is a critique of ‘integrative medicine’ as an ideal of medical progress on the grounds that it fails to realise the cognitive value of alternative medicine. After a brief account of the cognitive value of alternative medicine, I outline the form of ‘integrative medicine’ defended by the late Stephen Straus, former director of the US National Centre for Complementary and Alternative Medicine. Straus’ account is then considered in the light of Zuzana Parusnikova’s recent criticism of ‘integrative medicine’ and her distinction between ‘cognitive’ and ‘opportunistic’ engagement with alternative medicine. Parusnikova warns that the medical establishment is guilty of ‘dogmatism’ and proposes that one can usefully invoke Karl Popper’s ‘critical rationalism’ as an antidote. Using the example of Straus, I argue that an appeal to Popper is insufficient, on the grounds that ‘integrative medicine’ can class as a form of cognitively-productive, critical engagement. I suggest that Parusnikova’s appeal to Popper should be augmented with Paul Feyerabend’s emphasis upon the role of ‘radical alternatives’ in maximising criticism. ‘Integrative medicine’ fails to maximise criticism because it ‘translates’ alternative medicine into the theories and terminology of allopathic medicine and so erodes its capacity to provide cognitively-valuable ‘radical alternatives’. These claims are then illustrated with a discussion of ‘traditional’ and ‘medical’ acupuncture. I conclude that ‘integrative medicine’ fails to exploit the cognitive value of alternative medicine and so should be rejected as an ideal of medical progress.     

Focus: The Aging Brain: Palliative Care and the Humanities: Centralizing the Patient at the End of Life

Palliative care is a quickly growing facet of modern medicine. While scientific advancements have broken new ground for the possibilities of end-of-life care, sensitive treatment of the patient as an individual has lagged behind and has frequently led to an unsatisfactory experience for patients, families, and the medical community at large. This essay argues that centralizing patients during the terminal phases of treatment by using humanistic perspectives has the potential to bring new meaning and improved effectiveness to patients and physicians alike.     

The Canadian general internist: education and future role.

Available manpower data indicate that for the forseeable future there will be a continuing requirement in Canada for specialists in general internal medicine. While these specialists will be located predominantly in community hospitals, they will also be needed in university medical centres. The major roles of the general internist will be (a) to provide consultative service to primary care physicians and to other specialists, (b) to provide continuing care to patients with complex serious illness and (c) to participate in intensive care, particularly in community hospitals. Therefore training programs in this specialty must provide adequate experience in consultative medicine in both university and community hospitals, an opportunity to follow up patients with chronic serious illness over long periods, and experience in a variety of intensive care settings including surgical intensive care units. In some university departments the organization and supervision of training programs in this discipline have been carried out by a division of internal medicine that has equal status with other specialty divisions within the department. This seems to have been a salutory development.     

Community medicine for clinicians in Canada: a recommendation for postgraduate training.

A large gap presently exists between the predominantly biologic expertise of the medical profession and the complex mixture of biologic, behavioural and epidemiologic components of health problems today. Furthermore, the development of community medicine in Canada has been relatively separate from that of the clinical disciplines. To enable clinicians to acquire the knowledge and skills to manage these health problems, much more community-oriented research, applied behavioural science and clinical epidemiology is needed within the clinical sector of medicine. I have proposed a definition of clinical community medicine and presented a strategy for training clinicians in community medicine skills that calls for administrators of clinical postgraduate programs to develop training in clinical community medicine. Residency programs in community medicine cannot be expected to provide such training given their nonclinical priorities, which focus mainly on the training of public health physicians.     

Pharmacology and Diagnosis of Pesticide-Induced Illnesses

Although emphasis upon the concept of environmental health is a recent development in the medical community at large, the environment in which man worked has been of considerable concern to physicians in occupational medicine for a quarter of a century or more.Among the environmental factors which may adversely affect the health of exposed persons are the pesticides. The pharmacologic properties of these chemicals as well as the diagnostic signs and symptoms are presented herein.     

Emergency Preservation and Resuscitation Trial: A Philosophical Justification for Non‐Voluntary Enrollment

In a current clinical trial for Emergency Preservation and Resuscitation (EPR), Dr. Samuel Tisherman of the University of Maryland aims to induce therapeutic hypothermia in order to ‘buy time’ for operating on victims of severe exsanguination. While recent publicity has framed this controversial procedure as ‘killing a patient to save his life’, the US Army and Acute Care Research appear to support the study on the grounds that such patients already face low chances of survival. Given that enrollment in the trial must be non‐voluntary, the study has received an exemption from federal standards for obtaining informed consent. How exactly, if at all, is non‐voluntary enrollment morally justifiable? In this essay, I appeal to the notable work of Hans Jonas in an effort to defend the EPR trial's use of non‐voluntary enrollment. It is often thought and, as I show, it may appear that Jonas has called for the end of experimental medical practice. Still, I derive from Jonas a principle of double‐effect upon which physicians may be seen as morally permitted to pursue innovations in emergency medicine but only as a byproduct of pursuing therapeutic success. With this position, I argue that the EPR trial can be granted a stronger philosophical justification than simply waiving the requirement of obtaining informed consent. The double‐effect justification would obtain, perhaps regardless of the success of such innovative procedures as therapeutic hypothermia.     

Might there be a medical conscience?

I defend the feasibility of a medical conscience in the following sense: a medical professional can object to the prevailing medical norms because they are incorrect as medical norms. In other words, I provide an account of conscientious objection that makes use of the idea that the conscience can issue true normative claims, but the claims in question are claims about medical norms rather than about general moral norms. I further argue that in order for this line of reasoning to succeed, there needs to be an internal morality of medicine that determines what medical professionals ought to do qua medical professionals. I utilize a constructivist approach to the internal morality of medicine and argue that medical professionals can conscientiously object to providing treatment X, if providing treatment X is not in accordance with norms that would have been constructed, in light of the end of medicine, by the appropriate agents under the appropriate conditions.     

Practices of the Pregnant Self: Compliance With and Resistance To Prenatal Norms

A major challenge of medical anthropology is to assess howbiomedicine, as a vaguely-defined set of diverse texts,technologies, and practitioners, shapes the experience of selfand body. Through narrative analyses of in-depth, semi-structuredinterviews with 158 pregnant women in southern California, thispaper explores how the culture of biomedicine, encounteredformally at prenatal care check-ups and informally throughdiverse media, influences pregnant women's perceptions ofappropriate prenatal behavior. In the spirit of recent socialscientific work that draws on and challenges Foucauldian insightsto explore social relations in medicine, we posit a spectrum ofcompliance and resistance to biomedical norms upon whichindividual prenatal practices are assessed. We suggest thatpregnancy is, above all, characterized by a split subjectivity inwhich women straddle the authoritative and the subjugated, theobjective and the subjective, and the haptic as well as theoptic, in telling and often strategic ways. In so doing, weidentify the intersection between the disciplinary practices ofbiomedicine and the practices of pregnant women as a means offurnishing more fruitful insights into the oft-used term ``power'and its roles in constituting social relations in medicine.     

军校预防医学专业本科学员临床课程教学现状及建议

随着医学模式的转变,预防医学已经成为现代医疗体系的重要组成部分,在提高公共卫生健康水平方面发挥着越来越重要的作用。为了更好地开展预防医学工作,预防医学专业学员不仅要掌握牢固的预防医学专业知识,更要具备丰富的临床医学知识。针对预防医学专业本科学员的临床课程教学,我校经过多年的探索与改革,已经积累了丰富经验,教学质量较高;但现阶段仍然存在着一些问题。本文分析我校预防医学专业本科学员临床课程的教学现状及存在的主要问题,并提出建议;从而为进一步提高预防医学专业本科学员的临床课程教学质量提供依据。     

An interview with Olivia Gude about connecting school and community arts practice

ABSTRACT

Olivia Gude has a long and distinguished career as both a public artist and an art educator. She is currently the Angela Gregory Paterakis Professor and Chair of Art Education at the School of the Art Institute of Chicago (SAIC), where she works with graduate and undergraduate students to prepare for working as artist educators in school and community settings. Her scholarly work includes a number of articles and book chapters about art education and community art. Prof. Gude has worked as a community public artist for many years and has created over 30 large-scale mural and mosaic projects, working with intergenerational groups, teens, elders, and children. I interviewed Prof. Gude at the SAIC building in downtown Chicago to discuss how her school, university, and community art engagement as well as her work with the National Coalition for Core Arts Standards, might offer suggestions for transforming arts education for the twenty-first century and provide authentic connections between school and community. Prof. Gude discusses important enduring understandings and big ideas from the new Visual Arts National Core Arts Standards, the Spiral Workshop youth art and research project she created while at University of Illinois at Chicago, and how her experience as a community artist informs her work with students in classroom settings.     

预防医学本科生在临床实习中存在的问题及其改进建议

预防医学是现代医疗体系的重要组成部分,在提高公共卫生健康水平方面发挥着极其重要的作用。为了更好地开展预防医学工作,预防医学专业本科生不仅要牢固掌握预防医学专业知识,更要掌握一定的临床医学基础知识和技能。临床实习是医学生加深所学的临床理论知识并将其转化为实践操作的主要途径,在预防医学本科生的培养中具有重要意义。我校经过多年的探索与改革,在预防医学本科生的临床实习方面积累了大量经验,但现阶段仍然存在着一些问题。本文分析预防医学本科生在临床实习过程中存在的主要问题并提出改进建议,从而为进一步提高预防医学本科生的培养质量提供依据。     

Epistemological reflections on the art of medicine and narrative medicine

This article challenges the widespread view that there is both a science and an art of medicine. Through examination of recent work in medical humanities --Jodi Halpern's From Detached Concern to Empathy (2001), Kathryn Montgomery's How Doctors Think (2006), and Rita Charon's Narrative Medicine (2006)--I argue that while a variety of epistemic techniques are important in medicine, it is not helpful to dichotomize them as "science" versus "art." I assess the epistemic strengths and weaknesses of narrative medicine, a recent exemplar of humanistic medicine.     

En-case-ing the Patient: Disciplining Uncertainty in Medical Student Patient Presentations

The problem-oriented medical record is the widespread, standardized format for presenting and recording information about patients, which is taught to future physicians early in their medical training. Based on our participant observation of medical training, we analyze the ways in which the patient presentation operates in medical training as a disciplinary technology that manages uncertainty in the clinical decision-making process. We uncover various mechanisms at work including the construction of a coherent narrative structure in which chaotic experiences are re-organized and re-interpreted to fit neatly in a linear plot with a predictable ending, the atomization of the patient as a whole into separable “problems,” the attempt to solve these “problems” as though they are independent of one another, and the mystification of translations in scale, which give rise to much of the uncertainty in medicine. Operating at the boundary of the chaotic and often ungraspable world of the suffering experience of the patient and the highly structured realm of the medical record, a patient presentation is one medium through which both a disciplined record of experience and disciplined medical practitioners are produced. This process functions to transform the human subject patient into a recognizable, generic clinical case, and the medical student into an identifiable, professional future physician.     

In memoriam: Gustaf Bolinder 19/12 1888–16/7 1957

Veena Das's work on suffering suggests that the appropriate approach to the subject is one that grounds research in social experience. To honor this pitch of anthropology, I examine the global mediatization of the trauma of political violence and its moral implications. I also describe the professional appropriation of suffering that transforms political economic conditions into medical realities. Because social experience is itself undergoing a profound alteration in the present period of disordered capitalism, the very phenomenological conditions that we have assumed as an ‘existential’ basis for responding to human misery are also being ominously transformed.     

The role of values in scientific theory selection and why it matters to medical education

In this paper, I argue that the role of values in theory selection is an important issue within medical education. I review the underdetermination argument, which is the idea within philosophy of science that the data serving as evidence for theories are by themselves not sufficient to support a theory to the exclusion of alternatives. There are always various explanations compatible with the data, and we ultimately appeal to certain values as our grounds for choosing one theory over another. I explore some of the ways contemporary feminist philosophers have chosen to grapple with the problem of underdetermination and proposed solutions to systematize how values might be incorporated into theory choice, drawing primarily from the work of Helen Longino and Elizabeth Anderson. I conclude by discussing how value‐laden inquiry should be incorporated within medical education to promote reflection towards medicine’s normative underpinnings.     

Personalised Medicine: A Critique on the Future of Health Care

In recent years we have seen the emergence of “personalised medicine.” This development can be seen as the logical product of reductionism in medical science in which disease is increasingly understood in molecular terms. Personalised medicine has flourished as a consequence of the application of neoliberal principles to health care, whereby a commercial and social need for personalised medicine has been created. More specifically, personalised medicine benefits from the ongoing commercialisation of the body and of genetic knowledge, the idea that health is defined by genetics, and the emphasis the state places on individual citizens as being “responsible for” their own health. In this paper I critique the emergence of personalised medicine by examining the ways in which it has already impacted upon health and health care delivery.     

Focus: Allergic Diseases and Type II Immunity: Allergies and Adaptations: A Perspective on the Need for Culturally Responsive Care to Medically Indicated Dietary Restrictions

In medicine, we tend to think of food as being equivalent to nutrition, and food allergies are understood primarily as a biomedical process. In this piece, I explore how my experience with food allergies intersects with my cultural identity as a second-generation Indian-American. I also offer insights from my experiences in medical training and practice and reflect on the responsibility of health providers to understand the social and cultural context of food allergies.