Creating difficulties everywhere

In this essay we link the rationale for the medical humanities with radical hermeneutics, a move that infuses the medical humanities with incredulity and suspicion. This orientation is particularly important at this historical moment, when the evidence-based and competency blanket is threatening to overpower all aspects of medical education, including the medical humanities discourse itself. Radical hermeneutics works relentlessly against the final word on anything, and as such, it provides a critically provocative way of thinking about doctors, patients, illness, health, families, death--in short, the experience of being human. We use three literary examples to illustrate the complex, contradictory, perplexing, and disturbing questions related to a life in medicine: Rafael Campo's "Like a Prayer," Irvin Yalom's "Fat Lady," and Richard Selzer's "Brute."     

Pain, paradox, and value

The author argues that "as soon as one begins to study the understanding and management of pain in science, human medicine, and veterinary medicine, one begins to encounter a variety of apparent paradoxes." He contends that these paradoxes, ten of which he identifies and discusses in this essay, are based on flawed philosophical and valuational assumptions underlying science and medicine. Rollins concludes that, as social morality increasingly has an impact on science, a new ideology will evolve that is more receptive to the moral universe and more capable of a "coherent vision of pain, one which acknowledges that the medical notion of adequacy of anaesthesia is as much a moral as a scientific one."     

Animals as sentinels: using comparative medicine to move beyond the laboratory

The comparative medicine approach, as applied to the study of laboratory animals for the betterment of human health, has resulted in important medical and scientific progress. Much of what is known about the human health risks of many toxic and infectious hazards present in the environment derives from experimental studies in animals and observational (epidemiological) studies of exposed human populations. Yet there is a third source of "in vivo" knowledge about host-environment interactions that may be underused and -explored: the study of diseases in naturally occurring animal populations that may signal potential human health threats. Just as canaries warned coal miners of the risk of toxic gases, other nonhuman animals, due to their greater susceptibility, environmental exposure, or shorter life span, may serve as "sentinels" for human environmental health hazards. Traditionally, communication between human and animal health professionals about cross-species sentinel events has been limited, but progress in comparative genomics, animal epidemiology, and bioinformatics can now provide an enhanced forum for such communication. The "One Health" concept involves moving toward a comparative clinical approach that considers "shared risks" between humans and animals and promotes greater cooperation and collaboration between human and animal health professionals to identify and reduce such risks. In doing so, it also creates new opportunities for the field of comparative medicine that can supplement traditional laboratory animal research.     

Assessment of socio-economic ramifications

Implementation of remedial measures for contaminated sediments may well have to contend with the not in my backyard (NIMBY) syndrome. These are situations characterized by high levels of distrust which include transference of these feelings to the assessment techniques used to select the measures. Hence, there is an underlying contextual issue relating to the perceived legitimacy of the process through which decisions are made as the ramifications become apparent. The experiences of agencies searching for satisfactory solutions to such problems need to be more widely known.Moreover, remedial measures for contaminated sediments are but one portion of a set needed to rehabilitate degraded aquatic ecosystems. Recent collaborative work to outline feasible strategies for ecosystem rehabilitation in the Great Lakes is outlined. Such strategies are scientifically feasible, socio-economically defensible, and the institutions to address the problems are available. However, strategies need to be tailored to the circumstances of selected near-shore areas. For two such areas, analyses of societal arrangements have been directed to identifying the relevant actor system composed of government agencies and non-governmental groups, and assessing the alternatives to regulatory management. Various collaborative processes to facilitate rehabilitative management are noted, but the contextual issue remains pre-eminantly important.     

Style in medical journals.

A study of medical journals from 1962 showed a constant preoccupation with style. Editors and contributors on both sides of the Atlantic revile unnecessary obscurity and complexity and the use of jargon, barbarisms, vogue words, and weak impersonal constructions. They bewail the pompous use of verbiage and the "medspeak" typified by acronyms and neologisms created by affixation. Suggestions for possible causes of poor medical style range from editorial demands for compression and a general ignorance of the principles of good writing to faulty logic and the subordination of communication to status seeking. The consequences of bad writing may include the fragmentation of knowledge, an increase in the importance of abstracting services, a trend towards free glossy medical newspapers, and, as remedial measures, workshops and courses in medical writing. Some implications for English language teachers working with foreign medical graduates and preclinical students are discussed.     

Bioaccumulation of Key Metals and Other Contaminants by Seaweeds from the Egyptian Mediterranean Sea Coast in Relation to Human Health Risk

This study examined the bioaccumulation of key metals and other contaminants (SO₄, F, Na, K, Ca, Mg, P, Si, Fe, Mn, Zn, Ni, Co, Cu, and Cd) by seaweeds from the Egyptian Mediterranean Sea coast and their risk to human health. Bioaccumulation factor calculations indicated that S, F, Na, K, Zn, Cu, and Cd had high seaweed uptake and this referred to the potential pollution of the coastal area. Multivariate analysis of the studied contaminants confirmed the bioaccumulation factor results as well as the physiological processes in seaweeds. Human health risk assessment of F, Mn, Zn, Ni, Cu, and Cd was conducted using hazard quotient (HQ) and incremental lifetime cancer risk (ILCR) analyses. The carcinogenic assessment of sediments and ingestion of seaweeds using ILCR calculations revealed that Mn, Ni, and Cd in sediments and F and Zn in seaweeds require remedial action in order to reduce their human health risks. Additionally, HQ calculations for the contaminants in seaweeds and reference to toxicological references values from different agencies revealed that F and Co present high human health risk effects. Consequently, the potential public health risks from dietary exposure to hazardous contaminants in seaweeds must be continually subjected to research, regulation, and debate.     

Medicalization as a moral problem for preventative medicine

Preventive medicine is sometimes criticised as it contributes to medicalization of normal life. The concept ‘medicalization’ has been introduced by Zola to refer to processes in which the labels ‘healthy’ and ‘ill’ are made relevant for more and more aspects of human life. If preventive medicine contributes to medicalization, would that be morally problematic? My thesis is that such a contribution is indeed morally problematic. The concept is sometimes used to express moral intuitions regarding the practice of prevention and health promotion. Through analysis of these intuitions as well as some other moral concerns, I give an explication of the moral problems of medicalization within the context of preventive medicine.     

The "French Paradox" and beyond: neuroprotective effects of polyphenols

Chronic ethanol ingestion is known to cause oxidative damage to a number of organs including the brain. This is partly due to the ability of ethanol to enhance oxygen free radical production and lipid peroxidation. Increase in oxidative stress has been regarded as an important underlying factor for a number of human health problems including cardiovascular diseases, aging, as well as many age-related neurodegenerative diseases. The strikingly low incidences of coronary heart diseases (CHD) in France, despite intake of a high-fat diet, have been attributed to the consumption of red wine containing high levels of polyphenolic compounds. In recent years, understanding the "French Paradox" has stimulated new research interest to investigate whether polyphenolic antioxidants may offer protective effects beyond the cardiovascular system, and whether polyphenols from other botanical sources may similarly offer beneficial effects to human health. Our studies with animal models have provided information clearly indicating the ability of grape polyphenols to ameliorate neuronal damages due to chronic ethanol consumption. Studies with resveratrol, an important component of grape polyphenols, also show protective effects on neuron cell death induced by ethanol and other oxidative agents. These studies demonstrate an urgent need to extend research beyond the "French Paradox" towards better understanding molecular mechanisms of action of polyphenolic compounds and their application to human health.     

Under the microscope: Arcobacter

This review describes characteristics of the genus Arcobacter. Unlike its close phenotypically related neighbour Campylobacter, Arcobacter is not currently a major public health concern, but is considered as an emerging human pathogen, and is of significance towards animal health. This review focuses on the public health significance, culturing and typing, reservoirs, and antimicrobial studies of Arcobacter. Collectively, increasing knowledge in these areas will help to develop measures, which can be used to control this emerging pathogen.     

The Role of Health Systems Factors in Facilitating Access to Psychotropic Medicines: A Cross-Sectional Analysis of the WHO-AIMS in 63 Low- and Middle-Income Countries

Background

Neuropsychiatric conditions comprise 14% of the global burden of disease and 30% of all noncommunicable disease. Despite the existence of cost-effective interventions, including administration of psychotropic medicines, the number of persons who remain untreated is as high as 85% in low- and middle-income countries (LAMICs). While access to psychotropic medicines varies substantially across countries, no studies to date have empirically investigated potential health systems factors underlying this issue.

Methods and Findings

This study uses a cross-sectional sample of 63 LAMICs and country regions to identify key health systems components associated with access to psychotropic medicines. Data from countries that completed the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) were included in multiple regression analyses to investigate the role of five major mental health systems domains in shaping medicine availability and affordability. These domains are: mental health legislation, human rights implementations, mental health care financing, human resources, and the role of advocacy groups. Availability of psychotropic medicines was associated with features of all five mental health systems domains. Most notably, within the domain of mental health legislation, a comprehensive national mental health plan was associated with 15% greater availability; and in terms of advocacy groups, the participation of family-based organizations in the development of mental health legislation was associated with 17% greater availability. Only three measures were related with affordability of medicines to consumers: level of human resources, percentage of countries'' health budget dedicated to mental health, and availability of mental health care in prisons. Controlling for country development, as measured by the Human Development Index, health systems features were associated with medicine availability but not affordability.

Conclusions

Results suggest that strengthening particular facets of mental health systems might improve availability of psychotropic medicines and that overall country development is associated with affordability. Please see later in the article for the Editors'' Summary     

Interaction of lactic acid bacteria with metal ions: opportunities for improving food safety and quality

Certain species of lactic acid bacteria (LAB), as well as other microorganisms, can bind metal ions to their cells surface or transport and store them inside the cell. Due to this fact, over the past few years interactions of metal ions with LAB have been intensively investigated in order to develop the usage of these bacteria in new biotechnology processes in addition to their health and probiotic aspects. Preliminary studies in model aqueous solutions yielded LAB with high absorption potential for toxic and essential metal ions, which can be used for improving food safety and quality. This paper provides an overview of results obtained by LAB application in toxic metal ions removing from drinking water, food and human body, as well as production of functional foods and nutraceutics. The biosorption abilities of LAB towards metal ions are emphasized. The binding mechanisms, as well as the parameters influencing the passive and active uptake are analyzed.     

Parallel and divergent landscapes: cultural encounters in the ethnographic space of Tuareg medicine

This essay explores the dialogue between the local quest for healing and the anthropological quest for healing knowledge, and local assessments of knowledge-power relationships in these processes. The context is medical discourse among the Tuareg of Niger Republic, West Africa, and my research experiences among these people. I examine local medical specialists and their traditional and changing practice in terms of how they perceive and respond to wider knowledge and power systems that impinge on local health care. Paramount in these systems are central state policies and medical anthropological research on healing, as these intersect in a postcolonial and post-separatist/rebellion setting. The essay analyzes parallels between the exchange of medicine and the exchange of knowledge and reflects upon how anthropological knowledge of African healing systems is constructed in an environment highly charged with power and danger--of political violence and economic crisis. The broader issue addressed here is how to give greater empowerment to local residents' voices in their "indigenous critique" of the medical anthropological project.     

Approaches to assessing and managing cumulative ecosystem change,with the Bay of Quinte as a case study: an essay

Rising concern for the future of humans and the earth's ecosystems provides the backdrop for an essay on approaches to assessing and managing ecosystem health. A review and critique of two rival metaphors of human health, illness and wellness, provide the staring point for evaluation of parallel approaches to the assessment and management of ecosystems. The limitations of the metaphors are noted for humans and ecosystems. The impact assessment and ecosystem approach concepts of ecosystem assessment and management are contrasted. As a case history, the nature and pace of change in the Bay of Quinte ecosystem are reviewed, spanning from colonization by the Empire Loyalists at the end of the 18th century through the current development of a remedial action plan for the ecosystem. The review includes the long-term scientific study of the Bay's response to point-source phosphorus control (Project Quinte) and the recent efforts to develop and implement a coordinated clean-up program (Remedial Action Plan). From the lessons of the Quinte experience, a framework is derived, combining the illness and wellness approaches to health. The framework deals with five topics: uncertainty and the precautionary principle; an ecosystem health scale; indicators of ecosystem health; maximum allowable change; and, regulation and planning. Uncertainty should not be used to justify inaction. A precautionary principle assumes that impacts will occur and places the burden of proof on the proponents of ecosystem disturbance. An ecosystem health scale is defined using current, original, and potential conditions. Restoration to the original condition is unlikely but provides a justifiable direction for actions to establish sustainability. Indicators of ecosystem health with sustainable ranges are preferred over end-points and thresholds. The concept of maximum allowable change is promoted with a tentative suggestion that a fifty percent rule might be used. Finally, an argument for the combined use of regulation and planning. Regulatory approaches tend to perpetuate confrontation. Planning can be used to lengthen the time-horizon from quarterly reports to generations and identify self-regulating codes of behaviour. The framework is briefly discussed and placed in a broader context linking humans and ecosystem, illness and wellness.Based on the text of a talk presented at the Cumulative Impact Assessment Workshop held in Toronto, Ontario, December 1992, and sponsored by the North Central Division of the American Fisheries Society.     

A versatile enrichment of functionalized calixarene as a facile sensor for amino acids

Amino acids are the most important part of the human biological system due to their role in living processes. The role of amino acids stretches beyond their traditional role as a building block for proteins, and deficiency of amino acids could lead to decreased immunity, digestive problems, depression, fertility issues, lower mental alertness, slowed growth in children, and many other health issues. The acute detection of amino acids is necessary to determine the human health domain. Here, in this review, we summarize and study the calixarenes as complexes that are of immeasurable value and their utilization for amino acid detection. Key factors such as noncovalent forces, limit of detection, and the supramolecular chemistry of calixarenes with amino acids have been well described. This study presents the most recent efforts made towards the development of potential and highly efficient calixarene-based sensors for the detection of amino acids.     

A passion for the science of the human genome

The complete sequencing of the human genome introduced a new knowledge base for decoding information structured in DNA sequence variation. My research is predicated on the supposition that the genome is the most sophisticated knowledge system known, as evidenced by the exquisite information it encodes on biochemical pathways and molecular processes underlying the biology of health and disease. Also, as a living legacy of human origins, migrations, adaptations, and identity, the genome communicates through the complexity of sequence variation expressed in population diversity. As a biomedical research scientist and academician, a question I am often asked is: “How is it that a black woman like you went to the University of Michigan for a PhD in Human Genetics?” As the ASCB 2012 E. E. Just Lecturer, I am honored and privileged to respond to this question in this essay on the science of the human genome and my career perspectives.

“Knowledge is power, but wisdom is supreme.”

     

Adipose tissue can be generated in vitro by using adipocytes from human fat tissue mesenchymal stem cells seeded and cultured on fibrin gel sheet

The current study has developed an innovative procedure to generate ex novo fat tissue by culturing adipocytes from human fat tissue mesenchymal stem cells (hFTMSCs) on fibrin gel sheet towards applications in medicine and cosmetology. Fibrin gel has been obtained by combining two components fibrinogen and thrombin collected by human peripheral blood. By this procedure it was possible to generate blocks of fibrin gel containing adipocytes within the gel that show similar features and consistency to human fat tissue mass. Results were assessed by histological staining methods, fluorescent immune-histochemistry staining as well photos by scanning electron microscopy (SEM) to demonstrate the adhesion and growth of cells in the fibrin gel. This result opens a real possibility for future clinical applications in the treatment of reconstructive and regenerative medicine where the use of stem cell may eventually be a unique solution or in the field of aesthetic medicine where autograft fat stem cells may grant for a safer and better outcome with long lasting results.     

The dimensions of sports medicine

The history of sports medicine is reviewed in terms of European, United States and Canadian traditions. An orientation towards treatment, particularly the treatment of injuries in elite athletes, is noted. Encouragement is found in the trend to discussion between the several Canadian groups interested in sports medicine. It is suggested that in the leisured society of the future, sports medicine will form an increasing part of family practice. It is to be hoped that emphasis will be placed on a broad-based approach to prevention of accidents and disease, coupled with the effective promotion of positive health measures, particularly increased physical activity.     

Mercury content in lake sediments and suspended matter — temporal variation and relation to water chemistry

Twenty-five small, mainly oligotrophic, forest Swedish lakes were treated in different ways (e.g. liming) during 1987 in order to reduce the Hg levels in fish. The temporal variation of Hg concentration in sediments and water, and the extent that this variation can be related to normal lake characteristics and/or altered chemical conditions due to lake remedial measures was studied. Yearly mean alkalinity was increased from 0.07 to 0.18 meq l^–1 and pH from 6.0 to 6.5 due to the treatments. The Hg concentration, as well as the Hg:C ratio, in seston was reduced after treatment; the median Hg/C ratio in seston decreased from 1.6 g g^–1 during 1986 to 0.8 g g^–1 during 1988. In the water column the concentration of the reactive plus non-reactive Hg fraction (RIHg, detected after reduction with NaBH₄) showed a similar inter-year variation to the Hg content in seston, in contrast to the total Hg concentration in water column which was not decreased after the treatments. The increase in pH due to the remedial measures appeared to be the main cause of the decreased RIHg concentration, although the humic content (measured as colour) also explained a large part of the variation in RIHg concentration between the lakes. The decrease in the RIHg concentration in the lake water is the probable reason for the reduced Hg levels observed in the seston.     

Sex and gender in medicine

Gender specific medicine is a part of gender-research, which has been insufficiently considered up to the present in medicine, sanitation and politics. Part of the scientific medicine simply ignores the knowledge that men and women are different in feeling, thinking and social acting without any question. Doctors often incline to treat all their patients as if there was just one gender: i.e. the male one. It is without dispute that men and women vastly suffer from the same diseases, but they often go through them quite differently. The female body seems to work differently from the male one in nearly all respects--starting with the brain, going on with the heart, cardiovascular, lungs, stomach and intestines and ending up with the skin and immune order. Identical cases of illnesses bring about different symptoms on both sides. Therapeutics therefore have to be appropriate for the specific gender. This however demands complete thinking in preventive measures, therapy, development of one's education and research. Exactly for this reason the new "gender-model" is absolutely important and necessary in medicine as a new pattern of thinking. Only in this way one can realize a comprehensive revaluation of health and disease of both sexes. Pre-eminently one has to convince people that the embedding of "gender" both in medicine and the surrounding area is much more useful than costly from the scientific, political and individual point oft view.