Perspectives in Biology and Medicine

Perspectives in Biology and Medicine
Volume 46, Number 4, Autumn 2003


Contents

Articles

Science and Medicine

    Kahn, Jonathan.
  • Getting the Numbers Right: Statistical Mischief and Racial Profiling in Heart Failure Research
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    Subject Headings:
    • Heart failure -- Treatment -- United States.
    • Drug development -- Social aspects -- United States.
    • African Americans -- Health and hygiene.
    Abstract:
      The claim that blacks die from heart failure at a rate twice that of whites is informing efforts to develop and market the drug BiDil®, which is currently undergoing clinical trials to be approved by the FDA as the first drug ever specified to treat African Americans—and only African Americans—for heart failure. The drug and its companion statistic have since come to play prominent roles in debates about so-called "racial profiling" in medicine and the legitimacy of using social categories of race in biomedical research. Nonetheless, this statistic is wrong. The most current data available place the black:white mortality ratio for heart failure at approximately 1.1:1. The article tells the story of attempts to get to the source of the supposed 2:1 mortality ratio and explores some of the implications of the acceptance of these erroneous data, both for the allocation of resources to combat disease and for our broader understanding of the nature and meaning of race.

Ethics and Philosophy

    Tauber, Alfred I.
  • Sick Autonomy
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    Subject Headings:
    • Physician and patient -- United States.
    • Medical ethics -- United States.
    • Autonomy (Philosophy) -- United States.
    Abstract:
      Complex social and economic forces have placed patient autonomy at the center of medical ethics, and thereby displaced an older ethic of physician beneficence. This development arose, and is sustained, by waning trust in the traditional doctor-patient relationship. As patients have increasingly become clients and consumers, a contract basis for medical care has put the ancient covenant of care in jeopardy. Here, a philosophical approach to harmonize the apparent conflicting claims of patient autonomy and physician beneficence is offered by demonstrating that autonomy need not be understood as protecting a threatened identity. If persons are regarded as atomistic, certain defensive notions of individualistic rights-based autonomy prevail; if a relational construction of personal identity is employed instead, then respect for autonomy becomes part of a wider morality of relationship and care. By reconfiguring trust within this latter understanding of personhood, bioethics better balances its concerns over choices and actions with those of relationship and responsibility. Neither atomistic autonomy nor the ethics of responsibility can claim hegemony, for they are mutually interdependent, and a complete account of medicine's moral axis requires that they be integrated. This reorientation is crucial for reasserting the ethos of clinical medicine, whose fundamental mandate remains the care of others.
    Callahan, Daniel, 1930-
  • Individual Good and Common Good: A Communitarian Approach to Bioethics
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    Subject Headings:
    • Bioethics -- United States.
    • Communitarianism -- United States.
    • Individualism -- United States.
    Abstract:
      The field of bioethics emerged in the late 1960s and early 1970s. Among its early issues were the protection of human research subjects, the rights of patients, abortion, and reproductive issues. Partly as a reflection of the times, and of those issues, the field became focused on autonomy and individual rights, and liberal individualism came to be the dominant ideology in the 1980s and 1990s. Communitarianism, as an alternative ideology focused more on the common good and the public interest than on autonomy, was a neglected approach. But many bioethical issues can not reasonably be reduced to questions of individualism and choice only. Issues of genetics and reproduction will of necessity touch on the society as a whole, its values, and its social institutions. Serious ethical analysis must take the social implications seriously and not simply assume that they should be left to autonomous choices of individuals. Human beings are social animals and our nature is distorted if we think of ourselves only as co-existing social atoms. Various approaches to communitarianism are outlined, and the question of the relationship between individual good and common good is confronted.
    Tishler, Carl L.
    Bartholomae, Suzanne.
  • Repeat Participation Among Normal Healthy Research Volunteers: Professional Guinea Pigs in Clinical Trials?
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    Subject Headings:
    • Human experimentation in medicine -- Moral and ethical aspects -- United States.
    Abstract:
      The recent death of a normal healthy volunteer, as well as the increased use of normal volunteers as research subjects, has heightened the attention given to the participation of normal volunteers in clinical research. An overlooked sub-population of normal healthy volunteers are repeat, veteran volunteers. This essay discusses ethical and methodological issues associated with the use of repeat volunteers in research, along with existing guidelines regarding the use of repeat healthy volunteers, and concludes with recommendations for safeguarding repeat volunteers and ideas supporting centralized recruiting.

History and Biography

    Bendersky, Gordon.
  • The Maligning of a Country Doctor
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    Subject Headings:
    • Ehrenreich, Barbara. Complaints and disorders: the sexual politics of sickness.
    • English, Deirdre.
    • McDowell, Ephraim, 1771-1830 -- Contributions in ovariectomy.
    • Ovariectomy -- Social aspects -- United States -- History -- 19th century.
    • Sexual ethics -- United States -- History -- 19th century.
    • Women -- United States -- Social conditions -- 19th century.
    Abstract:
      This article traces the misidentification of the subject of an illustration in a text about women and illness in the 19th century.The heroic efforts of surgical pioneer Ephraim McDowell (1771-1830) and his brave patient Jane Todd Crawford are returned to their rightful place in medical history.
    Lewinsohn, Rachel, 1922-
  • Prophet in His Own Country: Carlos Chagas and the Nobel Prize
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    Subject Headings:
    • Chagas, Carlos, 1879-1934.
    • Chagas' disease -- History.
    • Nobel Prizes.
    Abstract:
      In 1909, Carlos Chagas (1878-1934) discovered a new protozoon, Trypanosoma cruzi, and the (previously unknown) disease that it causes. Within a few months, virtually single-handed, he described the pathogen, its vector, and the clinical features of American trypanosomiasis (Chagas disease), a feat unique in medical history. He headed the Oswaldo Cruz Institute after the death of its founder (1917) until his own death; and from 1920 until 1926 he also directed the Brazilian Department of Public Health. His discovery brought him worldwide acclaim, but at home antagonism against Chagas, muted for years, finally flared up in a campaign that was acted out in the 1921-22 plenary sessions of the National Academy of Medicine. Chagas's name was repeatedly proposed for the Nobel Prize but he never received it; this hostile campaign may have been instrumental in costing him the award.
    Grob, Gerald N., 1931-
  • The Rise of Peptic Ulcer, 1900-1950
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    Subject Headings:
    • Peptic ulcer -- United States -- History.
    Abstract:
      The seeming increase in the incidence of peptic ulcer after 1900 quickly occupied the attention of physicians. Their understanding and treatment of peptic ulcer was shaped not only by new diagnostic tools, but by differences between contesting medical specialties, broad concepts or paradigms current in the larger medical and scientific community, and prevailing social and ideological beliefs. Surgeons and internists, for example, were often at odds over appropriate therapies; each maintained that personal experiences demonstrated the efficacy of their therapies. Nor were etiological theories derived from empirical data. The claim that peptic ulcer resulted from focal infections was simply a reflection of the popularity of germ theory. Other explanations included the role of stress, race, constitutional makeup, psychosomatic factors, and the pressures of modern industrial society. Virtually all were derivative and reflected social and intellectual currents that were common in the larger society of which medicine was but a part. Thus, the history of peptic ulcer during the first half of the 20th century provides an instructive and in many ways a typical case study in the complexities posed by the emergence of modern medicine.

Medical Education and Practice

    Treeson, David.
  • Health Care in the Borderland
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    Subject Headings:
    • Medical care -- New Mexico -- Hidalgo County -- History -- 20th century.
    • Hidalgo Medical Services (N.M.) -- History -- 20th century.
    Abstract:
      For over 30 years, Hidalgo County, a geographically isolated and financially stressed community in the southwestern corner of New Mexico, has struggled to develop a stable primary health care service.The retirement of the county's general practitioner in the 1970s was followed by several decades of misses, near-misses, and out-and-out failures, when the community found it difficult to attract and impossible to keep a physician. In order to organize and fund a stable medical clinic, the community had to adapt to the realities of a new era in medicine. Primary care physicians in rural communities need access to medical information and to specialists, help in coping with the economic pressures of medical care, and support that will enable them to develop a sustainable lifestyle. Hidalgo County now has a modern health care delivery system. The experiences that led to the creation of the present clinic provide insight into the problems for the delivery of primary health care in remote areas and suggest solutions that may be relevant to other communities across rural America.

Culture and Society

    Sparling, Phillip B. (Phillip Belton), 1949-
  • College Physical Education: An Unrecognized Agent of Change in Combating Inactivity-Related Diseases
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    Subject Headings:
    • Physical education and training -- Study and teaching (Higher) -- United States.
    • Education, Higher -- Aims and objectives -- United States.
    • Hypokinesia -- United States -- Prevention.
    Abstract:
      Physical activity patterns during the young adult years are likely to be important influences on habitual physical activity during overall adult life and, consequently, have significant implications for long-term health outcomes. The potential reach and impact of college physical education on the promotion of physical activity to a large segment of the American population has been largely unrecognized. Over the last generation, many colleges and universities have reduced or eliminated their physical education requirements. Nonetheless, physical education can make important contributions in the primary prevention of inactivity-related chronic diseases and to the general education of the college student. Awareness and advocacy are needed to strengthen college physical education programs.
    Heller, Richard M., 1938-
    Heller, Toni W.
    Sasson, Jack M.
  • Mold: "Tsara'at," Leviticus, and the History of a Confusion
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    Subject Headings:
    • Molds (Fungi) -- History.
    Abstract:
      The noun tsara'at appears about two dozen times in the Hebrew Bible, almost exclusively in Leviticus, where it is used to describe a state of ritual defilement manifested as a scaly condition of the skin, a condition of cloth, leather, and the walls of houses. In the Septuagint, the Greek translation of the Hebrew Bible, negac tsara'at was translated as aphe lepras; in the Latin Vulgate, this became plega leprae. These words in Greek and Latin implied a condition that spread over the body, not a term of ritual impurity. Tsara'at has continued to be translated as "leprosy," even though this term is not appropriate, as there was no leprosy as we know it in the Middle East during the time period the Hebrew Bible was written. Others have suggested that the proper translation of tsara'at is "mold." The recent identification of a specific mold (Stachybotrys sp.) that contaminates buildings and causes respiratory distress, memory loss, and rash, and the fact that mold has been present for millennia, lend support to the translation of tsara'at as "mold."

Essay Review

    Benoit, Cecilia, 1954-
  • The Politics of Health Care Policy: The United States in Comparative Perspective
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    Subject Headings:
    • Weissert, Carol S. Governing health: the politics of health policy.
    • Weissert, William G.
    • Maioni, Antonia. Parting at the crossroads: the emergence of health insurance in the United States and Canada.
    • Swank, Duane. Global capital, political institutions, and policy change in developed welfare states.
    • Olsen, Gregg M. (Gregg Matthew), 1956- Politics of the welfare state: Canada, Sweden and the United States.
    • Medical policy -- United States.
    • Insurance, Health -- United States.

Book Reviews

    Lee, Philip R. (Philip Randolph), 1924-
    Lin, Cindy.
  • The Antibiotic Paradox: How the Misuse of Antibiotics Destroys Their Curative Powers (review)
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    Subject Headings:
    • Levy, Stuart B. Antibiotic paradox: how the misuse of antibiotics destroys their curative powers.
    • Drug resistance in microorganisms.
    Shepherd, H. R.
  • Big Shot: Passion, Politics, and the Struggle for an AIDS Vaccine (review)
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    Subject Headings:
    • Thomas, Patricia. Big shot: passion, politics, and the struggle for an AIDS vaccine.
    • AIDS vaccines -- Popular works.
    Straus, Stephen E.
  • The Role of Complementary and Alternative Medicine: Accommodating Pluralism (review)
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    Subject Headings:
    • Callahan, Daniel, 1930-, ed. Role of complementary and alternative medicine: accommodating pluralism.
    • Alternative medicine.



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