Perspectives in Biology and Medicine

Perspectives in Biology and Medicine
Volume 48, Number 1, Winter 2005
Special Issue: Health and Human Rights
Guest Editor: Paul Farmer and H. Jack Geiger

CONTENTS

Keynote Addresses, Physicians for Human Rights National Student Conference

Articles

Science and Medicine

    Smith, C. U. M. (Christopher Upham Murray)
  • Evolutionary Neurobiology and Aesthetics
    [Access article in HTML] [Access article in PDF]
    Subject Headings:
    • Senses and sensation -- Testing.
    • Aesthetics -- Psychological aspects.
    • Nervous system -- Evolution.
    Abstract:
      If aesthetics is a human universal, it should have a neurobiological basis. Although use of all the senses is, as Aristotle noted, pleasurable, the distance senses are primarily involved in aesthetics. The aesthetic response emerges from the central processing of sensory input. This occurs very rapidly, beneath the level of consciousness, and only the feeling of pleasure emerges into the conscious mind. This is exemplified by landscape appreciation, where it is suggested that a computation built into the nervous system during Paleolithic hunter-gathering is at work. Another inbuilt computation leading to an aesthetic response is the part-whole relationship. This, it is argued, may be traced to the predator-prey "arms races" of evolutionary history. Mate selection also may be responsible for part of our response to landscape and visual art. Aesthetics lies at the core of human mentality, and its study is consequently of importance not only to philosophers and art critics but also to neurobiologists.
    Rajan, Thiruchandurai V.
  • The Eye Does Not See What the Mind Does Not Know: the bacterium in the worm
    [Access article in HTML] [Access article in PDF]
    Subject Headings:
    • Bacterial genetics.
    Abstract:
      Symbiotic relationships underlie the evolutionary success of many different life forms. The filarial worms are long, slender nematode parasites that cause considerable pathology in large segments of the world's population. About 25 years ago, investigators first reported the presence of bacterial organisms living inside these parasitic worms. Recent molecular biological studies have indicated that these bacteria belong to the genus Wolbachia, members of which have been known to be associated with numerous species of insects. Elimination of the Wolbachia from the nematodes (by, for instance, treatment with broad spectrum antibiotics) results in profound disturbances in the physiology of the latter, including a complete block in reproduction. This observation, taken together with the fact that every individual worm examined to date contains Wolbachia, validates the classification of the latter as "endosymbionts." Many studies indicate that the Wolbachia may also play an important role in the pathology caused by the nematode worms, and that it might be possible to target therapy against the Wolbachia to treat the filarial disease. Intriguingly, the intense recent interest in Wolbachia is in complete contrast with the virtually complete indifference evoked by the original discovery of these organisms.

Ethics and Philosophy

    Tauber, Alfred I.
  • Medicine and the Call for a Moral Epistemology
    [Access article in HTML] [Access article in PDF]
    Subject Headings:
    • Medicine -- Philosophy.
    • Medical ethics.
    • Knowledge, Theory of.
    Abstract:
      For over a century, medicine has prided itself on its scientific orientation and technological accomplishments. But a conceptual crack lies at the foundation of contemporary medicine, one that may be characterized as a conflict between medicine's scientific epistemology and its moral philosophy. Moral refers to value, and more specifically in the clinical setting, to how facts must be ordered by the values attached to them. A "moral epistemology" seeks to bring these two domains into closer proximity. Clinical facts always reside in a complex array of systems that confer specific and often unique meanings to any finding. An integration of unsteady norms and the intuitive inference arising from the individuality of disease expression require that judgments order facts into their proper placement. And beyond this relaxed view of objectivity, clinical care must also incorporate judgments arising from the patient's (as well as the physician's) social and psychological realms that are removed from scientific concerns. Together, these various kinds of value judgments erect the scaffold of clinical care, in which a more complex moral epistemology emerges. A comprehensive biopsychosocial model of illness and its treatment articulates this integrated orientation, but until medicine embraces a philosophy that legitimates the full integration of facts and values, the appeal of such an approach will remain limited and its application ineffective.

History and Biography

    Benedek, Thomas G.
  • Gonorrhea and the Beginnings of Clinical Research Ethics
    [Access article in HTML] [Access article in PDF]
    Subject Headings:
    • Gonorrhea -- Treatment -- Europe -- History.
    • Medical ethics.
    Abstract:
      Research on ocular inflammation associated with gonorrhea began in conjunction with the entry of trachoma into Europe during the Napoleonic wars. The initial questions involved the cause of the contagiousness of gonorrhea and how the contagion spreads from the genitalia to other sites. Because efforts to infect animals with gonorrheal matter were unsuccessful, all experiments were conducted on human subjects. Once these two causes of blindness were tentatively differentiated, attempts to restore vision in an eye that had been blinded by a trachomatous membrane over the cornea by instilling gonorrheal pus began to be practiced. In 1841, Joseph Piringer described his use of this method to determine infectiousness decades before the discovery of pathogenic bacteria, as well as ethical concerns about the associated endangerment of patients. Beginning in the 1880s, research focused on the identification of the gonococcus and assessment of its pathogenicity.The ethical dilemma of inducing a disease with an unpredictable outcome persisted until the 1940s, when gonorrhea could be reliably cured by penicillin.
    Matta, Christina.
  • Ambiguous Bodies and Deviant Sexualities: hermaphrodites, homosexuality, and surgery in the United States, 1850-1904
    [Access article in HTML] [Access article in PDF]
    Subject Headings:
    • Homosexuality -- United States -- History.
    • Hermaphroditism -- Surgery -- United States -- History.
    Abstract:
      While the necessity of normalizing surgery on intersexed individuals is a topic of ongoing debate in the 21st century, the origins of surgery as a therapeutic practice for ambiguous or unusual genitalia lie in the 19th century.The first report of corrective surgery published in the United States appeared in the American Journal of the Medical Sciences in 1852, but surgery did not immediately replace more traditional social prescriptions designed to fit hermaphrodites into a dimorphic model of human sex. Only after homosexuality became a matter of discussion in American medical journals did the frequency of normalizing surgeries increase. This paper explores the connection between physicians' increased interest in preventing "abnormal" sexual behavior and their insistence that interventionist surgeries were the most appropriate means of treating cases of hermaphroditism.

Medical Educations and Practice

    Connelly, Julia E.
  • Narrative Possibilities: using mindfulness in clinical practice
    [Access article in HTML] [Access article in PDF]
    Subject Headings:
    • Physician and patient.
    • Clinical medicine.
    Abstract:
      Narrative is ever present in medicine and is an integral aspect of the doctor and patient relationship. Although theoretical discussions of narrative medicine and narrative ethics are important, they may serve to reify the patient's story, to make it a specific entity. In practice, the patient's story unfolds in the moment of communication depending on the individuals and the circumstances; the story is not an "object." Patients' narratives heard in clinical settings are often limited by physician behaviors, especially the tendency of physicians to control the interaction with the patient. To develop individual narratives effectively and competently, physicians must be able to help the patient tell the story that is most important, meaningful, and descriptive of the situation. If the patient's narrative is not heard fully, the possibility of diagnostic and therapeutic error increases, the likelihood of personal connections resulting from a shared experience diminishes, empathic opportunities are missed, and patients may not feel understood or cared for. The practice of mindfulness—moment-to-moment, nonjudgmental awareness—opens a doorway into the patient's story as it unfolds. Such mindful practice develops the physician's focus of attention and offers the possibility for a meaningful and important narrative to arise between patient and physician.

Culture and Society

    Mystakidou, Kyriaki.
    Parpa, Efi.
    Tsilika, Eleni.
    Katsouda, Emmanuela.
    Vlahos, Lambros.
  • The Evolution of Euthanasia and Its Perceptions in Greek Culture and Civilization
    [Access article in HTML] [Access article in PDF]
    Subject Headings:
    • Euthanasia -- Religious aspects -- Christianity -- History.
    • Euthanasia -- Law and legislation -- Greece -- History.
    • Greece -- Civilization.
    Abstract:
      Death has preoccupied humanity since before the dawn of civilization. As a multidimensional and moral problem, the end of life has concerned different civilizations, and different approaches to euthanasia, or "good death," have been developed in each culture. In Greece, there is a long record of the culture's evolving attitudes toward death and euthanasia.A more widespread knowledge of the views and traditions surrounding the act of euthanasia can contribute to a better understanding of the controversies surrounding modern attitudes and practice.
    Ferrence, Susan.
    Bendersky, Gordon.
  • Deformity in the "Boxing Boys"
    [Access article in HTML] [Access article in PDF]
    Subject Headings:
    • Boxing boys [visual works]
    • Abnormalities, Human, in art.
    • Sports injuries -- Greece.
    Abstract:
      The late Bronze Age wall painting the Boxing Boys (c. 17th-16th century BCE) was excavated in the ancient town of Akrotiri on the Greek island of Thera. This article considers a medical interpretation for the spinal-pelvic anomaly in the anatomy of one of the boys.The artist has depicted a combination of structural anatomical adjustments diagnostic of spondylolisthesis, a forward slippage of one of the lumbar vertebrae. The accurate portrayal of the surface appearance of this condition suggests that the artist painted directly from a live subject. Thus, the Boxing Boys mural may be the earliest visual record of a sports-induced injury. Although the meaning of the wall paintings is unclear, the wild goats (agrimia) on the adjoining walls simulate swayback as a reflection of the boy's torso deformity and share other features with the boxers, adding to the unifying characteristics of the room. The abnormal morphology appears to be the earliest achievement of transforming disease into aesthetic charm on a monumental scale.
    Rodenhauser, Paul.
  • Alternative Reality and Art: the creative world of Walter Inglis Anderson
    [Access article in HTML] [Access article in PDF]
    Subject Headings:
    • Anderson, Walter Inglis, 1903-1965 -- Mental health.
    • Schizophrenia -- United States -- History -- 20th century.
    Abstract:
      Both mental illness and creativity run in families. This observation suggests the possibility of genetic predisposition; in light of the known dynamic interrelationships among the environment, the personality, and the brain, however, it does not diminish the possibility of significant environmental influence on personal development. An examination of the biological, psychological, and social forces impacting the life ofWalter Inglis Anderson (1903-1965), the South's most important artist, serves as a case in point. Anderson's upbringing, including his mother's determination that her sons become artists and her beliefs about the shamanistic role of artists in society, might have played a large part in establishing an unusual and indelible frame of reference in a family whose history insinuated the possibility of untoward outcomes.Walter Anderson's life as an artist—one who lived at times in an alternative reality—raises questions about how a different set of circumstances might have affected his mental state as well as his talent. This essay discusses some of the important relationships, events, and circumstances in Walter Anderson's life from a biopsychosocial perspective, with emphasis on psychodynamic implications of his illness and its questionable diagnosis as schizophrenia.

Essay Review

    Blend, Michael J.
  • Can We Learn from Our Patients?
    [Access article in HTML] [Access article in PDF]
    Subject Headings:
    • Ruzic, Neil P. Racing to a cure: a cancer victim refuses chemotherapy and finds tomorrow's cures in today's scientific laboratories.
    • Ruzic, Neil P. -- Health.

Book Reviews

    Barrett, Kim E.
  • Microcompetition with Foreign DNA and the Origin of Chronic Disease (reivew)
    [Access article in HTML] [Access article in PDF]
    Subject Headings:
    • Polansky, Hanan. Microcompetition with foreign DNA and the origin of chronic disease.
    • Chronic diseases -- Genetic aspects.
    Basalla, George.
  • Volta: Science and Culture in the Age of the Enlightenment (review)
    [Access article in HTML] [Access article in PDF]
    Subject Headings:
    • Pancaldi, Giuliano. Volta: science and culture in the Age of the Enlightenment.
    • Volta, Alessandro, 1745-1827.
    Csikszentmihalyi, Mihaly.
  • The Midnight Disease: The Drive to Write, Writer's Block, and the Creative Brain (review)
    [Access article in HTML] [Access article in PDF]
    Subject Headings:
    • Flaherty, Alice. Midnight disease: the drive to write, writer's block, and the creative brain.
    • Writer's block.
    Pitrak, David.
  • Learning from HIV and AIDS (review)
    [Access article in HTML] [Access article in PDF]
    Subject Headings:
    • Ellison, George, 1963-, ed. Learning from HIV and AIDS.
    • Parker, Melissa, 1960-, ed.
    • Campbell, Catherine, 1959-, ed.
    • AIDS (Disease) -- Congresses.
    Holmes, Seth.
  • Pathologies of Power: Health, Human Rights and the New War on the Poor (review)
    [Access article in HTML] [Access article in PDF]
    Subject Headings:
    • Farmer, Paul, 1959- Pathologies of power: health, human rights and the new war on the poor.
    • Social stratification.



[Project MUSE] [Search Page] [Journals] [Journal Directory] [Top]