RATIONALE: The concept of evidence-based medicine is important in providing efficient health care. The process uses research findings as the basis for clinical decision making. Evidence-based practice helps optimize current health care and enables the practitioners to be suitably accountable for the interventions they provide. Little work has been undertaken to examine how allied health professionals change their clinical practice in light of the latest evidence. The use of opinion leaders to disseminate new evidence around the management of low back (...) pain into practice has been proposed. AIMS: The aim of this study was to investigate if physiotherapists' clinical management of patients with low back pain would change following an evidence-based education package, which utilized local opinion leaders and delivered the best evidence. METHOD: Thirty musculoskeletal physiotherapists from a Community Trust in North Staffordshire were cluster randomized by location of work, to two groups. The intervention group received an evidence-based programme on the management of low back pain, including advice regarding increasing activity levels and return to normal activity and challenging patients' fears and beliefs about their pain. The control group received a standard in-service training package on the management of common knee pathologies. The physiotherapists' clinical management of patients with low back pain was measured prior to training and 6 months post training. Outcome measures were based on physiotherapists completing 'discharge summary' questionnaires, which included information relating to the use and importance of therapies for treating their low back pain patients. RESULTS: There were few significant differences in treatment options between the intervention and control groups post training. Whilst there was some indication that physiotherapists were already utilizing aspects of psychosocial management for patients with low back pain, there was little change in what physiotherapists perceived to be important to patient recovery and actual clinical practice following the intervention. CONCLUSIONS: Psychosocial factors have been identified as an important factor in the recovery of patients with low back pain. This project incorporated the latest evidence on the management of low back pain and utilized the theory of opinion leaders to disseminate this evidence into clinical practice. Whilst there were some limitations in the overall size of the study, the results help to give an insight into the challenges faced by the health care system and researchers alike to ensure quality evidence is actually utilized by practitioners for the benefits of patient care. (shrink)

Ted Shotter's founding of the London Medical Group 50 years ago in 1963 had several far reaching implications for medical ethics, as other papers in this issue indicate. Most significant for the joint authors of this short paper was his founding of the quarterly Journal of Medical Ethics in 1975, with Alastair Campbell as its first editor-in-chief. In 1980 Raanan Gillon began his 20-year editorship . Gillon was succeeded in 2001 by Julian Savulescu, followed by John Harris and Soren Holm (...) in 2004, with Julian Savulescu starting his second and current term in 2011. In 2000 an additional special edition of the JME, Medical Humanities , was published, under the founding joint editorship of Martyn Evans and David Greaves. In 2003 Jane Macnaughton succeeded David Greaves as joint editor. Deborah Kirklin, under whose auspices MH became an independent journal, took over in 2008, and she was succeeded in 2013 by Sue Eckstein. This short paper offers reminiscences and reflections from the two journals’ various editors.From the start the JME was committed to clearly expressed reasoned discussion of ethical issues arising from or related to medical practice and research. In particular, both Edward Shotter and Alastair Campbell, each a cleric , were at pains to make clear that the JME was not a religious journal and that it had no sort of partisan axe to grind.Campbell's appointment as founding editor was something of a surprise, as the original intention had been to appoint a medical doctor, who could be expected to know medical practice from the inside. However, in 1972 Campbell, a Joint Secretary of the Edinburgh Medical Group, had published Moral dilemmas in medicine. …. (shrink)

Regulated secretory proteins are stored within specialized vesicles known as secretory granules. It is not known how proteins are sorted into these organelles. Regulated proteins may possess targeting signals which interact with specific sorting receptors in the lumen of the trans‐Golgi network (TGN) prior to their aggregation to form the characteristic dense‐core of the granule. Alternatively, sorting may occur as the result of specific aggregation of regulated proteins in the TGN. Aggregates may be directed to secretory granules by interaction of (...) a targeting signal on the surface with a sorting receptor. Novel targeting signals which confer on regulated proteins a tendency to aggregate under certain conditions, and in so doing cause them to be incorporated into secretory granules, have been implicated. Specific targeting signals may also play a role in directing membrane proteins to secretory granules. (shrink)

The concept of “ethical research” holds considerable sway over the ways in which contemporary biomedical, natural, and social science investigations are funded, regulated, and practiced within a variety of countries. Some commentators have viewed this “new” means of governance positively; others, however, have been resoundingly critical, regarding it as restrictive and ethics bodies and regulations unfit for the task they have been set. Regardless, it is clear that science today is an “ethical” business. The ways in which formal and informal (...) ethical discourses and practices—what might be called “regimes of normativity”—structure scientific work and the meanings it is ascribed with have, however, been underexplored. This article attends to how science and ethics articulate; how they are, in many ways, co-produced. Exploring these processes of co-production casts into sharp relief the essential emotionality of science; the relationships investigators have with their colleagues, work, and research participants pulse with emotion, potentially shaping in important ways the very kinds of knowledge that laboratories produce. (shrink)

Recent theoretical and philosophical movements within the study of material culture are more carefully attending to the variety of ways in which human artefacts, institutions, and cultural developments extend, shape and alter human cognition over time. Material Engagement Theory in particular has set out to map, explore and understand the relational nature of mind and material world as can be read through cultural artefacts. Within the context of MET, the neurological concept of metaplasticity has been expanded to include the affective (...) domains of technology, materials, and things in the neurological development and architecture of the plastic human mind; a ‘transactional’ relationship between a plastic mind and a plastic material world that are correlated at the ontological level. The challenges of mapping this metaplasticity of mind lie in understanding how the mind and material culture should be understood in relation to the constantly changing lifeworlds of humans over time; the ecological, social, technological and environmental contexts that form the historical specificity of cognitive development. This paper explores how the historical specificity of metaplasticity can be made tangible through the study of material culture, focusing upon the particular activity of oil painting. It will be argued that paintings can provide clues to the historical specificity of the mind that crosses the lifeworld of human action; the technological, phenomenological, philosophical, material, and social conditions underpinning the creation of a painted mark. Drawing from a range of sources that have a root within a Deleuzian process philosophy, the paper builds an account of painting that can be read as expressing the encultured and historical manipulation of paint as an expressive material in itself; an action rendered visible that express the historical emergence of mind. (shrink)

The development of the fifth edition of the American Psychiatric Association9s _Diagnostic and Statistical Manual of Mental Disorders_—the DSM-5—has reenergised and driven further forward critical discourse about the place and role of diagnosis in mental health. The DSM-5 has attracted considerable criticism, not least about its role in processes of medicalisation. This paper suggests the need for a sociology of psychiatric critique. Sociological analysis can help map fields of contention, and cast fresh light on the assumptions and nuances of debate (...) around the DSM-5; it underscores the importance of diagnosis to the governance of social and clinical life, as well as the wider discourses critical commentaries connect with and are activated by. More normatively, a sociology of critique can indicate which interests and values are structuring the dialogues being articulated, and just how diverse clinical opinion regarding the DSM can actually be. This has implications for the considerations of health services and policy decision-makers who might look to such debates for guidance. (shrink)

There is much law and many guidelines surrounding the whole issue of the indemnity for human volunteers when it comes to clinical trials. The system that had been put in place to protect individual volunteer drug trialists seems largely to have worked by the fact that there are so few examples of legal cases being issued. However, recent events have shown that when the system fails it fails somewhat spectacularly. The difficulty for groups such as the ethics committee is that (...) lawyers look for targets to try and meet the difference between the claims and the monies available and it might therefore always be possible that the ethics committee becomes centre stage in terms of the pursuit of the action. (shrink)

This article challenges the assumption inherent in many ethics codes that duties only arise when the project is sufficiently advanced that a formal research proposal can be put before an ethics committee for approval. Certain social science methodologies do not lend themselves to a simple demarcation between the preparation and the implementation of the research. It is therefore imperative that consideration is given to researchers' ethical duties prior to formal review. The problem of demarcation and of defining a duty are (...) explored in the particular context of a potential research project involving research on taxi-drivers' experiences of crime and the strategies that they employ to avoid victimisation. Two key issues emerge. First, in what circumstances, if any, can information supplied during this gestation period be used as ‘research data’? Secondly, there are concerns about the researcher's identity and role at this stage. These issues, and others, need to be the subject of further consideration by the relevant bodies so that researchers receive meaningful guidance on the duty prior to ethics review. (shrink)

ArgumentResearch into the biological markers of pathology has long been a feature of British psychiatry. Such somatic indicators and associated features of mental disorder often intertwine with discourse on psychological and behavioral correlates and causes of mental ill-health. Disorders of sociality – particularly psychopathy and antisocial personality disorder – are important instances where the search for markers of pathology has a long history; research in this area has played an important role in shaping how mental health professionals understand the conditions. (...) Here, I characterize the multiplicity of psychiatric praxis that has sought to define the mark of antisociality as a form of “ontological anarchy.” I regard this as an essential feature of the search for biological and other markers of an unstable referent, positing that uncertainties endure – in part – precisely because of attempts to build consensus regarding the ontology of antisociality through biomedical means. Such an account is suggestive of the co-production of biomarkers, mental disorder, and psychiatric institutions. (shrink)

The purpose of medical humanities is to improve the delivery of effective health care through a better understanding of disease in society, and in the individual. The interfaces between the science of medicine and the arts, philosophy, sociology and law interpret causes and effects of disease. The field of medical ethics is the most prominent offspring of this wider debate, yet the context of disease in the life of the individual and of society is profound and far-reaching. The influences of (...) medicine on the humanities and vice versa are all around, yet only recently have they been recognised in the wider world of health care. How can you encapsulate the essence of medical humanities and teach it to health professionals? Medical Humanities is designed to fill the need for a clear, well illustrated text that both provides the principles for the individual reader, and encourages discussion. The issues are explored in four main sections. Based on a highly successful seminar, and with contributions from leading writers, thinkers, and teachers, this book provides a comprehensive and authoritative reference for what is becoming a professional requirement in medicine. It will be invaluable for clinicians and students alike. (shrink)

The years from 1918 to 1945 remain central to European History. It was a breath-taking time during which the very best and very worst attributes of Mankind were on display. In the euphoria of peace which followed the end of the First World War, the Baltic States emerged as independent forces on the world stage, participating in thrilling experiments in national and transnational governance. Later, following economic collapse and in the face of rising totalitarianism among even Europe’s most cultured nations, (...) Baltic communities succumbed to nationalism too. During wartime, Baltic peoples became both victims and, sometimes, victimisers. Ultimately their victimhood lasted until the end of the Cold War, yielding consequences still discernible at the start of the twenty first century. Taking the period 1918 to 1945 as pivotal, this collection of essays examines some of the key themes in Baltic History as they are emerging today. These include appreciations of identity, autonomy and the rights of national minorities; the everyday and social foundations of international security; and the importance of historical memory to popular and political identities. (shrink)

The paper examines the very different insights of theorists into the interpretation of historical meaning of literary reception and Anglo-American theorists of the "new" history of political thought . Among the former, readers create meaning; among the latter, authorial intended meanings are fundamental. Both perspectives are valuable, but one-sided. The differences between them arise from different perspectives on the character of a text. But those perspectives are not as incompatible as has been supposed, especially by reception theorists. By examining the (...) incoherences of literary reception theory when viewed from the perspective of the intentionalists, and by examining the one-sidedness of intentionalist theory in the light of a modified version of the reception perspective, it is shown that an understanding of historical meaning requires both insights. The argument is illustrated by reference to the history of political thought, a history which might more usefully be conceived as the history of political literature. (shrink)

This book questions the generally accepted view that mechanics’ institutes made little contribution to adult working-class education from their foundation in the 1820s to 1890. The book traces the historical development of several mechanics’ institutes across Britain, establishing that many supported both male and female working-class membership before state intervention at the end of the nineteenth century resulted in the development of further education for all. Chapters of the book draw on historical accounts in supporting the claim that the movement, (...) until now seen as of little national significance, was a success, and particularly for the working classes for whom they were established. (shrink)

Medicine, as Byron Good argues, reconstitutes thehuman body of our daily experience as a medical body,unfamiliar outside medicine. This reconstitution can be seen intwo ways: as a salutary reminder of the extent to which thereality even of the human body is constructed; and as anarena for what Stephen Toulmin distinguishes as theintersection of natural science and history, in which many ofphilosophy''s traditional questionsare given concrete and urgent form.This paper begins by examining a number of dualities between themedical body and the (...) body familiar in daily experience. Toulmin''s epistemological analysis of clinical medicine ascombining both universal and existential knowledge is thenconsidered. Their expression, in terms of attention,respectively, to natural science and to personal history, isexplored through the epistemological contrasts between themedical body and the familiar body, noting the traditionalphilosophical questions which they in turn illustrate. (shrink)

Philosophy of the Social Sciences, Volume 52, Issue 3, Page 132-149, June 2022. An influential strand within Science and Technology Studies rejects the idea that science produces representations referring to objects or processes that exist independently of it. This radical ‘turn’ has been framed as ‘constructionist’, ‘nominalist’, and more recently as ‘ontological’. Its central argument is that science constructs or enacts rather than represents. Since most practitioners of science believe that it involves representation, an implication of the radical turn must (...) be that ‘representation’ is a folk concept; perhaps even a myth or an ideology. This paper explores this anti-representationalism and its implications for the relationship between STS and mainstream social science, in part through drawing parallels with ethnomethodology. (shrink)

In the United States, the National Institute of Mental Health is seeking to encourage researchers to move away from diagnostic tools like the Diagnostic and Statistical Manual of Mental Disorders. A key mechanism for this is the “Research Domain Criteria” initiative, closely associated with former NIMH Director Thomas Insel. This article examines how key figures in US psychiatry construct the purpose, nature, and implications of the ambiguous RDoC project; that is, how its novelty is constituted through discourse. In this paper, (...) I explore and analyze these actors’ accounts of what is new, important, or desirable about RDoC, demonstrating how they are constituted through institutional context and personal affects. In my interviews with mental health opinion leaders, RDoC is presented as overly reliant on neurobiological epistemologies, distant from clinical imaginaries and imperatives, and introduced in a top-down manner inconsistent with the professional norms of scientific research. Ultimately, the article aims to add empirical depth to current understandings about the epistemological and ontological politics of contemporary psychiatry and to contribute to science and technology studies debates about “the new” in technoscience. Accordingly, I use discussions about RDoC as a case study in the sociology of novelty. (shrink)

Originally published in 1987. This book analyses what Englishmen understood by the term contract in political discussions during the late seventeenth and early eighteenth centuries. It provides evidence for reconsidering conventional accounts of the relationships between political ideas, groups and practices of the period. But also suggests cause for examining the general history of modern European contract theory. It considers contract as a term appearing in a spectrum of works from philosophical treatise to sermons and polemical pamphlets. Looking at the (...) various vocabularies relating to contractualist ideas, the author suggests that standard histories of social contract theory and particular histories of English political thought during this unstable period have misrepresented the meaning of the term contract as a key term in political argument. He shows that there were in fact three different categories of contract theory but allows that the various kinds of contractualism did share certain broad features. This study of a crucial age in the history of appeals to contract in political argument will be of interest to political philosophers and historians. features. This study of a crucial age in the history of appeals to contract in political argument will be of interest to political philosophers and historians. (shrink)

The work of Alfred Schutz was an important early influence on Harold Garfinkel and therefore on the development of ethnomethodology. In this article, I try to clarify what Garfinkel drew from Schutz, as well as what he did not take from him, specifically as regards the task of social inquiry. This is done by focusing in detail on one of Schutz’s key articles: ‘Concept and Theory Formation in the Social Sciences’. The aim is thereby to illuminate the relationship between Schutz’s (...) views on the character of social science and Garfinkel’s radical proposal for a re-specified focus of investigation. This is further pursued by examining an important debate about the link between Schutz and ethnomethodology. (shrink)

This response welcomes Sheehan et al’s discussion of the criticisms that have been made of mandatory, pre-emptive ethics regulation and their outline of a philosophical rationale for it. However, it is argued that they misrepresent some of the key criticisms and fail to provide any effective response to them.

In this book the author argues that human musical understanding is rooted in the traditions of culture and that experience of music depends crucially on what the individual brings to it.

This is a response to an article by Stephen Gorard in a previous issue of the journal. It addresses the issue of how achievement gaps in educational performance between ethnic and other groups, and changes in these, can best be measured. The approach recommended by Gorard is compared with that of the authors he criticises. The conclusion reached is that both approaches are of value: that they provide different kinds of information. Which is the most useful on any occasion depends (...) on the purpose guiding the inquiry, and on the assumptions that can be made about the social processes being modelled. (shrink)

This book is a critique of Cambridge School Historical Contextualism as the currently dominant mode of history of political thought, drawing upon Michael Oakeshott's analysis of the logic of historical enquiry.

has become an honorific title used by researchers to commend their work, or the particular approach they adopt. Conversely, the work of others is often dismissed on the grounds that it is "uncritical". However, there are important questions about what the term critical means, about what we should be critical of, and about the form that criticism ought to take. These questions are addressed here in relation to both the role of the social researcher itself and that of researchers operating (...) as public intellectuals. It is argued that the distinction between these roles is an important one, and has implications for what can legitimately be criticised, on what grounds, and in what way. In each case, there are proper limits to criticism, albeit different ones. Like anything else, criticism is not always a good thing. Key Words: critical social research • scientific criticism • social criticism • public intellectuals. (shrink)

Herbert Blumer was a key figure in what came to be identified as the Chicago School of Sociology. He invented the term ‘symbolic interactionism’ as a label for a theoretical approach that derived primarily from the work of John Dewey, George Herbert Mead and Charles Cooley. But his most influential work was methodological in character, and he is generally viewed today as a prominent critic of positivism, and of the growing dominance of quantitative method within US sociology. While this picture (...) is broadly accurate, it neglects an important strand in his methodological thinking. He was committed to the goal of a science of social life, while at the same time he was uncertain whether such a science is possible. In his Appraisal of Thomas and Znaniecki’s The Polish Peasant, he identified a serious dilemma facing this project: the problem of how a scientific approach can be made compatible with the distinctive nature of human social life. In the first chapter of his most influential book, Symbolic Interactionism, he advocates a naturalistic approach to case study, and seems to treat this as avoiding the dilemma. However, there is evidence to suggest that, even towards the end of his life, he regarded the problem as still unresolved. In this article, I examine both sides of Blumer’s dilemma, and whether his attitude towards it changed. However, my interest here is not only historiographical. I evaluate Blumer’s arguments and show that his intellectual struggle with this issue remains relevant today, despite the shifts that have taken place in social science methodology and the philosophy of science since his death. (shrink)

Qu’elle soit ingrate ou réussie, la vieillesse soulève des questions incontournables : celles de la mort et de la souffrance, de la responsabilité et de la vulnérabilité. Du silence et de la parole aussi. Être vulnérable, c’est être fragile, friable ; c’est avoir besoin de son prochain. La vulnérabilité est liée, notamment, à la maladie, au grand âge, à la dépendance ou au fardeau de l’aide. Or, les personnes aidées et aidantes sont surtout des femmes. Il y a les femmes (...) du grand âge et les femmes de tous les âges, qui exécutent à leurs côtés, bénévolement, un travail domestique de santé. Faisons apparaître les obstacles au respect des droits et au pouvoir d’agir de ce « couple vulnérable » aidant-aidé, dans une perspective critique et féministe du droit et de l’éthique. Brisons le silence. (shrink)