Bacterial resistance mechanisms to the antibiotics known as β‐lactams, which include the penicillins and cephalosporins, can take several forms but frequently involve the production of β‐lactamases from either plasmid‐ or chromosomally‐encoded loci. Gram negative bacteria express a β‐lactamase from evolutionarily related chromosomal ampC genes. Genetic analysis of both inducible and constitutively expressed AmpC β‐lactamases provide insights into the mechanisms regulating production of the enzyme. Evolutionary relationships between the genes of different species are discussed, as well as the regulatory mechanisms that (...) in both laboratory mutants and clinical isolates lead to overproduction of β‐lactamase. (shrink)

The discovery of penicillin by Alexander Fleming in 1928 revolutionized the way infections were treated. In the context of World War II, the government of the United States politicized the production and use of penicillin as yet another weapon to win the war. It was carefully rationed on the home front, while being used with reckless abandon in the treatment battle wounds and venereal diseases on the battlefield. Penicillin was described as a miracle drug that would be (...) able to cure everyone, when in reality it was only being used to benefit the military and the American war effort, at the expense of civilian lives. (shrink)

The discovery, made in Oxford, that crude penicillin could cure systemic and life‐threatening bacterial infections was followed by attempts to purify penicillin, to determine its structure and then to produce it by total chemical synthesis. The β‐lactam structure of the molecule, first proposed in October 1943, was a source of controversy until 1945. However, no useful chemical synthesis was achieved and fermentation became the commercial source of the antibiotic.In 1953, one of the products of a Cephalosporium sp. from (...) Sardinia was shown to be a new and hydrophilic penicillin (penicillin N). This was contaminated with a substance having the same side‐chain but a characteristic absorption spectrum. The latter, cephalosporin C, showed antibacterial activity but was not inactivated by a penicillinase. The determination of its β‐lactam structure and isolation of its nucleus enabled pharmaceutical companies to produce many semisynthetic cephalosporins.A new tripeptide was later found to be an intermediate in the biosynthesis of both penicillin N and cephalosporin C, and this was followed by the complete elucidation of the biosynthetic pathways leading to these compounds and to benzylpenicillin. (shrink)

Penicillin is a serendipitous discovery par excellence. But, what does this say about Alexander Fleming’s praiseworthiness? Clearly, Fleming would not have received the Nobel Prize, had not a mould accidently entered his laboratory. This seems paradoxical, since it was beyond his control. The present article will first discuss Fleming’s discovery of Penicillin as an example of moral luck in science and technology and critically assess some common responses to this problem. Second, the Control Principle that says that people (...) are not responsible for things beyond their control will be defended. An implication of this principle is that Alexander Fleming’s desert, which is based on his epistemic skills, remains untouched by luck. Third, by distinguishing different notions of praiseworthiness, a way to resolve the paradox of moral luck will be elaborated. Desert provides only a pro tanto reason to determine whether someone is an appropriate addressee of reward. Here, luck can make a difference. Forth, it will be argued that stimulating the quest for socially beneficial science provides a compelling reason to treat scientists with equal desert differently. Penicillin provides striking evidence for the importance of this quest and showcasing it incentivizes the making of socially beneficial science. Ultimately, it will be justified why Fleming deserved the Nobel Prize in at least one sense of the concept. (shrink)

Penicillin is a serendipitous discovery par excellence. But, what does this say about Alexander Fleming’s praiseworthiness? Clearly, Fleming would not have received the Nobel Prize, had not a mould accidently entered his laboratory. This seems paradoxical, since it was beyond his control. The present article will first discuss Fleming’s discovery of Penicillin as an example of moral luck in science and technology and critically assess some common responses to this problem. Second, the Control Principle that says that people (...) are not responsible for things beyond their control will be defended. An implication of this principle is that Alexander Fleming’s desert, which is based on his epistemic skills, remains untouched by luck. Third, by distinguishing different notions of praiseworthiness, a way to resolve the paradox of moral luck will be elaborated. Desert provides only a pro tanto reason to determine whether someone is an appropriate addressee of reward. Here, luck can make a difference. Forth, it will be argued that stimulating the quest for socially beneficial science provides a compelling reason to treat scientists with equal desert differently. Penicillin provides striking evidence for the importance of this quest and showcasing it incentivizes the making of socially beneficial science. Ultimately, it will be justified why Fleming deserved the Nobel Prize in at least one sense of the concept. (shrink)

Penicillin is a serendipitous discovery par excellence. But, what does this say about Alexander Fleming’s praiseworthiness? Clearly, Fleming would not have received the Nobel Prize, had not a mould accidently entered his laboratory. This seems paradoxical, since it was beyond his control. The present article will first discuss Fleming’s discovery of Penicillin as an example of moral luck in science and technology and critically assess some common responses to this problem. Second, the Control Principle that says that people (...) are not responsible for things beyond their control will be defended. An implication of this principle is that Alexander Fleming’s desert, which is based on his epistemic skills, remains untouched by luck. Third, by distinguishing different notions of praiseworthiness, a way to resolve the paradox of moral luck will be elaborated. Desert provides only a pro tanto reason to determine whether someone is an appropriate addressee of reward. Here, luck can make a difference. Forth, it will be argued that stimulating the quest for socially beneficial science provides a compelling reason to treat scientists with equal desert differently. Penicillin provides striking evidence for the importance of this quest and showcasing it incentivizes the making of socially beneficial science. Ultimately, it will be justified why Fleming deserved the Nobel Prize in at least one sense of the concept. (shrink)

The 1940s and 1950s were marked by intense debates over the origin of drug resistance in microbes. Bacteriologists had traditionally invoked the notions of ‘training’ and ‘adaptation’ to account for the ability of microbes to acquire new traits. As the field of bacterial genetics emerged, however, its participants rejected ‘Lamarckian’ views of microbial heredity, and offered statistical evidence that drug resistance resulted from the selection of random resistant mutants. Antibiotic resistance became a key issue among those disputing physiological vs. genetic (...) explanations of variation in bacteria. Postwar developments connected with the Lysenko affair gave this debate a new political valence.Proponents of the neo-Darwinian synthesis weighed in with support for the genetic theory. However, certain features of drug resistance seemed inexplicable by mutation and selection, particularly the phenomenon of ‘multiple resistance’—the emergence of resistance in a single strain against several unrelated antibiotics. In the late 1950s, Tsutomu Watanabe and his collaborators solved this puzzle by determining that resistance could be conferred by cytoplasmic resistance factors rather than chromosomal mutation. These R factors could carry resistance to many antibiotics and seemed able to promote their own dissemination in bacterial populations. In the end, the vindication of the genetic view of drug resistance was accompanied by a recasting of the ‘gene’ to include extrachromosomal hereditary units carried on viruses and plasmids. (shrink)

An argument that what makes science distinctive is its emphasis on evidence and scientists' willingness to change theories on the basis of new evidence. Attacks on science have become commonplace. Claims that climate change isn't settled science, that evolution is “only a theory,” and that scientists are conspiring to keep the truth about vaccines from the public are staples of some politicians' rhetorical repertoire. Defenders of science often point to its discoveries (penicillin! relativity!) without explaining exactly why scientific claims (...) are superior. In this book, Lee McIntyre argues that what distinguishes science from its rivals is what he calls “the scientific attitude”—caring about evidence and being willing to change theories on the basis of new evidence. The history of science is littered with theories that were scientific but turned out to be wrong; the scientific attitude reveals why even a failed theory can help us to understand what is special about science. McIntyre offers examples that illustrate both scientific success (a reduction in childbed fever in the nineteenth century) and failure (the flawed “discovery” of cold fusion in the twentieth century). He describes the transformation of medicine from a practice based largely on hunches into a science based on evidence; considers scientific fraud; examines the positions of ideology-driven denialists, pseudoscientists, and “skeptics” who reject scientific findings; and argues that social science, no less than natural science, should embrace the scientific attitude. McIntyre argues that the scientific attitude—the grounding of science in evidence—offers a uniquely powerful tool in the defense of science. (shrink)

In this essay, I look at two negative portrayals of egoism. I summarize in detail the superb All About Eve—which won six Academy Awards, including Best Picture. The movie is about the rise of a ruthlessly ambitious actress, and how she treats her main competitor. Eve Harrington worms her way into top theatrical actress Margo Channing’s inner circle by pretending to be an admirer, but she is really a schemer who wants to eclipse Margo’s star in the theater universe. However, (...) Eve runs into trouble when she attempts to manipulate tart-tongued theater critic, Addison de Witt. The movie portrays the New York theater industry as being full of narcissists. I then review the classic film noir The Third Man (1949), rated by the prestigious British Film Institute as the greatest film of the 20th century. The film centers around a charismatic, handsome criminal mastermind Harry Lime living in bombed-out post-War Vienna. Lime is a man of no conscience or empathy—a true psychopath. He cripples children by selling hospitals adulterated penicillin. But we (the audience) still feel sympathy for him. I end the piece by explaining the psychological mechanisms at work that give rise to our paradoxical sympathy. (shrink)

A personal story of the ways in which persistence, chance, and creativity interact in biomedical research. This first book by the author of Zen and the Brain examines the role of chance in the creative process. James Austin tells a personal story of the ways in which persistence, chance, and creativity interact in biomedical research; the conclusions he reaches shed light on the creative process in any field. Austin shows how, in his own investigations, unpredictable events shaped the outcome of (...) his research and brought about novel results. He then goes beyond this story of serendipity to propose a new classification of the varieties of chance, drawing on his own research and examples from the history of science—including the famous accidents that led Fleming to the discovery of penicillin. Finally, he explores the nature of the creative process, considering not only the environmental and neurophysiological correlates of creativity but also the role of intuition in both scientific discoveries and spiritual quests. This updated MIT Press paperback edition includes a new introduction and recent material on medical research, creativity, and spirituality. (shrink)

Syphilis occupies a unique position in the history of U.S. medicine and medical ethics. Given its widespread prevalence and variable presentation, syphilis was a major professional concern among late nineteenth‐ and early twentieth‐century physicians. Syphilis was also at the center of perhaps the most famous example of medical racism in our history, the U.S. Public Health Service Syphilis Study at Tuskegee, in which officials followed the natural history of the disease in a cohort of black men for forty years without (...) offering treatment, even once penicillin became available. In this essay, I call attention to a less well‐known aspect of syphilis and its history. I examine one of the disease's most dreaded manifestations, neurosyphilis (also known as general paresis or general paralysis of the insane), and its treatment via malarial inoculation from the 1920s into the 1950s. The goal of this treatment, dramatic even to observers at the time, was to produce spiking fevers that would kill the syphilitic spirochete and arrest the disease process. My focus will be on developments at St. Elizabeths Hospital, a large‐scale federal psychiatric facility in the District of Columbia that served the city's residents and members of the U.S. military. Physicians at St. Elizabeths were the first in the United States to experiment with malarial fever therapy, treating their initial cohort of patients in December of 1922.Malarial fever therapy raised a host of ethical questions, rendered all the more complex from today's vantage point by efforts to understand them within the context of the time. What sorts of risks, both from malaria and via indirect exposure, might be deemed acceptable in the treatment of a devastating and almost invariably fatal disease? How ought researchers and clinicians to have approached the question of consent, itself an evolving concept in the early decades of the twentieth century, when the disease they were targeting impaired a patient's ability to reason effectively? Finally, at a time when segregated and inferior care for black Americans was the norm and when the black community bore a disproportionate burden of disease, who would have had access to malarial fever therapy, and at what cost? (shrink)

These days, science is everywhere. It pervades our whole society. Sometimes it is just a clutter of commonplace frivolities, like new fashion fabrics. Sometimes it miraculously preserves our life, like penicillin. Sometimes, like climate change, it looms over us as a portent of doom: sometimes it promises a way of escape from such a fate. Sometimes, like a nuclear warhead, it enshrouds us in political terror: sometimes, like a verification technology, it offers an antidote to such evils. How should (...) we respond to this ambiguous and ubiquitous thing called science? (shrink)

Stuttering is one of the most well-known speech disorders, but the underlying neurological mechanisms are debated. In addition to genetic factors there are also major non-genetic contributions. It is here proposed that infection with group A beta-hemolytic streptococcus (GAS) was a major underlying cause of stuttering until the mid 1900s, when penicillin was introduced for the treatment of streptococcal infections about 1946. The main mechanism proposed is an autoimmune reaction from tonsillitis, targeting specific molecules, for example within the basal (...) ganglia. It is here also proposed that GAS infections may have continued to cause stuttering to some extent, to the present date, though more rarely. If so, early diagnosis of such cases would be of importance. Childhood cases with sudden onset of stuttering after throat infection may be particularly important to assess for possible GAS infection. The support for this hypothesis primarily comes from three lines of argument. First, medical record data from the 1930s strongly indicates that there was one type of medical event in particular that preceded the onset of childhood stuttering with unexpected frequency: diseases related to GAS throat infections. In particular, this included tonsillitis and scarlet fever, but also rheumatic fever. Rheumatic fever is a childhood autoimmune sequela of GAS infection, which was a relatively widespread medical problem until the early 1960s. Secondly, available reports of changes of the childhood prevalence of stuttering indicates striking parallels between stuttering and the incidence of rheumatic fever, with (1) decline from the early 1900s, (2) marked decline from the introduction of penicillin about 1946, and (3) reaching a more stable level in the 1960s. The correlations between the data for stuttering and for rheumatic fever after introduction of penicillin are very high, at about 0.95. Thirdly, there are established biological mechanisms linking GAS tonsillitis to immunological effects on the brain. In addition, a small number of more recent case reports have provided further support for the hypothesis linking stuttering to GAS infection. Overall, it is proposed that the available data provides strong evidence for the hypothesis that GAS infection was a major cause of stuttering until the mid 1900s. (shrink)

By now, it should be clear: in the face of disinformation and disaster, we cannot hot take, life hack, or meme our way to a better future. But how should we respond instead? In How to Think like a Philosopher, Julian Baggini turns to the study of reason itself for practical solutions to this question, inspired by our most eminent philosophers, past and present. Baggini offers twelve key principles for a more human, balanced, and rational approach to thinking: pay attention; (...) question everything (including your questions); watch your steps; follow the facts; watch your language; be eclectic; be a psychologist; know what matters; lose your ego; think for yourself, not by yourself; make connections, not theories; and don't give up. Each chapter is chockfull of real-world examples showing these principles at work-from the discovery of penicillin to the fight for trans rights-and how they lead to more thoughtful conclusions. More than a book of tips and tricks (or ways to be insufferably clever at parties), How to Think like a Philosopher is an invitation to develop the habits of good reasoning that our world desperately needs. (shrink)

ArgumentThis article examines how antimicrobial resistance (AMR) came to be constituted as a matter of public concern in Sweden in conjunction with the development of an inter-professional organization called Strama, founded to promote rational prescription of antibiotics. An outbreak of penicillin-resistant pneumococci in the mid-1990s was crucial for this development, because it brought attention to AMR as an urgent public threat. This outbreak fuelled the constitution of AMR as caused by consumption of antibiotics and as a matter of disease (...) control. As a consequence, Strama was able to mobilize the Swedish health officers responsible for disease control. The outbreak is conceptualized as a “transformative event” – an event that makes an issue and its associated risks concrete and urgent. Transformative events play the crucial role of expediting the transformation of issues into matters of public concern. (shrink)

This Article explores the process of discovering legal scholarship. One may read, read, and read cases and statutes and articles to generate one's own piece of scholarship. But research, though necessary, does not produce durable scholarship. Lasting scholarship is like discovering penicillin. It is like capturing a fleeting revelation. It is an experience reported in language. True legal scholarship is researched poetry of the highest order. Rumi, Frost, Keats would have been great legal scholars. (This article might benefit new (...) law professors who are striving to make their scholarship float in the ocean of words.). (shrink)

We think that science is special: its products ‐ technological spin‐offs ‐ dominate our lives. Sometimes it enriches our lives; sometimes it impoverishes them or even takes them away. For better or for worse, no institution has had more impact on the character of our existence this millennium than science. Penicillin, computers, atomic bombs make modern life modern life.

„Ich habe gerade gelesen, dass man aus verschimmeltem Brot Penicillin machen kann. Und deshalb denke ich immer, man kann aus jedem etwas machen. Aber aus dir gar nichts." Dieses Zitat stammt von Dieter Bohlen, dem berühmt-berüchtigten Juror in Deutschlands prominentestem Fernseh-Talentschuppen "Deutschland sucht den Superstar". Es ist einer von zahllosen Sprüchen, mit denen er (angeblich spontan) die Kandidatinnen und Kandidaten abkanzelt, die ihm nicht gefallen. Der Ratsvorsitzende der Evangelischen Kirche, Bischof Wolfgang Huber, hat Bohlen deshalb Anfang 2007 vorgeworfen, nicht (...) nur die "einfachsten Umgangsformen" zu missachten, sondern auch die Menschenwürde der Betroffenen verletzt zu haben. Mit dieser Kritik beruft sich Bischof Huber auf einen der prominentesten Begriffe in der Ethik, den Begriff der Menschenwürde, und zwar auf eine Weise, die die ganze Zwiespältigkeit dieses Begriffs deutlich macht. In meinem Beitrag möchte ich diese Ambivalenz als Ausgangspunkt nehmen, um zu skizzieren, was Menschenwürde eigentlich ist und worin das ethische Interesse an diesem Begriff besteht. (shrink)

Some classic historical vignettes depict scientists achieving breakthroughs without effort: Archimedes grasping the principles of buoyancy while bathing, Galileo Galilei discovering the isochrony of the pendulum while sitting in a cathedral, James Watt noticing the motive power of steam while passing time in a kitchen, Alexander Fleming finding penicillin in Petri dishes that he had omitted to clean before going on holiday. These stories suggest that, to establish important findings in science, hard work is not always necessary. In this (...) article, I suggest that such stories capture an important aspect of scientific.. (shrink)

Cortisone, initially known as ‘compound E’ was the medical sensation of the late 1940s and early 1950s. As early as April 1949, only a week after Philip Hench and colleagues first described the potential of ‘compound E’ at a Mayo Clinic seminar, the New York Times reported the drug’s promise as a ‘modern miracle’ in the treatment of rheumatoid arthritis. Given its high profile, it is unsurprising that historians of medicine have been attracted to study the innovation of cortisone. It (...) arrived at the end of a decade of ‘therapeutic revolutions’, kicked off by penicillin transforming the treatment of bacterial infections and ending with hopes of a revolution in the treatment of non-infectious, chronic inflammatory diseases. Despite these studies of cortisone’s introduction, few historians have taken the story forward and considered how cortisone was adopted and adapted into clinical practice. This article tells the longer of how the drug and its derivatives were taken from research laboratories and integrated into clinical practice; what has in recent decades become known as translational medicine. In exploring cortisone’s first decade in Britain, we focus specifically on its role in the treatment of RA. Our approach is always to consider cortisone’s use in the context of other treatments available to clinicians, and at local and national institutional settings. We do not discuss the many other therapeutic uses of cortisone, which ranged for topical applications for skin diseases to the management of cancers, especially childhood leukaemia, nor do we discuss its close analogue ACTH—AdenoCorticoTropic Hormone. We think there are lessons in our study for TM policies today. (shrink)

Cortisone, initially known as ‘compound E’ was the medical sensation of the late 1940s and early 1950s. As early as April 1949, only a week after Philip Hench and colleagues first described the potential of ‘compound E’ at a Mayo Clinic seminar, the New York Times reported the drug’s promise as a ‘modern miracle’ in the treatment of rheumatoid arthritis. Given its high profile, it is unsurprising that historians of medicine have been attracted to study the innovation of cortisone. It (...) arrived at the end of a decade of ‘therapeutic revolutions’, kicked off by penicillin transforming the treatment of bacterial infections and ending with hopes of a revolution in the treatment of non-infectious, chronic inflammatory diseases. Despite these studies of cortisone’s introduction, few historians have taken the story forward and considered how cortisone was adopted and adapted into clinical practice. This article tells the longer of how the drug and its derivatives were taken from research laboratories and integrated into clinical practice; what has in recent decades become known as translational medicine. In exploring cortisone’s first decade in Britain, we focus specifically on its role in the treatment of RA. Our approach is always to consider cortisone’s use in the context of other treatments available to clinicians, and at local and national institutional settings. We do not discuss the many other therapeutic uses of cortisone, which ranged for topical applications for skin diseases to the management of cancers, especially childhood leukaemia, nor do we discuss its close analogue ACTH—AdenoCorticoTropic Hormone. We think there are lessons in our study for TM policies today. (shrink)

Cortisone, initially known as ‘compound E’ was the medical sensation of the late 1940s and early 1950s. As early as April 1949, only a week after Philip Hench and colleagues first described the potential of ‘compound E’ at a Mayo Clinic seminar, the New York Times reported the drug’s promise as a ‘modern miracle’ in the treatment of rheumatoid arthritis. Given its high profile, it is unsurprising that historians of medicine have been attracted to study the innovation of cortisone. It (...) arrived at the end of a decade of ‘therapeutic revolutions’, kicked off by penicillin transforming the treatment of bacterial infections and ending with hopes of a revolution in the treatment of non-infectious, chronic inflammatory diseases. Despite these studies of cortisone’s introduction, few historians have taken the story forward and considered how cortisone was adopted and adapted into clinical practice. This article tells the longer of how the drug and its derivatives were taken from research laboratories and integrated into clinical practice; what has in recent decades become known as translational medicine. In exploring cortisone’s first decade in Britain, we focus specifically on its role in the treatment of RA. Our approach is always to consider cortisone’s use in the context of other treatments available to clinicians, and at local and national institutional settings. We do not discuss the many other therapeutic uses of cortisone, which ranged for topical applications for skin diseases to the management of cancers, especially childhood leukaemia, nor do we discuss its close analogue ACTH—AdenoCorticoTropic Hormone. We think there are lessons in our study for TM policies today. (shrink)

ABSTRACT Monoclonal antibodies played a key role in the development of the biotechnology industry of the 1980s and 1990s. Investments in the sector and commercial returns have rivaled those of recombinant DNA technologies. Although the monoclonal antibody technology was first developed in Britain, the first patents were taken out by American scientists. During the first Thatcher government in Britain, blame for the missed opportunity fell on the scientists involved as well as on the National Research and Development Corporation, which had (...) been put in place after World War II to avoid a repeat of the penicillin story, when patent rights were not sought. Instead of apportioning the blame, this essay suggests that despite past experiences and despite the new channels that were in place, Britain was not in a “patent culture” in the 1970s. It traces the long and painful process that made a commercial attitude among publicly funded British research scientists and in a civil service institution like the Medical Research Council both possible and desirable. In this process the meaning of the term “public science” also changed dramatically. (shrink)

This essay details a historical crossroad in biochemistry and microbiology in which penicillin was a co-agent. I narrate the trajectory of the bacterial cell wall as the precise target for antibiotic action. As a strategic object of research, the bacterial cell wall remained at the core of experimental practices, scientific narratives and research funding appeals throughout the antibiotic era. The research laboratory was dedicated to the search for new antibiotics while remaining the site at which the mode of action (...) of this new substance was investigated. This combination of circumstances made the bacterial wall an ontology in transit. As invisible as the bacterial wall was for clinical purposes, in the biological laboratory, cellular meaning in regard to the action of penicillin made the bacterial wall visible within both microbiology and biochemistry. As a border to be crossed, some components of the bacterial cell wall and the biochemical destruction produced by penicillin became known during the 1950s and 1960s. The cell wall was constructed piece by piece in a transatlantic circulation of methods, names, and images of the shape of the wall itself. From 1955 onwards, microbiologists and biochemists mobilized new names and associated conceptual meanings. The composition of this thin and rigid layer would account for its shape, growth and destruction. This paper presents a history of biochemical morphology: a chemistry of shape – the shape of bacteria, as provided by its wall – that accounted for biology, for life itself. While penicillin was being established as an industrially-manufactured object, it remained a scientific tool within the research laboratory, contributing to the circulation of further scientific objects. (shrink)

Antibiotic allergies are commonly reported among patients, but most do not experience reactions on rechallenge with the same agents. These reported allergies complicate management of infections in patients labelled as having penicillin allergy, including serious infections where penicillin-based antibiotics are the first-line (most effective and least toxic) treatment option. Allergy labels are rarely questioned in clinical practice, with many clinicians opting for inferior second-line antibiotics to avoid a perceived risk of allergy. Reported allergies thereby can have significant impacts (...) on patients and public health, and present major ethical challenges. Antibiotic allergy testing has been described as a strategy to circumvent this dilemma, but it carries limitations that often make it less feasible in patients with acute infections or in community settings that lack access to allergy testing. This article provides an empirically informed ethical analysis of key considerations in this clinical dilemma, usingStaphylococcus aureusbacteraemia in patients with penicillin allergies as a case study. We argue that prescribing first-line penicillin-based antibiotics to patients with reported allergies may often present a more favourable ratio of benefits to risks, and may therefore be more ethically appropriate than using second-line drugs. We recommend changes to policy-making, clinical research and medical education, in order to promote more ethically acceptable responses to antibiotic allergies than the status quo. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Modern Vs. Contemporary Medicine: The Patient-Provider Relation in the Twenty-First CenturyRobert M. Veatch (bio)The revolution in medical ethics of the past quarter century has begun reshaping the patient-provider relation in such a way that it will never be the same. 1 Dramatic changes have occurred at the level of specific decisions such as consent, forgoing treatment, and birth technologies, but the most significant impact will be on the way (...) the relation is conceptualized and the kinds of authority each party in the relation will be assumed to possess. The change is so fundamental that it deserves to be called a change from modern to contemporary medicine.Contrasting Modern and Contemporary MedicineModern MedicineMedicine of the modern period can be said to have had its origins in the sixteenth century with the emergence of the scientific mentality in such figures as Francis Bacon, but it really took off in the enlightenment of the eighteenth century. While intellectuals in medicine up to that time tended to be in conversation with those of philosophy, theology, and the arts, the emergence of medicine as a science changed that communication.The effect of the scientizing of medicine was that physicians tended to lose contact with the humanists. It was as if a physician, if he mastered the medical science, could, without any intervening value judgments, know how to treat the patient. In fact, for some conditions, there was (and still is) so much consensus [End Page 366] on the values that it is as if they were not present at all. If a patient has pneumonia, the most important element in a clinical decision seems to be pharmacological knowledge of whether a drug can produce a cure. The clinician knowledgeable of penicillin seems all that is needed.Upon reflection a suppressed premise becomes obvious: if it is better to live with the penicillin than to die without it, then one ought to take the penicillin. Since almost no one doubts the wisdom of that value judgment, all that seems to be needed is pharmacological knowledge. This view of medicine implies that certain treatments are “medically indicated,” as if the knowledge of the science could demonstrate that certain treatments were appropriate, in fact, were “treatments of choice.”Of course, on rare occasions, someone would question the value presumption. We discovered that certain patients with metastatic cancer who developed pneumonia might not automatically agree that it is better to live with the penicillin. Also Christian Scientists might deny that use of the drug led to the best possible consequences. These were set aside as unusual cases, ethically exotic problems, to be addressed outside the normal bounds of medical science. We still believed that medical science together with competent diagnostic skills were the critical factors in deciding what the appropriate treatment was.Some clinicians spoke as if these decisions could be made with no value judgments at all (except in cases in which outside “religious” or “cultural” influences contravened). Many more sophisticated clinicians, however, understood all along that an implicit value system was built into the medical profession. Some have even claimed that the very concept of medicine contains within it a set of norms or goals or values that are “intrinsic to the practice” (Pellegrino and Thomasma 1988, p. 116). For many those values are encapsulated in the Hippocratic tradition, particularly the core Hippocratic principle that the physician should act always for the benefit of the patient according to his ability and judgment.When physicians began spending their time learning medical science, the richness of their conversation with the philosophical and religious traditions of the day was lost. Clinicians, without a rich knowledge of those traditions, hit upon the Hippocratic ethic, embracing it as the epitome of their goals without real understanding of its implications and potential conflicts with other ethical traditions (cf. Veatch and Mason 1987).Contemporary MedicineThe most critical contribution of the medical ethics of the current generation has been the calling into question of the Hippocratic ethic, especially the presumption that science by itself (or aided by a single, core ethic intrinsic to all practice of medicine) is sufficient to practice medicine. This generation’s medical ethics... (shrink)

We say that celebrated accidents shape public perception of safety and risk in health care. Take the so-called celebrated story of the three Colorado nurses who, by administering bezathine penicillin intravenously, caused the death of a neonate. The nurses were charged with criminal negligence, with one pleading guilty to a reduced charge and another fighting the charge and eventually being exonerated. “Celebrated” accidents seem to follow a predictable script and cast participants in recognizable roles. They present heroes, survivors, and (...) victims. And, of course, they put villains, or anti-heroes, center stage – the chief protagonists of a fatal plot. (shrink)

The antibiotic streptomycin was discovered soon after penicillin was introduced into medicine. Selman Waksman, who was awarded the Nobel Prize for the discovery, has since generally been credited as streptomycin's sole discoverer. However, one of Waksman's graduate students, Albert Schatz, was legally recognized as streptomycin's co-discoverer and received a share of the royalties from the drug. The aim of this essay is to discuss the streptomycin story, largely using previously unquoted archival material, and in particular to provide further evidence (...) for the important role which Schatz played in the discovery. (shrink)

Hastings Center Report, Volume 51, Issue 5, Page 3-3, September‐October 2021.

This essay explores what Jewish ethics has to say about globalization in relation to the AIDS crisis. Special attention is paid to the consequences in affirming current intellectual trends to transcend traditional limits in both society and thought for rethinking traditional Jewish values. The discussion proceeds from two presuppositions. The first is that there is an intimate connection between ethics, science, and politics. The second is that the history of Jewish ethics involves three distinct forms that are generally correlated but (...) rarely identical in content and moral judgment. These three forms are law, wisdom or virtue, and covenant. The discussion considers related issues of accidental connections in time between the bubonic plague and Zionism and between AIDS and homosexuality in relation to moral–theological issues related to divine providence and distributive justice. (shrink)