“HTA is a multidisciplinary process that summarizes information about the medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner. Its aim is to inform the formulation of safe, effective, health policies that are patient focused, and seek to achieve best value” (EUnetHTA 2007). Even though the assessment of ethical aspects of a health technology is listed as one of the objectives of a HTA process, in practice, the integration (...) of these dimensions into reports remains limited. The article is focused on four points: 1. the HTA concept; 2. the difficult HTA-ethics relationship; 3. the ethical issues in HTA; 4. the methods for integrating ethical analysis into HTA. (shrink)

El artículo pone en evidencia la dimensión ético-antropológica de la historia de la medicina. En el pasado podemos encontrar aquellos elementos de relevancia ética que están en estrecha continuidad con el presente. Desde los orígenes el médico ha experimentado el conflicto entre el mundo del deseo y el mundo del límite. El cuidado de los enfermos comienza desde ahí, de la consciencia de compartir el mismo deseo, el mismo límite, el mismo destino. El artículo mira la historia de la medicina (...) como historia de la humanidad; dentro está toda la vida humana, según la definición del historiador Fielding Garrison . En esta perspectiva la dimensión ético-antropológica emerge sobre todo en las múltiples figuras de médicos ejemplares caracterizados por valores como el valor, la dedicación, la empatía, pero sobre todo por un gran sentido de humanidad y de solidaridad por sus enfermos. En fin, una lectura ético-social puede emerger del arte y de la literatura. Ellas son no sólo testimonio de una época sino también un sismógrafo de las dimensiones éticas de la medicina.This article highlights the ethical-anthropological level of the history of medicine. It explores the close connection between past and present regarding those elements of ethical relevance in medicine. Since the beginning, the physician experienced the conflict between hopes and limits. Medical care springs exactly from the awareness of sharing the same desire, the same limit, and the same destiny. This article regards the history of medicine as history of mankind; according to the historian Fielding Garrison, the history of medicine embodies the entire human life . In this perspective, the ethical-anthropological dimension emerges particularly in many exemplary figures of physicians, distinguished for courage, commitment, empathy, humanity and solidarity towards their patients. Finally, arts and literature can be regarded as instruments to get a cultural perspective, as well as guidelines for social and ethical key of interpretation. They are not only historical documents, but also a seismograph, registering the fundamental historical dimension of medicine. (shrink)

The provision of standardized hearing aids is now considered to be a crucial part of the UK National Health Service. Yet this is only explicable through reference to the career of a woman who has, until now, been entirely forgotten. Dr Phyllis Margaret Tookey Kerridge was an authoritative figure in a variety of fields: medicine, physiology, otology and the construction of scientific apparatus. The astounding breadth of her professional qualifications allowed her to combine features of these fields and, later in (...) her career, to position herself as a specialist to shape the discipline of audiometry. Rather than framing Kerridge in the classic ‘heroic-woman’ narrative, in this article we draw out the complexities of her career by focusing on her pursuit of standardization of hearing tests. Collaboration afforded her the necessary networks to explore the intricacies of accuracy in the measurement of hearing acuity, but her influence was enhanced by her ownership of Britain's first Western Electric audiometer, which she placed in a specially designed and unique ‘silence room’. The room became the centre of Kerridge's hearing aid clinic that, for the first time, allowed people to access free and impartial advice on hearing aid prescription. In becoming the guardian expert and advocate of the audiometer, Kerridge achieved an objectively quantified approach to hearing loss that eventually made the latter an object of technocratic intervention. (shrink)

Nanomedicine has the potential to transform medical therapy and diagnosis. Its technologies predict improved drug delivery systems with site-specific treatment, precise new surgical techniques that would reduce patient trauma and treatment cause, and even cellular repair that would make age-related conditions such as Alzheimer’s disease a thing of the past. Currently, nanomedicine products are reaching the world market with an annual growth rate of twenty-five percent. However, like any emerging new technology, along with doomsday scenarios of nanoparticles gone amuck, nanomedicine (...) raises serious ethical, moral, and social issues that may potentially limit its technological developments. In this essay, I briefly evaluate some of these issues, and argue that ethical and epistemic issues should be considered prior to research and development. By examining three crucial epistemic challenges in nanomedicine—toxicity, nanodrugs and drug delivery systems, and clinical trials—I argue that by implementing a multi-criterion decision analysis framework as outlined by Linkov, Satterstorm and Corey, these challenges can bridge the knowledge gap between R&D and the introduction of nanomedicine technologies into the market. (shrink)

Nanotechnology & Society is the second anthology published by The Nanoethics Group and is a welcome addition to the emerging field of nanoethics. Editors Fritz Allhoff and Patrick Lin are among the leading philosophers in nanoethics and founders of The Nanoethics Group. While their first anthology, Nanoethics: The Ethical and Social Implications of Nanotechnology, presented a general introduction to critical issues in nanoethics, in this new book Allhoff and Lin recognize nanotechnology’s “strange schizophrenia”—as a brave new science filled with unlimited (...) futuristic vision contrasted with the exaggerated hype of research progress—and strive to foster a solid foundation for nanoethics. (shrink)

In some peripheral parts of Europe, prehistoric menhirs, dolmens, henges, and other megalithic constructions made such strong marks on the terrain that they became integral to the landscape. In the Middle Ages, such monuments were often used as landmarks or boundary markers and, indeed, ended up in coeval descriptions of the territory. In some instances, prehistoric monuments were Christianized to promote the conversion of “pagan” populations; in other cases, they stimulated the creation of stone artifacts - stelae, crosses, standing stones (...) - that might have been used as well as instruments of conversion. The investigation in this article revolves around analysis of the landscape of Sardinia, medieval descriptions of Sardinia’s terrain, and examination of some early medieval stone artifacts there. Parallels found in similar contexts in the British Isles are also considered. (shrink)

During the early twentieth century, otologists began collaborating with organizers of the New York League for the Hard of Hearing to build a bridge to “adjust the economic ratio” of deafness and create new research avenues for alleviating or curing hearing loss. This collegiality not only defined the medical discourse surrounding hearing impairment, anchoring it in hearing tests and hearing aid prescription, but, in so doing, solidified the notion that deafness was a “problem” in dire need of a “solution.” Public (...) health campaigns thus became pivotal for spreading this message on local and national levels. This paper focuses on how, from the 1920s to 1950s, as otologists became more involved with social projects for the deaf and hard of hearing — advocating lip-reading, community work, and welfare programs — at the same time, they also mandated for greater therapeutic regulation, control of hearing aid distribution, and standardization of hearing tests. The seemingly paradoxical nature of their roles continued to reinforce the stigmatization of deafness: with widespread availability of effective help, the hearing impaired were expected to seek out therapeutic or technological measures rather than live with their affliction. (shrink)

Describing how the study of artifacts is greatly enhanced by an understanding of the history of museums, Ken Arnold remarks that there is “an implicit faith in the power of objects to tell, or at least ask, historians things that the written word alone cannot” (1999, p. 145). Rather than remaining mute objects or passive accessories to textual descriptions, artifacts (and the museums that house them) are tangible incarnations of the culture from which they emerged, providing unique information on the (...) attitudes and behaviors of the past. In practice, studying and learning from artifacts can sometimes pose methodological problems, as a text-oriented historian may have no idea of how to “read” an object in order to reveal its secrets of the past. Historians and philosophers are trained almost exclusively to work with written and oral documents, limiting their analysis by neglecting such a valuable group of sources. However, as outlined in a special issue of Studies in the History and Philosophy of Science (2007, vol. 38, no. 2), it is apparent that a new historiographical tide has swept over scholars, encouraging new studies and methodologies for working with artifacts, objects, and images. (shrink)