ObjectiveTo explore the effect of modified constraint-induced movement therapy on upper limbs residual dysfunction for infancy with the sequelas of unilateral brachial plexus injury.MethodsSingle blind randomized controlled trial of mCIMT vs. standard care. An enrolling 31 infants with a uBPI exhibiting residual dysfunction of the affected upper limb for over 6 months was conducted. And functional outcomes pertaining to the affected upper limb were assessed via AMS, GRES, RHS, and MSS at 0, 3, and 6 months after treatment.ResultsNo differences (...) were found in baseline AMS, MSS, GRES, or RHS between the control and mCIMT groups [F = 0.062, P = 0.086; F = 0.483, P = 0.499; F = 0.272, P = 0.610; Z = −0.336, P = 7.373]. At the 3- and 6-month follow-up time points, AMS, MSS, and GRES scores were significantly improved over baseline in both groups [mCIMT: F = 183.750, 128.614, 110.085, P < 0.05; Control: F = 204.007, 75.246, 51.070, P < 0.05]. No significant differences were found between two treatment groups at the 3-month follow-up time point [F = 0.565, P = 0.465; F = 0.228, P = 0.641; F = 0.713, P = 0.413; Z = −0.666, P = 0.505]. However, at the 6-month follow-up time point, AMS and MSS scores were significantly improved in the mCIMT group relative to the control group [F = 8.077, P = 0.013; F = 18.692, P = 0.001].ConclusionmCIMT may benefit the rehabilitation of residual upper limb dysfunction associated with a uBPI in infants.Clinical Trial Registration[www.chictr.org.cn], identifier [ChiCTR1900022119]. (shrink)

Background: There is a growing interest in using cognitive behavioural therapy with people who have Asperger Syndrome and comorbid mental health problems. Aims: To examine whether modified group CBT for clinically significant anxiety in an AS population is feasible and likely to be efficacious. Method: Using a randomised assessor-blind trial, 52 individuals with AS were randomised into a treatment arm or a waiting-list control arm. After 24 weeks, those in the waiting-list control arm received treatment, while those initially randomised (...) to treatment were followed-up for 24 weeks. Results: The conversion rate for this trial was high, while attrition was 13%. After 24 weeks, there was no significant difference between those randomised to the treatment arm compared to those randomised to the waiting-list control arm on the primary outcome measure, the Hamilton Rating Scale for Anxiety. Conclusions: Trials of psychological therapies with this population are feasible. Larger definitive trials are now needed. Declaration of Interest: None Trial Registration: ISRCTN 30265294, UKCRN 8370. (shrink)

Stem cell tourism—the flow of patients from home countries to destination countries to obtain stem cell treatment—is a growing business in China. Many concerns have been raised regarding fraudsters that operate unsafe stem cell therapies and an officialdom that turns a blind eye to the questionable technology. The Chinese regulatory approach to stem cell research is based on Guidelines and Administrative Measures, rather than legislation, and may have no binding force on certain institutions, such as military hospitals. There is no (...) liability and traceability system and no visible set of penalties for non-compliance in the stem cell legal framework. In addition to the lack of safety and efficacy systems in the regulations, no specific expert authority has been established to monitor stem cell therapy to date. Recognizing the global nature of stem cell tourism, this article argues that resolving stem cell tourism issues may require not only the Chinese government but also an international mechanism for transparency and ethical oversight. A stringent set of international regulations that govern stem cell therapies can encourage China to improve stem cell regulation and enforcement to fulfill its obligations. Through an international consensus, a minimum standard for clinical stem cell research and a central enforcement system will be provided. As a result, rogue clinics that conduct unauthorized stem cell therapies can be penalized, and countries that are reluctant to implement the reconciled regulations should be sanctioned. (shrink)

Grafting embryonic brain tissue into the brain of patients with visual field loss due to cerebral lesions may become a method to restore visual function. This method is not without risk, however, and will only be considered in cases of complete blindness after bilateral occipital lesions, when other, risk-free neuropsychological methods fail.

The introduction of new medical treatments based on invasive technologies has often been surrounded by both hopes and fears. Hope, since a new intervention can create new opportunities either in terms of providing a cure for the disease or impairment at hand; or as alleviation of symptoms. Fear, since an invasive treatment involving implanting a medical device can result in unknown complications such as hardware failure and undesirable medical consequences. However, hopes and fears may also arise due to the cultural (...) embeddedness of technology, where a therapy due to ethical, social, political and religious concerns could be perceived as either a blessing or a threat. While Deep Brain Stimulation (DBS) for treatment resistant depression (TRD) is still in its cradle, it is important to be proactive and try to scrutinize both surfacing hopes and fears. Patients will not benefit if a promising treatment is banned or avoided due to unfounded fears, nor will they benefit if DBS is used without scrutinizing the arguments which call for caution. Hence blind optimism is equally troublesome. We suggest that specificity, both in terms of a detailed account of relevant scientific concerns as well as ethical considerations, could be a way to analyse expressed concerns regarding DBS for TRD. This approach is particularly fruitful when applied to hopes and fears evoked by DBS for TRD, since it can reveal if our comprehension of DBS for TRD suffer from various biases which may remain unnoticed at first glance. We suggest that such biases exist, albeit a further analysis is needed to explore this issue in full. (shrink)

Blindness in therapy? Love? Or science? In this paper we dispute what seems an obvious truism these days: that increasing the influence of scientific research on psychotherapy is a good thing. We begin with an exploration of two distinct capacities that contribute in significant ways to human flourishing: knowledge and love. We then argue that modern society rather onesidedly capitalizes on the growth of scientific knowledge. This has an important drawback because the dominant model of growth presupposed in (...) scientific research is built on the idea of reducing the potentially disturbing influence of the subjective engagement of the scientist with the object of knowledge. This is ordinarily quite a fruitful idea that has, however, paradoxically bad effects in evidence-based therapy. This is the case, we argue, because in a scientifically informed therapy the therapist should, in some sense, try to be blind to the effects of his expertise on his clients’ expectations of his expertise. A scientific, disengaged perspective therefore frustrates the therapist’s need to invest in the formation of a charitable relationship with his clients. Next we argue that the popular prejudice against love – that it is blind – is not as plausible as it is considered to be. To be sure, love invites cognition to accept a subservient role, but, we argue, this has some advantages too. It encourages the lover to discern particularly positive and promising features of the object of his love, and this, we argue, is crucial to a successful therapy in two ways. On the one hand, the therapist needs to engage with these positive and promising features to succeed in building the needed charitable relationship with his clients. And on the other hand clients often go into therapy because they lack access to their own positive and promising features and are therefore unable to entertain a charitable relationship with themselves. We conclude that with respect to psychotherapy there might be good reason for contemporary society to capitalize on the growth of love, rather than the growth of knowledge. (shrink)

Homeopathy is one of the most widely practiced alternative systems of medicine in the world. Current scientific understanding is unable to explain its mode of action, and the therapy is often dismissed by detractors who claim—despite growing evidence to the contrary— that it is ineffective. While homeopathy’s philosophical foundations and the nature of its medicines differ markedly from those of its mainstream counterpart, biomedical researchers are nevertheless employing conventional methods to study it—including lab-based animal experimentation. This article considers the (...) implications of using violent methodology to investigate a gentle system of medicine founded on treating the individual and on doing no harm. (shrink)

Background Previous reports have described that simple cognitive training using reading aloud and solving simple arithmetic calculations, so-called “learning therapy”, can improve executive functions and processing speed in the older adults. Nevertheless, it is not well-known whether learning therapy improve a wide range of cognitive functions or not. We investigated the beneficial effects of learning therapy on various cognitive functions in healthy older adults. Methods We used a single-blinded intervention with two groups (learning therapy group: LT (...) and waiting list control group: WL). Sixty-four elderly were randomly assigned to LT or WL. In LT, participants performed reading Japanese aloud and solving simple calculations training tasks for 6 months. WL did not participate in the intervention. We measured several cognitive functions before and after 6 months intervention periods. Results Compared to WL, results revealed that LT improved inhibition performance in executive functions (Stroop: LT (Mean = 3.88) vs. WL (Mean = 1.22), adjusted p =.013 and reverse Stroop LT (Mean = 3.22) vs. WL (Mean = 1.59), adjusted p =.015), verbal episodic memory (logical memory: LT (Mean = 4.59) vs. WL (Mean = 2.47), adjusted p =.015), focus attention(D-CAT: LT (Mean = 2.09) vs. WL (Mean = -0.59), adjusted p =.010) and processing speed compared to the waiting list control group (digit symbol coding: LT (Mean = 5.00) vs. WL (Mean = 1.13), adjusted p =.015 and symbol search: LT (Mean = 3.47) vs. WL (Mean = 1.81), adjusted p =.014). Discussion This RCT can showed the benefit of learning therapy on inhibition of executive functions, verbal episodic memory, focus attention, and processing speed in healthy elderly people. Our results were discussed under overlapping hypothesis. Trial registration “This trial was registered in The University Hospital Medical Information Network Clinical Trials Registry (UMIN000006998).”. (shrink)

Social anxiety disorders are among the most prevalent mental disorders, with high impact on the life of an affected social system and its individual social system members. We developed a manualized disorder-specific integrative systemic and family therapy for SAD, and evaluated its feasibility in a pilot randomized controlled trial. The ISFT is inspired by Helm Stierlin’s concept of related individuation developed during the early 1980s, which has since continued to be refined. It integrates solution-focused language, social network diagnostics, and (...) genogram work, as well as resource- and problem orientation for both case conceptualization and therapy planning. Post-Milan symptom prescription to fluidize the presented symptoms is one of the core interventions in the ISFT. Theoretically, the IFST is grounded in radical constructivism and “Cybern-Ethics,” multi-directional partiality, and a both/and attitude toward a disorder-specific vs. non-disorder-specific therapy approach. SAD is understood from the viewpoint of social systems theory, especially in adaptation to a socio-psycho-biological explanatory model of social anxiety. In a prospective multicenter, assessor-blind pilot RCT, we included 38 clients with SAD : 18 patients participated in the ISFT, and 20 patients in Cognitive Behavioral Therapy. Within-group, simple-effect intention-to-treat analyses showed significant reduction in social anxiety, while intention-to-treat mixed-design ANOVA demonstrated the advantage of ISFT. Per-protocol analyses supported these results. The remission rate based on blind diagnosticians’ ratings was good to satisfactory ; this has yet to be verified in a subsequent confirmatory RCT. The article will present the ISFT rationale and manual, including a special focus on multi-person settings, and the central findings from our pilot RCT. (shrink)

Background We report a randomised controlled clinical trial of neurofeedback therapy intervention for ADHD/ADD in adults. We focus on internal mechanics of neurofeedback learning, to elucidate the primary role of cortical self-regulation in neurofeedback. We report initial results; more extensive analysis will follow. Methods Trial has two phases: intervention and follow-up. The intervention consisted of neurofeedback treatment, including intake and outtake measurements, using a waiting-list control group. Treatment involved $\sim$40 hour-long sessions 2-5 times per week. Training involved either theta/beta (...) or sensorimotor-rhythm regimes, adapted by adding a novel 'inverse-training' condition to promote self-regulation. Follow-up (ongoing) will consist of self-report and executive function tests. Setting Intake and outtake measurements were conducted at University of Helsinki. Treatment was administered at partner clinic Mental Capital Care, Helsinki. Randomisation We randomly allocated half the sample then adaptively allocated the remainder to minimise baseline differences in prognostic variables. Blinding Waiting-list control design meant trial was not blinded. Participants 54 adult Finnish participants (mean age 36 years; 29 females) were recruited after screening by psychiatric review. 44 had ADHD diagnoses, 10 had ADD. Measurements Symptoms were assessed by computerised attention test (T.O.V.A.) and self-report scales, at intake and outtake. Performance during neurofeedback trials was recorded. Results Participants were recruited and completed intake measurements during summer 2012, before assignment to treatment and control, September 2012. Outtake measurements ran April-August 2013. After dropouts, 23 treatment and 21 waiting-list participants remained for analysis. Initial analysis showed that, compared to waiting-list control, neurofeedback promoted improvement of self-reported ADHD symptoms, but did not show transfer of learning to T.O.V.A. Comprehensive analysis will be reported elsewhere. Trial Registration "Computer Enabled Neuroplasticity Treatment (CENT)", ISRCTN13915109. Partly funded by Finnish science agency TEKES, project #440078. (shrink)

BackgroundAcrophobia is a specific phobia characterized by a severe fear of heights. The purpose of the present study was to investigate the efficacy of two therapies that may ameliorate symptoms of acrophobia and anxiety sensitivity, i.e., virtual reality exposure therapy (VRET) and eye movement desensitization and reprocessing (EMDR) therapy with a Waiting List Control Condition (WLCC).MethodsWe applied a three-armed randomized controlled pre-post-test design with 45 female adolescent students. Students who met DSM-5 criteria for acrophobia were randomly assigned to (...) either VRET (N = 15;Mage = 17.26; SD = 1.32), EMDR (N = 15;Mage = 17.15; SD = 1.57), or a WLCC (N = 15;Mage = 17.50; SD = 1.26). The study groups were evaluated one week before the intervention and one week after the last intervention session regarding symptoms of acrophobia (Severity Measure for Acrophobia) and anxiety sensitivity (Anxiety Sensitivity Index).ResultsThe data showed that both the application of VRET and EMDR therapy were associated with significantly reduced symptoms of acrophobia (d = 1.03 for VRET and d = 1.08 for EMDR) and anxiety sensitivity (d = 1.15 for VRET and d = 1.13 for EMDR) in comparison to the Waiting List.LimitationsThe sample consisted only of adolescent women. Due to the recognizable differences between the two interventions, the therapists and the participants were not blind to the conditions.ConclusionThe results suggest that both VRET and EMDR are interventions that can significantly improve symptoms of acrophobia and anxiety sensitivity in female adolescents.Clinical Trial Registrationhttps://www.irct.ir/trial/57391, identifier: IRCT20210213050343N1. (shrink)

Congenital nystagmus in infants and young children can lead to early blindness. Previous neuroimaging studies have demonstrated that EB is accompanied by alterations in brain structure and function. However, the effects of visual impairment and critical developmental periods on brain functional connectivity at rest have been unclear. Here, we used the voxel-wise degree centrality method to explore the underlying functional network brain activity in adolescents with EB. Twenty-one patients with EBs and 21 sighted controls underwent magnetic resonance imaging. Differences (...) between the two groups were assessed using the DC method. Moreover, the support vector machine method was used to differentiate patients with EB patients from the SCs according to DC values. Compared with the SCs, the patients with EB had increased DC values in the bilateral cerebellum_6, cerebellum vermis_4_5, bilateral supplementary motor areas, and left fusiform gyrus; the patients with EB had decreased DC values in the bilateral rectal gyrus and left medial orbital frontal gyrus. The SVM classification of the DC values achieved an overall accuracy of 70.45% and an area under the curve of 0.86 in distinguishing between the patients with EB and the SCs. Our study may reveal the neuromechanism of neuroplasticity in EB; the findings provide an imaging basis for future development of restorative visual therapies and sensory substitution devices, and future assessments of visual rehabilitation efficacy. (shrink)

Introduction: Schools have become a primary setting for providing mental health care to youths in the U.S. School-based interventions have proliferated, but their effects on mental health and academic outcomes remain understudied. In this study we will implement and evaluate the effects of a flexible multidiagnostic treatment called Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems on students' mental health and academic outcomes.Methods and Analysis: This is an assessor-blind randomized controlled effectiveness trial conducted across (...) five school districts. School clinicians are randomized to either MATCH or usual care treatment conditions. The target sample includes 168 youths referred for mental health services and presenting with elevated symptoms of anxiety, depression, trauma, and/or conduct problems. Clinicians randomly assigned to MATCH or UC treat the youths who are assigned to them through normal school referral procedures. The project will evaluate the effectiveness of MATCH compared to UC on youths' mental health and school related outcomes and assess whether changes in school outcomes are mediated by changes in youth mental health.Ethics and Dissemination: This study was approved by the Harvard University Institutional Review Board. We plan to publish the findings in peer-reviewed journals and present them at academic conferences.Clinical Trial Registration:ClinicalTrials.gov ID: NCT02877875. Registered on August 24, 2016. (shrink)

The Republic’s ban on poetry is a major reason for the prominent place that liberal critics assign to Plato among the enemies of the open society, Friedrich Nietzsche's description of Plato as “the greatest enemy of art Europe has yet produced” being often cited. In this article, I argue that, while Plato's ethical stance remains unacceptable for most readers today, his understanding of aesthetic experience in the Republic appears highly perceptive when seen in the light of cognitive studies and can (...) be thought‐provoking for current debates. As I try to show in the first half of the article, Plato's assessment of responses to poetry and theater resonate with embodied and enactive views of cognition. To corroborate this thesis, I point out in the second half that while theory has been blind to the significance of Plato's aesthetics, its major ideas are substantiated in practice. Contemporary psychotherapy and its increasing deployment of virtual reality unknowingly and with the opposite intent realize Plato's approach to the cognitive dynamics and ethical potential of aesthetic experience. (shrink)

Ratnayake's interesting paper challenges two claims, that cognitive distortions in depression involve epistemic issues; and that cognitive behavioral therapy can rectify those epistemic issues. We are going to discuss both claims here and offer some reasons not to underestimate the epistemic relevance of CBT. First, there may be epistemic issues underlying cognitive distortions in depression that CBT can effectively address, including blind acceptance of negative automatic thoughts and insensitivity to evidence. But, even if CBT were primarily in the business (...) of enhancing utility as opposed to validity, this would have significant, though indirect, epistemic benefits.All human agents, whether they have a... (shrink)

Anders was a preeminent critic of technology and critic of the atomic bomb as he saw this hermeneutico-phenomenologically in the visceral sense of beingand time: the sheer that of its having been used as well as the bland politics of nuclear proliferation functions as programmatic aggression advanced in the name of defense and deterrence. The tactic ofsheerly technological, automatic, mechanical, aggression is carried out in good conscience. The preemptive strike is, as Baudrillard observed, the opponent’s fault: such are the wages (...) of evil. Violence in good conscience characterizes the postwar, cold war era and the present day with its mushrooming effects ofneo-fascism under the titles of national security and anti-terrorism. Karl Krauss’ 1913 bon mot regarding psychoanalysis as the very insanity it claims to cure [Psychoanalyse ist jene Geisteskrankheit, für deren Therapie sie sich halt] has never been more apt for political translation—straight into the heart of what Lacan called the Real which has ‘always been’ the political register. Where Habermas and heirs have tended to disregard Anders , just as most philosophers of technology have ignored the political as well as theethical in their eagerness to avoid suspicion of technophobia, we continue to require both critical theory and a critical philosophy of technology, a conjunction incorporating Ander’s complicated dialectic less of art in Benjamin’s prescient but still innocent age of technological reproduction but and much rather “on the devastation of life in the age of the third industrial revolution.” Thus rather thanreading Anders’ critique of the bomb as limited to a time we call the Atomic Age—as Anders himself varied Samuel Beckett’s 1957 Endgame asEndzeit that is “Endtime,” here invoking the eschatological language of Jacob Taubes as Anders does—this essay connects his reflections on the bomb with his critique of technology and the obsolescence of humanity as of a piece with our dedication to hurling ourselves against our own mortality. This concern with the violence of technology, this hatred of the vulnerability of having been born and having been set on a path unto death inspires Anders’ engagement with the sons of Eichmann—the heirs of those who designed and executed the Nazi death camps and extermination chambers of the Holocaust—and the sons of Claude Eatherly—the heirs ofboth those who designed and those who as pilots deployed the bombings that exploded nothing the stuff of the sun itself against the Empire of the Sun in the attacks on Hiroshima and Nagasaki. We, embroiled as we are in wartime after wartime, suppressing public protest on a scale like never before, in country after country across the globe, cannot dispense with Anders today. (shrink)

This article is about the philosopher as a potential therapist. It starts from tendencies exhibited by a group of contemporary philosophers involved in a so-called human enhancement. Drawing on the newest discoveries of genetics, genetic engineering and pharmacology, they offer a set of therapies aimed at the extensive ‘improvement’ of the human condition. In the second part of the paper, selected ideas concerning philosophical therapy by the Ancient philosophers are presented. They basically employed personal contact, conversation, and wise counselling. (...) Then these two approaches to this kind of therapy are compared and contrasted. The contemporary approaches offer novel, technical ways of intervention but are blind as far as far-reaching goals and the essential goods of human life are concerned. Despite serious cultural differences, the contemporary therapy can learn a lot from the ancients. If the human being is to be treated by philosophers, an integral picture of who the former is must be taken into account. This means that both his interiority and exteriority should be subjects to the therapy. (shrink)

During the mid 1980s, the renowned American documentary filmmaker Fred Wiseman produced a four-part series of films that sought to record the operations of institutions in Talladega, Alabama, devoted to the care and training of people with disabilities. These films—designated as the Multi-handicapped Series—have received much less attention than Wiseman's earlier work, as if films about disability mark a drastic departure from his previous award-winning productions, such as Titicut Follies (1965) and Hospital (1970). The Multi-handicapped Series takes up general categories (...) of disabled populations as discrete documentary topics, Deaf (1986), Blind (1986), Multi-handicapped (1986) and Adjustment & Work (1986) as opposed to a specific location as in his earlier films. As a result, the latter series of films identify social and interpersonal structures developed in the name of specific conditions. Like Foucault's research on disciplinary tactics, Wiseman's films seek out many of the segregated social spaces typically occupied by persons classified as deviant: prisons, hospitals, charity networks, sheltered workshops, resident facilities, and vocational training structures. The Multi-handicapped Series focuses on the activities of professions and practitioners in education, administration, and therapy, as well as the institutional roles designed for bodies marked as disabled. Unlike its 19th century predecessor classification, feebleminded, the latter twentieth century U.S. policy answer has been waged as a matter of dividing disabilities into a binary structure of orthopedic or cognitive categories. Such a development has left many crossover bodies in a diagnostic no-body's-land. To analyze the history of these developments, this essay recognizes the formation of today's disability category as an effect of new regimes of power; a form of domination based upon the application of particularized diagnostic pathologies that provide the basis for cordoning off bodies which fail to fit neatly within the cognitive/orthopedic binary. As documents of the social spaces that are occupied by disabled people, Wiseman's films offer a rare contemplation of institutional practices and their application to populations viewed as nonnormative. (shrink)

Deep brain stimulation is an experimental procedure for treatment-resistant depression. Some results show promise, but blinded trials had limited success. Ethical questions center on vulnerability: especially on whether depressed patients can weigh the risks and benefits effectively, whether depression causes “desperation,” and whether media portrayals create unrealistic hopes. We interviewed 24 psychiatric inpatients with treatment-resistant depression, qualitatively analyzing their comments. Most had minimal interest in deep brain stimulators. Some might consider them if their depression worsened, if alternatives were exhausted, or (...) if the evidence were stronger. Fears focused on the surgery, adverse effects, and the novelty of the device. Patients felt the depression interfered with their ability to weigh the risks and benefits. Patients seemed highly attuned to the risks, and were skeptical that the treatment would be effective. We conclude that ethical concerns about vulnerability remain, yet patients with treatment-resistant depression were thoughtful and cautious about trying a novel therapy. (shrink)

In a randomized clinical trial (RCT), a group of patients, initially assembled through a mixture of deliberation (involving explicit inclusion and exclusion criteria) and serendipity (which patients happen to walk into which doctor’s clinic while the trial is in progress), are divided by some random process into an experimental group (members of which will receive the therapy under test) and a control group (members of which will receive some other treatment – perhaps placebo, perhaps the currently standard treatment for (...) the condition at issue). In a ‘double blind’ trial neither the patient nor the clinician knows to which of the groups a particular patient belongs. The results of double blind randomized controlled trials are almost universally regarded as providing the ‘gold standard’ for evidence in medicine. Fairly extreme claims to this effect can be found in the literature. For example the statistician Tukey wrote (1977, p. 679) “almost the only source of reliable evidence [in medicine] … is that obtained from … carefully conducted randomised trials”. And the clinician Victor Herbert claimed (1977, p. 690) “..the only source of reliable evidence rising to the level of proof about the usefulness of any new therapy is that obtained from wellplanned and carefully conducted randomized, and, where possible, coded (double blind) clinical trials. [Other] studies may point in a direction, but cannot be evidence as lawyers use the term evidence to mean something probative … [that is] tending to prove or actually proving”. Finally, the still very influential movement in favour of ‘Evidence Based Medicine’ (EBM) that began at McMaster University in the 1980s was initially often regarded as endorsing the claim that only RCTs provide real scientifically telling evidence. (shrink)

Deep brain stimulation (DBS) to different sites allows interfering with dysfunctional network function implicated in major depression. Because a prominent clinical feature of depression is anhedonia--the inability to experience pleasure from previously pleasurable activities--and because there is clear evidence of dysfunctions of the reward system in depression, DBS to the nucleus accumbens might offer a new possibility to target depressive symptomatology in otherwise treatment-resistant depression. Three patients suffering from extremely resistant forms of depression, who did not respond to pharmacotherapy, psychotherapy, (...) and electroconvulsive therapy, were implanted with bilateral DBS electrodes in the nucleus accumbens. Stimulation parameters were modified in a double-blind manner, and clinical ratings were assessed at each modification. Additionally, brain metabolism was assessed 1 week before and 1 week after stimulation onset. Clinical ratings improved in all three patients when the stimulator was on, and worsened in all three patients when the stimulator was turned off. Effects were observable immediately, and no side effects occurred in any of the patients. Using FDG-PET, significant changes in brain metabolism as a function of the stimulation in fronto-striatal networks were observed. No unwanted effects of DBS other than those directly related to the surgical procedure (eg pain at sites of implantation) were observed. Dysfunctions of the reward system--in which the nucleus accumbens is a key structure--are implicated in the neurobiology of major depression and might be responsible for impaired reward processing, as evidenced by the symptom of anhedonia. These preliminary findings suggest that DBS to the nucleus accumbens might be a hypothesis-guided approach for refractory major depression. (shrink)

The prevalence of dementia is increasing with the ever-growing population of older adults. Non-pharmacological, music-based interventions, including sensory stimulation, were reported by the Lancet Commission in 2020 to be the first-choice approach for managing the behavioural and psychological symptoms of dementia. Low frequency sinusoidal vibration interventions, related to music interventions through their core characteristics, may offer relief for these symptoms. Despite increasing attention on the effectiveness of auditory music interventions and music therapy for managing dementia, this has not included (...) low frequency vibration. This scoping review, following the JBI methodology guidelines, was conducted to investigate participants’ responses to both sound and mechanical vibration, the characteristics of the delivered interventions, methodological challenges, and the specifics of the research experiments reported. An extensive search was conducted in BMC, CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, ERIC, MEDLINE, Pedro, ProQuest Central, PsycINFO, Scopus, and Web of Science. Current Controlled Trials, Clinical Trials, and Google Scholar were also searched as well as a hand search in relevant journals. Studies on adults with all types of dementia, investigating tactile low frequency sound or mechanical vibration in any context were considered. Data from eight full-length studies were extracted using the data extraction table developed by the authors and were included in the analysis and critical appraisal. Issues in quality related to, for example, control groups and blinding. Few studies addressed participants’ subjective responses to the interventions. Reporting on the intervention characteristics was unclear. It appeared more frequent sessions led to better outcomes and home-based interventions potentially addressing the issue of access and feasibility. Future research should include neuroimaging to measure and confirm the hypothesised mechanism of cerebral coherence. Standardised reporting of intervention characteristics is also needed to ensure replicability of the experiments. Higher quality research is needed to investigate the impact and effect of low frequency vibration for the symptoms of dementia and compare outcomes in meta-syntheses. (shrink)

A sand table is an intentional structure that is an early, indeed ancient, interactive platform for visualization and simulation. An intellectual furnishing that is also a tangible instance of speculative infrastructure, the sand table offers a tactile space for the rehearsal of tactics, staccato words whose roots lie in haptics and arrangement. While common in military settings, sand tables have also been used to teach the blind, train wilderness firefighters, conduct therapy for trauma victims, illustrate stories to children, and (...) play imaginative games. Today there is a direct line from this seemingly modest technology—an implementation of what has been called elemental media—to augmented reality and other tangible interfaces. Part media history, part media archaeology, this article argues that sand tables belong to the lineage of platforms for speculative thinking and world-building that culminated in the rise of the digital computer amid a Cold War complex of scenario-driven futurology (whose centerpiece was the so-called situation room). It also suggests that sand, in its literal granularity—the physical affordances of the minute particulars of its particulate matter—offers an alternative to the binary regimen of ones and zeros that is the extractive product of the refined silica out of which semiconductors are still made. (shrink)

Grounded in evidence-based cognitive behavioral therapy (CBT), The Blindspots Between Us reveals the most common "hidden" biases that blind us to the truth, and which lead to misunderstandings and damaged relationships. Using this guide, readers will learn to identify their own blindspots, and move beyond them for better relationships-and a better world.

IntroductionThe Managing Cancer and Living Meaningfully therapy for patients with advanced cancer was tested against a supportive psycho-oncological counseling intervention in a randomized controlled trial. We investigated whether CALM was delivered as intended ; whether CALM therapists with less experience in psycho-oncological care show higher adherence scores; and whether potential overlapping treatment elements between CALM and SPI can be identified.MethodsTwo trained and blinded raters assessed on 19 items four subscales of the Treatment Integrity Scale covering treatment domains of CALM. (...) A random sample of 150 audio recordings were rated on a three-point Likert scale with 1 = “adherent to some extent,” 2 = “adherent to a sufficient extent,” 3 = “very adherent.”ResultsAll 19 treatment elements were applied, but in various frequencies. CALM therapists most frequently explored symptoms and/or relationship to health care providers and allowed expression of sadness and anxiety about the progression of disease. The exploration of CALM treatment element SC_1 was most frequently implemented in a satisfactory or excellent manner, whereas the treatment element SMP_4: Therapist promotes acknowledgment that some life goals may no longer be achievable was not implemented in a satisfactory manner. In terms of treatment differentiation, no treatment elements could be identified which were applied significantly more often by CALM therapists than by SPI therapists.ConclusionResults verify the application of CALM treatment domains. However, CALM therapists’ adherence scores indicated manual deviations. Furthermore, raters were not able to significantly distinguish CALM from SPI, implying that overlapping treatment elements were delivered to patients. (shrink)

I show that the latter Wittgenstein's treatment of language and the mind results in a conception of the human subject that goes against the exclusive emphasis on the cognitive that characterizes our modern conception of knowledge and the self. For Wittgenstein, our identification with the cognitive ego is tantamount to a blindness to our own nature — blindness that is entrenched in our present culture. The task of philosophy is thus transformed into a form of cultural therapy (...) that seeks to awaken in us a sensitivity to different modes of awareness than the merely intellectual. Its substance of reflection becomes not only the field of conscious rational thought, but the tension in our nature between reason and vital feeling, that is, between culture and life. (shrink)

Touch is the first sense to develop in the womb, yet often it is overlooked. The Senses of Touch examines the role of touching and feeling as part of the fabric of everyday, embodied experience. -/- How can we think about touch? Problems of touch and tactility run as a continuous thread in philosophy, psychology, medical writing and representations in art, from Ancient Greece to the present day. Picking through some of these threads, the book ‘feels’ its way towards writing (...) and thinking about touch as both sensory and affective experience. -/- Taking a broadly phenomenological framework that traces the tactility from Aristotle through the Enlightenment to the present day, it examines the role of touch across a range of experiences including aesthetics, digital design, visual impairment and touch therapies. The Senses of Touch thereby demonstrates the varieties of sensory experience, and explores the diverse range of our ‘senses’ of touch. (shrink)

This article addresses the need for discourse and dialogue on ethics in the fields of Animal Assisted Therapy in general and Equine-assisted Therapy specifically. Utilizing animals as partners in a therapeutic process requires major cultural paradigm shifts regarding intelligence and emotion and consideration of the ethical implications for the care and agency of these animals. There is a paucity of literature and very little is known about the impact that therapy has on animals. This study suggests that (...) this blind spot may be the result of the legacy of underlying, post-Christian, Western scientific beliefs about human-animal relationships. Practitioners in the field tend to fall into the broad categories of ‘utilitarians’ or ‘stewards’. The author, an EAT practitioner from Native American cultural healing tradition, offers suggestions on the ways in which Native American constructs about animals may provide valuable alternatives to commonly-held Western viewpoints creating opportunities for deeper, more authentic relationships, reciprocity and a greater understanding of horse-human relationships. (shrink)

Background Fecal microbiota transplant (FMT) is a treatment modality that involves the introduction of stool from a healthy pre-screened donor into the gastrointestinal tract of a patient. It exerts its therapeutic effects by remodeling the gut microbiota and treating microbial dysbiosis-imbalance. FMT is not regulated in Jordan, and regulatory effort for FMT therapy in Jordan, an Islamic conservative country, might be faced with unique cultural, social, religious, and ethical challenges. We aimed to assess knowledge, attitudes, and perceptions of ethical (...) and social issues of FMT use among Jordanian healthcare professionals. Methods An observational, cross-sectional study design was used to assess knowledge, attitudes, and perceptions of ethical and social issues of FMT among 300 Jordanian healthcare professionals. Results A large proportion (39 %) thought that the safety and efficacy of this technique are limited and 29.3 % thought there is no evidence to support its use. Almost all (95 %) responded that they would only perform it in certain cases, if ethically justified, and 48.3 % would use it due to treatment failure of other approaches. When reporting about reasons for not using it, 40 % reported that they would not perform it due to concerns about medical litigation, fear of infections (38 %), and lack of knowledge of long safety and efficacy (31.3 %). Interestingly, all practitioners said they would perform this procedure through the lower rather than upper gastrointestinal tract modality and the majority will protect the patient’s confidentiality via double-blinding (43.3 %). For a subset of participants (n = 100), the cultural constraints that might affect the choice of performing FMT were mainly due to donor’s religion, followed by dietary intake, and alcohol consumption. Conclusions Our healthcare practitioners are generally reluctant to use the FMT modality due to religious and ethical reasons but would consider it if there was a failure of other treatment and after taking into consideration many legislative, social, ethical and practice-based challenges including safety, efficacy and absence of guidelines. (shrink)

Definition of the problemHealth Apps are becoming increasingly important for a preventive and responsible orientation of the health system. Currently, most of these digital health applications (DiGA) are based on so-called self-tracking technologies which record physiological and psychological data via sensors, usually combined with personalized everyday information. In the last few years, these digital developments have launched an intense and clearly polarized debate about the opportunities and dangers of self-tracking in healthcare.ArgumentsAfter a brief overview of medical self-tracking, this essay wants (...) to systematize and check the polarized discourse on the basis of its decisive individual and social potentials. It turns out that self-measurement techniques have long been an integral part of medical practice in diagnostics and therapy.ConclusionThe area of tension between individual empowerment and potential loss of control by the users will be emphasized as being especially important for the implementation of health Apps in primary health care. Finally, possible implications for the current design of the new German Digital Care Law (Digitale-Versorgung-Gesetz) are shown and some existing “blind spots” are highlighted. (shrink)

Zunehmend gewinnen Health Apps an Bedeutung für eine präventive und eigenverantwortliche Ausrichtung des Gesundheitssystems. Die meisten dieser digitalen Gesundheitsanwendungen basieren derzeit auf sog. Selftracking-Technologien, mit deren Hilfe physiologische und psychische Daten sensorgestützt aufgezeichnet und diese zumeist um personalisierte Alltagsinformationen ergänzt werden. Die digitalen Entwicklungen dieser Art lösten in den letzten Jahren eine intensive und deutlich polarisierte Debatte über die Chancen und Gefahren von gesundheitlichem Selftracking aus. Ziel dieser Arbeit ist es, nach einem kurzen Überblick über das Feld des medizinischen Selftracking (...) den polarisierten Diskurs zunächst anhand seiner entscheidenden individuellen und gesellschaftlichen Potenziale zu systematisieren und zu prüfen. Es stellt sich heraus, dass Selbstvermessungstechniken keineswegs ein neues Phänomen, sondern vielmehr seit langem fester Bestandteil medizinischen Wirkens in Diagnostik und Therapie sind. Als für die Implementierung von Health Apps in die medizinische Regelversorgung besonders bedeutend wird das Spannungsfeld zwischen individuellem Empowerment und potentiellem Kontrollverlust der Nutzenden herausgestellt. Abschließend werden mögliche Implikationen für die aktuelle Ausgestaltung des neuen Digitale-Versorgung-Gesetzes aufgezeigt und auf einige bestehende „blinde Flecken“ hingewiesen. (shrink)

This volume brings together research in the GeoHumanities from various intellectual perspectives to illustrate the benefits of humanities-inspired approaches in understanding and confronting historically entrenched and recently emergent health-related challenges. In three main sections, this volume seeks to foreground the richness of work entangling medicine and health with the concerns of geography and of the Humanities. This volume will be of interest to academics and researchers in the Geographies of health and medicine, social sciences in GeoHumanities, and health humanities, and (...) students in programs focusing on the humanities and health. In the book's first section, Bodies, the authors explore the material, sensory and more than physical capacities of bodies in accounting for experiences of death, air raids, immigration, dance therapy, asthma and blindness. Section two, Voice, addresses the nature of evidence, HIV/AIDS policy, patient voices in animal research, homelessness, and constructions of truth. The final section, Practice, focuses on creative writing, as well as the pedagogic tools of teaching with the asylum, the creative practice of nuclear emergency planning zones, arts-based care for the elderly, and cartographic practices within health research. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Fetal Tissue ResearchMary Carrington Coutts (bio)I. IntroductionThe use of tissue from fetal remains for transplantation and biomedical research has become a controversial issue in recent years, involving scientists, doctors, patients, and the federal government. Fetal tissue is potentially useful in a wide range of treatments for a number of serious diseases, some of them affecting millions of people. Despite the promise, transplantation research using fetal tissue from induced abortion (...) slowed dramatically in the U.S. in 1988, when a moratorium was declared on federal funding for such research involving humans. That moratorium was lifted by President Clinton on January 21, 1993. Though the future of fetal tissue transplantation research is brighter, public debate on the issue is likely to continue, exacerbated by the "acrimonious abortion debate" (VI, Post 1991, p. 14).Using fetal tissue in biomedical research and in transplantation is not a new practice. As early as 1928 unsuccessful attempts were made to transplant fetal pancreas cells into diabetics (VII, Fichera 1928). Fetal tissue was used effectively in biomedical research during the 1950s, and was instrumental in the culture of the polio virus, which led to the development of the polio vaccine. Fetal tissue cultures were also essential in the development of the rubella vaccine, and continue to be used in virology research. Transplantation of fetal thymus cells into patients with DiGeorge Syndrome has been recognized as effective therapy since the late 1960s.Many of the therapeutic applications involving fetal tissue are still experimental, so it is difficult to pinpoint fetal tissue transplantation's therapeutic potential. One promising application is the transplantation of human fetal brain cells into the substantia nigra of patients with Parkinson's disease to restore motor function. Fetal neural transplants have also shown promise for patients suffering from Alzheimer's disease, spinal cord and other neural tissue injuries, and possibly some forms of cortical blindness. Fetal liver cells may be useful for treatment of some kinds of bone marrow disease seen in leukemia and aplastic anemia patients. [End Page 81] Fetal tissue transplantation may also help those suffering from blood clotting disorders, such as sickle cell anemia, thalassemia, and hemophilia. Fetal pancreatic tissue has potential applications in the treatment of diabetes, especially juvenile onset diabetes. Human gene therapy may also employ embryonic and early fetal cells.The Center for Biomedical Ethics at the University of Minnesota reports that more than 1,000 patients have received transplanted fetal tissue worldwide. Countries where fetal tissue transplantation has occurred include: Australia, Canada, China, the Commonwealth of Independent States (formerly the U.S.S.R.), Cuba, Czechoslovakia, Finland, France, Germany, Great Britain, Hungary, India, Italy, Mexico, Norway, Spain, Sweden, and Yugoslavia (IV, Vawter 1992, p. 2; I, Spain 1988; VII, Reinikainen 1989).Fetal tissue has unique characteristics that make it especially valuable in some treatments. Fetal cells develop much faster than adult cells, hastening the therapeutic effect—a potentially significant benefit for gravely ill patients. They are also less likely to be rejected by transplant recipients because they are less antigenic than adult cells. This reduces the need for the exact tissue matches that can be so difficult to obtain. Fetal tissue is also easier to culture and proliferates more readily than comparable adult tissue. Furthermore, fetal tissue is in greater supply, due to the number of elective abortions.Questions about the use of fetuses and fetal tissue in biomedical research were raised in the United States in the early 1970s. Between 1969 and 1973, all 50 states enacted the Uniform Anatomical Gift Act, allowing for the donation of all or part of the body of a dead fetus for research or therapeutic research. Prospects for the use of fetal tissue increased after the Supreme Court decision in Roe v. Wade legalized abortion. As the availability of fetal tissue increased so did the concern over the potential for controversial research on living, soon-to-be-aborted fetuses, and anxiety over maltreatment of dead abortuses. Vivid examples include Geoffrey Chamberlain's 1968 report of an experiment on a fetus of 26 weeks gestational age. Delivered by hysterotomy from a 14-year-old patient, the fetus was attached to an "artificial placenta" and kept alive for more than... (shrink)

Background: Parkinson’s disease is a neurodegenerative disease in which the progressive loss of dopaminergic neurons leads to initially sporadic and eventually widespread damage of the nervous system resulting in significant musculoskeletal and cognitive deterioration. Loss of motor function alongside increasing cognitive impairment is part of the natural disease progression. Gait is often considered an automatic activity; however, walking is the result of a delicate balance of multiple systems which maintain the body’s center of mass over an ever-changing base of support. (...) It is a complex motor behavior that requires components of attention and memory to prevent falls and injury. In addition, evidence points to the critical role of salient visual information to gait adaptability. There is a growing understanding that treatment for PD needs to address movement as it occurs naturally and walking needs to be practiced in more complex environments than traditional therapy has provided.MethodsIn this single-blinded randomized-controlled pilot study, an immersive treadmill training was piloted to determine feasibility and preliminary efficacy on gait and cognition in people with PD. Eighteen participants with Hoehn and Yahr stages I-III PD were randomized to either an intervention or a waitlist control group. Following baseline data collection, the intervention group trained for 30 min, three times/week for 4 weeks on a split belt treadmill combined with a first-person immersive video game targeting visuospatial skills and working memory. Assessment was repeated after 4 weeks of training for the experimental group and 1-month after baseline for the control group. Primary motor outcomes were captured with the APDM Opal sensors during 6 MWT, TUG, and TUG Cognitive. Secondary outcomes of cognition were measured with the Montreal Cognitive Assessment, Verbal Fluency and the Symbol Digit Modality Test. Within subject differences were calculated using the Wilcoxon Signed Ranked Test and between subject comparisons were analyzed using the Mann Whitney U-test.ResultsThis novel treadmill training program was well-tolerated with all participants in the intervention group completing 4 weeks of training three times a week without any adverse effects. After immersive cognitive motor training, the experimental group made clinically relevant improvements in gait speed and walking distance during the 6 MWT while members of the control group showed no change or decreased gait speed and walking distance over the 1-month trial. In addition, the experimental group demonstrated significant improvement for the TUG Cognitive and those changes were greater than the control group. The experimental group also improved scores on MoCA and SDMT cognitive outcome measures while the control group did not.ConclusionThe use of immersive gaming technology to engage specific areas of cognition related to gait is feasible in PD. The treadmill training program paired with a customized interactive video game improved walking velocity in addition to non-significant but consistent improvements in other gait measures and cognitive performance in participants with early to mid-stage PD. (shrink)

The mythical scientist in early twentieth-century America cut a lone figure, “impersonal as the chill northeast wind” and “oblivious of everything save his experiment.” He toiled through the night in his laboratory, “a place unimpressive and unmagical save for the constant-temperature bath with its tricky thermometer and electric bulbs,” as if working in the lab were a prayer that promised illumination—“alone, absorbed, [and] contemptuous of academic success and of popular classes,” he knew all about material forces, but he was blind (...) to the vital force that created all others. Accustomed to the “beautiful dullness of long labors,” he remained “illimitably ignorant” of literature, art, and music. He believed that unerring techniques in experimentation, impartial observations, and exquisitely minute calculations would bring progress—a steady march toward the truth. He chose the highest calling in the world because he was “intensely religious—so religious that he will not accept quarter-truths, because they are an insult to his faith.” He was “so devoted to Pure Science . . . that he would rather have people die by the right therapy than be cured by the wrong. Having built a shrine for humanity, he wanted to kick out of it all mere human beings.” This autocratic figure, brilliantly insane and tyrannically honest, embodied the cult of science and objectivity. (shrink)

Complementary and alternative medicine research presents unique problems for research ethics committees which must be considered in some detail. Applying conventional research techniques to CAM raises a number of issues which ethics committees may find challenging. CAM is widely available and this will have a substantial effect on any proposed research strategy as so many individuals will have pre-existing opinions about these treatments. Whilst many complementary therapies may eventually be ‘validated’ by appropriate clinical trial methodologies other research methods could be (...) more appropriate in the early stages of a research strategy, particularly in view of the widespread availability in both the public and private sectors. Safety, efficacy, cost-effectiveness and patient preference also need evaluation; and these cannot be adequately assessed through double blind randomised placebo controlled trials. If the research question is clear, then thoughtful and often innovative evaluative processes can be designed to answer the socially and clinically relevant issues posed by this area of medicine. There are a number of agencies and organizations available to offer advice to ethics committees in this newly emerging field of CAM research including CAM Strategy Research and Development, the Foundation for Integrated Health and the Research Council for Complementary Medicine. (shrink)

American orthodox medicine consolidated its professional authority in the early 20th Century on the basis of its unbiased scientific method. The centerpiece of such a method is a strategy for identifying truly effective new therapies, i.e., the randomized clinical trial (RCT). A crucial component of the RCT in illnesses without established treatment is the placebo control. Placebo effects must be identified and distinguished from pharmacological effects because placebos produce actual but unexplained therapeutic successes. The blinding necessary for a proper placebo-controlled (...) RCT therefore introduces an epistemic bias into orthodox medicine: therapeutic successes that rely upon a direct link between knowing and healing, such as placebo effects, are discarded in favor of therapeutic successes that rely upon an indirect link between knowing and healing, such as pharmacological interventions. Where the capacity to produce therapeutic results once validated the method of clinical medical science, now method validates results. The clinical consequences of this method of testing therapies include a diminished vision of the therapeutic potential of the doctor-patient relationship and of the potential human resources available for healing. Keywords: doctor-patient relationship, epistemology, placebo effect, professionalization, randomized clinical trials CiteULike Connotea Del.icio.us What's this? (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Courage To LiveAntonella ColaceI am not the patient. I have not received an organ. I am her mother; I am a shadow patient. My responsibility was to make decisions about a gift for my one-year-old daughter in the summer of 2007. A liver.Elisa had a hepatoblastoma. After chemotherapy, the tumor might have been removed, but in the final stages of the work-up a portal vein malformation necessitated a (...) transplant. The medical team at a hospital in northern Italy informed us of the intervention.So many words! Trying to understand what they were saying seemed like a lost cause to me, but I quickly realized that these were people I should trust blindly.These medical team members, by the end of the experience, would all become part of my family. They embraced us in their capacity as professionals and as human beings. I never felt alone or excluded.How many times late in the evening I heard a soft knock at the door of Elisa’s hospital room and behind that delicate touch, I found her doctor ready to leave for home, but not before one last [End Page 131] recommendation for his little patient and a wish of peaceful sleep.The relationship between health workers and the family has developed into an effective relationship of communion and understanding, which has often translated into affectionate terms in communicating with each other. They asked me: “Mom, how is Elisa?”..... Yes—mom!These highly trained medical experts have understood that a parent can sometimes somehow discern the danger behind the otherwise asymptomatic daughter’s subdued attitude; or a surreptitiously high fever, of little concern because Elisa was playing and laughing.I was made to feel an active part of every initiative and decision. My observation point on Elisa, who could not speak for herself, was fundamental for them.I never experienced the hospital as a hostile environment—quite the contrary!It comforted me to have people around us, ready to intervene, reason, and solve the physiological difficulties of my little girl. The hospital was a room in my house, a room whose door was always ajar and in need, I crossed its threshold full of trust, hope, and courage.Today some of those doctors and nurses are my friends. I have a lot of respect for them, gratitude, and admiration.Elisa being placed on the transplant list and waiting for a donor were the first obstacles to overcome.The “warrior” fought against two monsters, time and the tumor. The timing was everything because Elisa had to be in the period of non-toxicity after chemotherapy but could not wait too many weeks without active therapy in favor of a cancer that, lurking like a vulture, was only waiting for the ideal moment to start growing again.The most dramatic thing to overcome and accept was hoping for someone’s death. For Elisa to live, someone else had to die. I felt like an executioner. I didn’t think of anything else; I didn’t sleep at night.In the end, choosing to visualize death as a gift, I had to accept it.It was summer, on August 20th, and another hot and boring night in hospital awaited us. The nurse came into the room to tell me that our lottery ticket had won that night. There was a compatible liver for Elisa. The organ would come from a young woman who had died while swimming in the Sicilian Sea.If they had stabbed me at that moment, maybe not a drop of blood would have left my body. I was paralyzed, incredulous, terrified.My daughter had already been operated on, but it would be different this time. This time they would open her abdomen to remove her diseased liver and replace it with that of a dead young woman, by now sealed in a body bag in a Sicilian morgue. A cold body, deaf now, silent!A young woman for whom, while I was rejoicing, some other shadow patient was despairing, caught up in an unstoppable whirlwind of pain.I felt like throwing up while I cried tears of joyful hope. Guilt grew in my... (shrink)

Notice the key concepts: wonder, purification of emotion, piercing the blindness of activity, transcendent functions. There are echoes here of the Platonic doctrine of philosophy as the care of the soul, therapy, the turning of the soul from fantasy to reality. Education, says Plato, is the art of orientation, the shedding of the leaden weights which progressively weigh us down as we become more and more sunk in the material world and the world of desire, eating and similar (...) pleasures and indulgences. All this is in the context of the Cave, and a form of vision which is to become able to bear ‘the sight of real being and reality at its most bright… which is a form of goodness’. (shrink)

On top of elaborate methods and approaches in research, diagnostics, and therapy, medicine is in need of a theory of its own thought and action; without theoretical reflection and referentiality, action becomes blind and thought takes on a monotonous and circular character. Take the concept of health. The field of medicine, more and more taking its cues from evidence-based medicine , is onesidedly oriented to concepts of health which are based on notions of standard values for large populations or—in (...) the shadow of the genome project—see health as the outcome of an intact genome, often turning a blind eye to the individual aspects of health. With an eye in particular to Friedrich Nietzsche's philosophy, the present paper looks into some continental European theories of individual health, seeking to determine to what extent they can contribute to reducing medicine's theory deficit and what consequences this may have for research, diagnostics, and therapy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Adam Smith and the Virtues of EnlightenmentFred D. Miller Jr.Charles L. Griswold. Adam Smith and the Virtues of Enlightenment. Cambridge: Cambridge University Press, 1999. Pp. xiv + 412. Cloth, $59.95.For over a century, scholars have been vexed by the so-called "Adam Smith problem," which concerns the relationship between the two works which Smith published during his lifetime: The Theory of Moral Sentiments (TMS) in 1759, and An Inquiry (...) into the Nature and Causes of the Wealth of Nations (WN) in 1776 (citations are to the Liberty Classics reprints of the Oxford University Press editions). Many have regarded them as discordant: while TMS is apparently concerned with classical ethics, WN seems to assume that humans are basically egoistic, although they can be directed toward the public good by means of the "invisible hand." It is tempting to view Smith as a transitional author: TMS is the swan song of virtue ethics, whereas WN is a pioneering work in a new tradition of political economy.Griswold challenges this temptation in this brilliant study, arguing that Smith had a coherent and integrated philosophical viewpoint encompassing TMS, WN, and other surviving writings. Griswold views Smith as offering a virtue ethics and "throwing in his lot with the ancient moralists" (65). He argues, "We cannot grasp Smith's diagnosis of and therapy for the modern age without devoting considerable attention to his analysis of the virtues (especially the virtue of justice) as well as to the theory of the emotions, of the impartial spectator, and of sympathy" (20). Smith tried to reconcile a traditional ethics with modern skepticism and the new values associated with commercial society and religious secularism. Griswold's book illuminates a wide range of themes in Smith's moral philosophy: his view of rhetoric, method, and system underlying TMS (chapter 1); sympathy and self-interest (chapter 2); moral psychology and the theory of the impartial spectator (chapter 3); Smith's skepticism and reservations about philosophy (chapter 4); virtue theory (chapter 5); justice (chapter 6); the relationship between TMS and WN (chapter 7); and nature versus artifice in ethics (chapter 8). The epilogue critically discusses whether Smith's moral theory falls into subjectivism, and whether [End Page 439] Smith goes too far in excluding philosophers such as Socrates from ordinary moral discourse.A brief review cannot do justice to Griswold's compelling interpretation, and I shall focus on his solution to "the old problem of how the moral theory and the political economy mesh" (21). Griswold argues, "Smith sees himself as synthesizing an ancient view about the nature of virtue with a modern approach to the problem of the source of moral value. Consequently the moral psychology (especially the notions of sympathy and the impartial spectator) and the virtue theory must be understood in light of each other" (181). Further, "The virtue theory is the moral foundation of Smith's political economy, political theory, and 'natural jurisprudence.' Hence the virtue theory is closely tied to his doctrine of liberty as well as to his views about the pursuit of wealth. However 'ancient' the virtue theory may in some respects be, Smith combines it with a modern view of the social and political institutions appropriate to virtue" (ibid.). With impressive erudition Griswold argues that "taken together... TMS and WN form complementary parts of a larger whole" (265), and that Smith thinks "the virtues of a free and commercial society" may be defended on the basis of views espoused in WN: skepticism of state interference in economic and social matters, anti-utopianism, and the doctrine of the invisible hand (21). Yet WN does not place blind faith in laissez faire but advocates social justice, compulsory public education and greater taxes on the rich (254, 264, 359).Has Griswold, then, finally solved the Adam Smith Problem? There remains the problem that WN apparently neglects central themes of TMS: sympathy, the impartial spectator, and benevolence. In TMS virtue has distinctive components: "Concern for our own happiness recommends to us the virtue of prudence: concern for that of other people, the virtues of justice and beneficence" (TMS 262). These constitute perfect virtue: "The man who acts according to the rules of perfect... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Adam Smith and the Virtues of EnlightenmentFred D. Miller Jr.Charles L. Griswold. Adam Smith and the Virtues of Enlightenment. Cambridge: Cambridge University Press, 1999. Pp. xiv + 412. Cloth, $59.95.For over a century, scholars have been vexed by the so-called "Adam Smith problem," which concerns the relationship between the two works which Smith published during his lifetime: The Theory of Moral Sentiments (TMS) in 1759, and An Inquiry (...) into the Nature and Causes of the Wealth of Nations (WN) in 1776 (citations are to the Liberty Classics reprints of the Oxford University Press editions). Many have regarded them as discordant: while TMS is apparently concerned with classical ethics, WN seems to assume that humans are basically egoistic, although they can be directed toward the public good by means of the "invisible hand." It is tempting to view Smith as a transitional author: TMS is the swan song of virtue ethics, whereas WN is a pioneering work in a new tradition of political economy.Griswold challenges this temptation in this brilliant study, arguing that Smith had a coherent and integrated philosophical viewpoint encompassing TMS, WN, and other surviving writings. Griswold views Smith as offering a virtue ethics and "throwing in his lot with the ancient moralists" (65). He argues, "We cannot grasp Smith's diagnosis of and therapy for the modern age without devoting considerable attention to his analysis of the virtues (especially the virtue of justice) as well as to the theory of the emotions, of the impartial spectator, and of sympathy" (20). Smith tried to reconcile a traditional ethics with modern skepticism and the new values associated with commercial society and religious secularism. Griswold's book illuminates a wide range of themes in Smith's moral philosophy: his view of rhetoric, method, and system underlying TMS (chapter 1); sympathy and self-interest (chapter 2); moral psychology and the theory of the impartial spectator (chapter 3); Smith's skepticism and reservations about philosophy (chapter 4); virtue theory (chapter 5); justice (chapter 6); the relationship between TMS and WN (chapter 7); and nature versus artifice in ethics (chapter 8). The epilogue critically discusses whether Smith's moral theory falls into subjectivism, and whether [End Page 439] Smith goes too far in excluding philosophers such as Socrates from ordinary moral discourse.A brief review cannot do justice to Griswold's compelling interpretation, and I shall focus on his solution to "the old problem of how the moral theory and the political economy mesh" (21). Griswold argues, "Smith sees himself as synthesizing an ancient view about the nature of virtue with a modern approach to the problem of the source of moral value. Consequently the moral psychology (especially the notions of sympathy and the impartial spectator) and the virtue theory must be understood in light of each other" (181). Further, "The virtue theory is the moral foundation of Smith's political economy, political theory, and 'natural jurisprudence.' Hence the virtue theory is closely tied to his doctrine of liberty as well as to his views about the pursuit of wealth. However 'ancient' the virtue theory may in some respects be, Smith combines it with a modern view of the social and political institutions appropriate to virtue" (ibid.). With impressive erudition Griswold argues that "taken together... TMS and WN form complementary parts of a larger whole" (265), and that Smith thinks "the virtues of a free and commercial society" may be defended on the basis of views espoused in WN: skepticism of state interference in economic and social matters, anti-utopianism, and the doctrine of the invisible hand (21). Yet WN does not place blind faith in laissez faire but advocates social justice, compulsory public education and greater taxes on the rich (254, 264, 359).Has Griswold, then, finally solved the Adam Smith Problem? There remains the problem that WN apparently neglects central themes of TMS: sympathy, the impartial spectator, and benevolence. In TMS virtue has distinctive components: "Concern for our own happiness recommends to us the virtue of prudence: concern for that of other people, the virtues of justice and beneficence" (TMS 262). These constitute perfect virtue: "The man who acts according to the rules of perfect... (shrink)

In this systematic review, we summarized and evaluated the evidence for effects of, and associations between, immersive nature-experience on mental, physical and social health promotion outcomes. Immersive nature-experience was operationalized as non-competitive activities, both sedentary and active, occurring in natural environments removed from everyday environments. We defined health according to the World Health Organization’s holistic and positive definition of health and included steady-state, intermediate, and health promotion outcomes. An electronic search was performed for Danish, English, German, Norwegian, and Swedish articles (...) published between January 2004 and May 2017. Manual approaches, e.g., bibliographies from experts, supplemented the literature search. Data were extracted from 461 publications that met the inclusion criteria. To assess the status and quality of the evidence for health promotion effects of immersive nature-experience, we focused on the subset of studies based on controlled designs (n = 133). Outcome level quality of the evidence was assessed narratively. Interventions most often involved adventure-based activities, short-termed walking, and seated relaxation in natural environments. We found positive effects on a range of health promotion outcomes grouped under psychological wellbeing (n = 97; ≈55% positive; ≈13% mixed; ≈29% non-significant; 2% negative); psychosocial function (n = 67; ≈61% positive; ≈9% mixed; ≈30% non-significant); psychophysiological stress response (n = 50; ≈58% positive; ≈18% mixed; ≈24% non-significant), and cognitive performance (n = 36; ≈58% positive; ≈6% mixed; ≈33% non-significant; 3% negative); and social skills and relationships (n = 34; ≈70% positive; ≈7% mixed; ≈22% non-significant). Findings related to outcomes categorized under physical health, e.g., risk of cardiovascular disease, were less consistent (n = 51; ≈37% positive; ≈28% mixed; ≈35% non-significant). Across the types of interventions and outcomes, the quality of the evidence was deemed low and occasionally moderate. In the review, we identify, discuss, and present possible solutions to four core methodological challenges associated with investigating immersive nature-experience and health outcomes: 1) intervention and program complexity; 2) feasibility and desirability of randomization; 3) blinding of participants and researchers; and 4) transferability and generalizability. The results of the review have been published as a popular-scientific report and a scientific research overview, both in Danish language. (shrink)

This article considers issues concerning cases where the use of placebo is lawful or is not lawful under aspects of German criminal law. It will differentiate between cases of individual therapy and cases of supervised experiments within the scope of medical tests. Thereby, it reveals that a medication of placebo with regard to an individual patient seems to be lawful if there is no alternative possibility of a better treatment using a chemically effective medicine and if the limits of (...) presumed consent are complied with. On the other hand, in the context of the supervised experiment, the assignment of a patient to a group treated with placebo is only lawful if the patient has been fully informed about the possibilities of a treatment and if the patient has given consent to it. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Literature Against Philosophy, Plato to Derrida: A Defense of PoetryPaul M. HedeenLiterature Against Philosophy, Plato to Derrida: A Defense of Poetry, by Mark Edmundson; 239 pp. New York: Cambridge University Press, 1995, $59.95 cloth, $17.95 paper.In this age of suspicion, it is refreshing to meet a believer like Mark Edmundson, someone merging “versions of freedom and fate” (p. 235). To many, such an accommodation is automatically suspect; to (...) many, a voice as sweet and civil as his is enough to make the molars ache. Not that Edmundson always makes believing look easy, but he dances rather gracefully with the “descendental” (p. 236) as he sings a late-millennial tribute to “the poems we love” (p. 237). His analysis of sophisticated doubters is impressive for its respectful tone. Edmundson models how a traditional literary intellectual uses, rather than bests, not only what important philosophers promise, but also what literature delivers.Edmundson’s discussion begins with Plato’s dismissal of literature as “a harmful diversion” (p. 7). This establishes the classical sources of philosophy’s antipathy to literature’s “pleasure and vitality” (p. 237) and sets the tone for an analysis of “descendentalism,” the various modern and postmodern searches for “ultimate truths” in “the bedrock” of experience (p. 22).To Edmundson’s mind, Freud’s general hypothesis that there are analyzable forces in the unconscious legitimizes various contemporary attempts to subordinate literature to philosophy. For example, de Man’s metaphor of blindness and insight follows Freud as “a figure for [the] dramatic irony... that arises when speakers say more than they know, and... where the surplus of meaning is taken in by some third party” (p. 42).Power issues are in the foreground as the critic becomes an analyst/interpreter of meanings that would otherwise be latent or repressed (p. 43). As Edmundson shows, de Man can transform symbol and allegory into instances of repression, tropes “that record... how they will be misunderstood...” (p. 49). Such pre-Derridean insights still allow de Man to offer an approximate defense of highly allegorical texts that “proffer images for their own correct deconstruction” (p. 49). Only these, finally, are “worthy of being called literature” (p. 49).In short, “de Man succeeded in transferring the Freudian model of repression from the sphere of analytic therapy to that of rhetorical analysis” (p. 53) thus initiating “a self-perpetuating order” (p. 55). Does Edmundson decry such orders? Generally, yes, but gently. One of the strengths of this book is Edmundson’s desire not to compete with his subjects; predominantly, he avoids for himself the authoritarian positions he suspects, choosing instead to stir up the “trouble between poets and philosophers... that keeps them in productive dialogue and competition” (p. 63).Derrida’s chief role in this competition, his polemic against presence, and “his proffered alternative” (p. 79), différance, remind Edmundson of de Man’s [End Page 538] analysis of repression. “Derrida seems to think,” Edmundson writes, that “the texts of Western metaphysics surrender their secret holdings when one simply listens...” (p. 80). Like Freud and de Man, then, Derrida is out to unlock what is repressed: “we might think of différance as... a name for those powers that Derrida’s deconstruction strives to release” (p. 81).For Edmundson, however, Derrida’s chief insight—that “philosophy is a tissue of words, manifold [not unified] in their associations”—contradicts philosophy’s self-described superiority to and dominance over literature (p. 84). For if both literature and philosophy are merely made of words, “how,” Edmundson asks, “can philosophy conceivably function as a stable template to discipline and delimit literary range, to disenfranchise poetry” (p. 84)? Walking this tightrope, Derrida dramatizes “the struggle between poetry and philosophy... [on] a level of extraordinary and unprecedented refinement” (p. 84). Edmundson’s purpose—as it was with de Man—is not to debunk Derrida, but to redescribe him: no longer metaphysics’ “fearsome terminator,” he is a philosopher “within” this tradition (p. 96). Because Derrida continues Freud’s idea of authority, his analyses are “disturbingly mistake-proof,” risking little themselves but asking of literature great sacrifices of “vital force” (p. 112).Edmundson then takes on historicism. After a... (shrink)

Ocular gene transfer clinical trials are raising hopes for blindness treatments and attracting media attention. News media provide an accessible health information source for patients and the public, but are often criticized for overemphasizing benefits and underplaying risks of novel biomedical interventions. Overly optimistic portrayals of unproven interventions may influence public and patient expectations; the latter may cause patients to downplay risks and over-emphasize benefits, with implications for informed consent for clinical trials. We analyze the news media communications landscape (...) about ocular gene transfer and make recommendations for improving communications between clinicians and potential trial participants in light of media coverage. (shrink)

The conclusion to be drawn from the preceding observations and theorizing should be that we must be very much aware of what has been called “technological functionalism” (Pieper, 1986:11). While functionalism as such is not bad, the moment it succumbs to mere structural technicality, the functions stop functioning: forced “adaptivity” takes the place of “adaptable” interaction.That this problem is not due to a primordial blame, to be attached to the computer, becomes clear when one compares the computerized environment to other (...) surroundings, such as, for example, the psychiatric treatment. In the psychiatric interview, as Davis (1986, 1988) has shown, the interest of the therapist is often limited to establishing a “contract” for treatment: for the therapist to function properly, there must be a therapy-defined (or therapy-definable) problem for him/her to attack, using the skills and experiences of the profession of which he/she is a representative and for which he/she has been properly trained.This function, however, may not coincide with the patient's needs: it may well be the case that the problem which originally caused the patient to approach the therapist for treatment, in the end turns out not to be the problem that both agree on as the objective of the therapeutic treatment. “Re-formulating” the patients' problem in terms suitable to the available resources and techniques is thus typically a case of adapting the human to the system: again, we're faced with technological functionalism in the shape of what has been called “forced adaptivity” (see Mey, 1986).We need to think seriously about the way we handle our computerized structures and their functions, and in particular about the design of supportive systems such as large databases, computer conferencing, or even simple electronic mail services. While adaptivity always is a case of manipulation, by which humans are tooled to the needs and strictures of the computer, adaptability, by contrast, allows such manipulation only inasmuch as those needs and strictures reflect, and are imposed by, the users' needs. The blind, mechanical force that makes us adapt ourselves to the machine should be replaced by the enlightened, humanizing force of the adaptable computer. (shrink)

It is widely believed that medically inert treatments (“placebos”) can bring about therapeutic benefits. There is also evidence that medically active treatments may also have “placebo” effects. Since anything that has the potential to benefit patients ought to be exploited, subject to appropriate ethical standards, it has been suggested that more should be done to investigate and exploit the power of the placebo for therapeutic benefit. I explore the acute epistemic and ethical constraints that such exploitation is likely to face, (...) and conclude that effective exploitation is unlikely. (shrink)