The purpose of the study is to analyze trends and threats in the provision of medicines to the population of Russia. Recently, Russia has been facing an acute threat to the economic security of the pharmaceutical industry, due to the likelihood of increasing influence on the Russian industry by world players. Therefore, the analysis of trends in the development of the pharmaceutical industry and threats to the medicinal supply of the Russian population has now become particularly relevant. The (...) scientific novelty lies in the justification of the need to develop innovative import substitution of medicines in Russia. As a result, the key problems and factors that hinder the development of the domestic pharmaceutical industry at the present stage are identified. (shrink)

The essay outlines the development of the history of science and medicine in Croatia since the first half of the 20th century, addressing in more detail some recent research trends that seem to have the potential to reshape and reposition this relatively marginal field within the national academic landscape. It examines the origins and implication of the “historicization” of the history of science, as manifested in, among other things, tentative convergence between the history of science and medicine (...) and “general” history. Also considered are changes in the understanding of what counts as science and who as a historian of science within a specialist community in a small country that has struggled with balancing between the national and wider contexts, and with embracing newer conceptual frameworks and methodological approaches. (shrink)

There is evidence of persistent inequalities in household financial protection of health and drugs spending in Latin America. Despite the expansion of coverage, strong inequalities persist in access to health and family spending on drugs in the region. Out-of-pocket spending in medicines is regressive in greater need for affordable medicines.

Systems medicine, which is based on computational modelling of biological systems, is emerging as an increasingly prominent part of the personalized medicine movement. It is often promoted as ‘P4 medicine’. In this article, we test promises made by some of its proponents that systems medicine will be able to develop a scientific, quantitative metric for wellness that will eliminate the purported vagueness, ambiguity, and incompleteness—that is, normativity—of previous health definitions. We do so by examining the most (...) concrete and relevant evidence for such a metric available: a patent that describes a systems medicine method for assessing health and disease. We find that although systems medicine is promoted as heralding an era of transformative scientific objectivity, its definition of health seems at present still normatively based. As such, we argue that it will be open to influence from various stakeholders and that its purported objectivity may conceal important scientific, philosophical, and political issues. We also argue that this is an example of a general trend within biomedicine to create overly hopeful visions and expectations for the future. (shrink)

AimsTo examine attitudes towards physician-assisted suicide (PAS) among physicians in Sweden and compare these with the results from a similar cross-sectional study performed in 2007.ParticipantsA random selection of 250 physicians from each of six specialties (general practice, geriatrics, internal medicine, oncology, surgery and psychiatry) and all 127 palliative care physicians in Sweden were invited to participate in this study.SettingA postal questionnaire commissioned by the Swedish Medical Society in collaboration with Karolinska Institute in Stockholm. ResultsThe total response rate was 59.2%. (...) Slightly fewer than half [47.1% (95% CI 43.7–50.5)] of the respondents from the six specialties accepted PAS, which is significantly more than accepted PAS in the 2007 study [34.9% (95% CI 31.5–38.3)]. Thirty-three percent of respondents were prepared to prescribe the needed drugs. When asked what would happen to the respondent’s own trust in healthcare, a majority [67.1% (95% CI 63.9–70.3)] stated that legalizing PAS would either not influence their own trust in healthcare, or that their trust would increase. This number is an increase compared to the 2007 survey, when just over half [51.9% (95% CI 48.0–55.2)] indicated that their own trust would either not be influenced, or would increase.ConclusionsThe study reveals a shift towards a more accepting attitude concerning PAS among physicians in Sweden. Only a minority of the respondents stated that they were against PAS, and a considerable proportion reported being prepared to prescribe the needed drugs for patient self-administration if PAS were legalized. (shrink)

This is a qualitative examination of ethics consultation requests, outcomes, and ethics committee recommendations at a tertiary/quaternary pediatric hospital in the U.S. The purpose of this review of consults over an 18-year period is to identify specific trends in the types of ethical dilemmas presented in our pediatric setting, the impact of consultation and committee development on the number and type of consults provided, and any clinical features and/or challenges that emerged and contributed to the nature of ethical situations (...) and dilemmas. Furthermore, in reviewing clinical ethics consultation trends for nearly two decades, we can identify topic areas for further ethics education and training for ethics consultants, ethics committee members, and pediatric healthcare teams and professionals based on our experiences. Our study with nearly two decades of data prior to the COVID-19 pandemic can serve as groundwork for future comparisons of consultation requests and ethics support for pediatric hospitals prior to, during, and following a pandemic. (shrink)

Short-term humanitarian medical volunteerism has grown significantly among both clinicians and trainees over the past several years. Increasingly, both volunteers and their respective institutions have faced important challenges in regard to medical ethics and professional codes that should not be overlooked. We explore these potential concerns and their risk factors in three categories: ethical responsibilities in patient care, professional responsibility to communities and populations, and institutional responsibilities towards trainees. We discuss factors increasing the risk of harm to patients and communities, (...) including inadequate preparation, the use of advanced technology and the translation of Western medicine, issues with clinical epidemiology and test utility, difficulties with the principles of justice and clinical justice, the lack of population-based medicine, sociopolitical effects of foreign aid, volunteer stress management, and need for sufficient trainee supervision. We review existing resources and offer suggestions for future skill-based training, organisational responsibilities, and ethical preparation. (shrink)

Debates about end of life decisions should accept that public opinion on these matters is still fluidChanges in the past half century in the attitudes of the American public regarding euthanasia and suicide in the case of incurable disease have been dramatic, and they attest to the success of a social movement that has been in part a phenomenon “of the times” . But they are also in part a consequence of a highly visible social movement and vigorous deliberate actions (...) intended to shape public opinion, moving it in a direction favourable to concrete changes in law, public policy, and precepts of the profession of medicine.During much of this period, a bewildering plethora of polls has been conducted, related in one way or another to the question of how the public has viewed the issues about end of life decisions. End of life decisions have an important bioethical component, especially as they raise questions of who makes choices and how those choices can be made in an ethical manner. Does the individual have complete control of his or her own fate? Who can act as surrogate? What role, if any, should physicians play, and what are the interests of the state in such decisions? Anyone who wants to write a justification for, or promote advocacy of, any kind of policy regarding these issues ought to be seriously acquainted with trends in public attitudes. While public opinion cannot be the final arbiter of what is ethically correct, knowledge of it will help us to address the issues in a way that will best benefit the public discourse. Unfortunately, hardly any presentation of the polls related to the subject has attempted to reconcile the …. (shrink)

There is an alarming trend in the field of medicine, whose portents are ominous but do not seem to shake the complacency and merry making doing the rounds. The wants of the medical man have multiplied beyond imagination. The cost of organizing conferences is no longer possible on delegate fees. The bottom-line is: Crores for a Conference, Millions for a Mid-Term. However, the problem is that sponsors keep a discreet but careful tab on docs. All in all, costs of (...) medicines escalate, and quality medical care becomes a luxury. The whole brunt of this movement is borne by the patient. Companies like GlaxoSmithKline, Bayer, Pfizer, Bristol-Myers Squibb, AstraZeneca, Schering-Plough, Abbott Labs, TAP Pharmaceuticals, Wyeth and Merck have paid millions of dollars each as compensation in the last few years. The financial condition of many pharmaceutical majors is not buoyant either. Price deflation, increased Rand D spending, and litigation costs are the main reasons. In the future, the messy lawsuits situation would no longer be restricted to industry. It would involve academia and practising doctors as well. Indian pharma industry captains, who were busy raking in the profits at present, would also come under the scanner. If nothing else, it means industry and docs will have to sit down and do some soul searching. Both short and long-term measures will have to be put into place. Short-term measures involve reduction in i) pharma spending over junkets and trinkets; ii) hype over 'me too' drugs; iii) manipulation of drug trials; iv) getting pliant researchers into drug trials; iv) manipulation of Journal Editors to publish positive findings about their drug trials and launches; v) and for Indian Pharma, to conduct their own unbiased clinical trial of the latest drug projected as a blockbuster in the West, before pumping in their millions. The long-term measures are related to the way biomedical advance is to be charted. We have to decide whether medicine is to become a corporate enterprise or remain a patient welfare centered profession. A third approach involves an eclectic resolution of the two. Such amount of patient welfare as also ensures profit, and such amount of profit as also ensures patient welfare is to be forwarded. For, profit, without patient welfare, is blind. And patient welfare, without profit, is lame. According to this approach, medicine becomes a patient welfare centered professional enterprise. The various ramifications of each of these approaches are discussed in this monograph. (shrink)

In a recent issue of the Journal of Medicine and Philosophy, several scholars wrote on the topic of ethics expertise in clinical ethics consultation. The articles in this issue exemplified what we consider to be two troubling trends in the quest to articulate a unique expertise for clinical ethicists. The first trend, exemplified in the work of Lisa Rasmussen, is an attempt to define a role for clinical ethicists that denies they have ethics expertise. Rasmussen cites the dependence (...) of ethical expertise on irresolvable meta-ethical debates as the reason for this move. We argue against this deflationary strategy because it ends up smuggling in meta-ethical assumptions it claims to avoid. Specifically, we critique Rasmussen’s distinction between the ethical and normative features of clinical ethics cases. The second trend, exemplified in the work of Dien Ho, also attempts to avoid meta-ethics. However, unlike Rasmussen, Ho tries to articulate a notion of ethics expertise that does not rely upon meta-ethics. Specifically, we critique Ho’s attempts to explain how clinical ethicists can resolve moral disputes using what he calls the “Default Principle” and “arguments by parity.” We show that these strategies do not work unless those with the moral disagreement already share certain meta-ethical assumptions. Ultimately, we argue that the two trends of attempting to avoid meta-ethics by denying that clinical ethicists have ethics expertise, and attempting to articulate how ethics expertise can be used to resolve disputes without meta-ethics both fail because they do not, in fact, avoid doing meta-ethics. We conclude that these trends detract from what clinical ethics consultation was founded to do and ought to still be doing—provide moral guidance, which requires ethics expertise, and engagement with meta-ethics. To speak of ethicists without ethics expertise leaves their role in the clinic dangerously unclear and unjustified. (shrink)

In the late twentieth century the impressive achievements of modern medicine are obvious, yet medicine seems to have failed to satisfy public expectation. Government regulation of hospitals and doctors is tightening in most Western countries and health funding is a divisive political issue. Medical complaints departments are increasingly busy. In the United States medical litigation has reached alarming levels, and a similar trend can be seen in other developed countries. Is there something wrong with medical research and practice? (...) This book, written by a surgeon with more than thirty years experience of clinical medicine, examines what it is that doctors do, and what it is that patients expect of them. It finds that in the face of uncertainty, expectation and reality ofen often diverge. Starting from the communication difficulties that exist between doctors and patients, Humane Medicine explores the roles of science, ethics and the humanities in medical practice. It forcefully argues that more science cannot heal this rift, nor can better education in ethics. To foster better communication, medical teachers must change their philosophy and methods, so that value-laden issues in clinical medicine are interwoven with the necessary science. Professor Little outlines some possible ways to achieve this. This important book will be of interest to medical students and their teachers, clinicians, health policy planners and other readers concerned about the direction of the medical profession. (shrink)

Since its inception in September 2010, the Network for Public Health Law has responded to hundreds of public health legal technical assistance claims from around the country. Based on a review of these data, a series of major trends in public health practice and the law are analyzed, including issues concerning: the Affordable Care Act, tobacco control, emergency legal preparedness, health information privacy, food policy, vaccination, drug overdose prevention, sports injury law, public health accreditation, and maternal breastfeeding. These and (...) other emerging themes in public health law demonstrate the essential role of law and practice in advancing the public's health. (shrink)

Trust in medicine is often conceived of on an individual level, with respect to how people rely on particular clinicians or institutions. Yet as discussions of trust during the Covid‐19 pandemic highlighted, trust decisions are not always as individual or interpersonal as this conception suggests. Rather, individual instances of trusting behavior are related to social trust, which is conceived as a willingness to be vulnerable to people in general, based on a sense of shared norms. In this essay, I (...) propose that individual and social trust are connected to each other in what can be termed a “climate of trust.” I explain how masking trends during the pandemic facilitated a “climate of distrust,” and I consider the role that clinicians might play in transforming climates of distrust into climates of trust. (shrink)

Das normative Grundverständnis der kurativen Medizin und ein Trend, sich ihr zu entwinden, wird beschrieben. Durch systematische Betrachtung des Trends wird der Begriff einer „wunscherfüllenden Medizin“ eingeführt und mit der kurativen Medizin kontrastiert. Am Beispiel der Schönheitschirurgie und der Kritik des „Schönheitswahns“ wird deutlich gemacht, dass die Bewertung von Phänomenen wunscherfüllender Medizin in liberalen Gesellschaften sich nur auf schwache normative Ressourcen stützen kann. Nutzen-Risiko-Argumente und Kohärenzargumente, bezogen auf Lebensentwürfe, stellen die vergleichsweise stärksten dar. Wunscherfüllende Medizin erscheint zwiespältig, einerseits erhöht (...) sie die Klientenzentrierung und Responsivität des Medizinsystems, andererseits befördert sie Kommerzialisierungstendenzen. (shrink)

Childhood obesity is an increasing health threat. The National Institutes of Health is the primary funding agency for research into the causes, mechanisms, consequences, and prevention and treatment of childhood obesity. Using the NIH Strategic Plan for Obesity Research as the framework, this article summarizes the research that has been funded in the past five years as well as new research areas with great potential.

Childhood obesity continues to rise in the United States, with now over 17% of children and adolescents considered overweight. Childhood obesity predisposes an entire generation to increased risk of chronic diseases and disabilities and is a severe threat to the economic well-being of the nation. At first thought, the solution to the obesity epidemic may seem simple: encourage people to eat less and exercise more. However, the reality is that behavioral change is difficult to achieve without also considering the interplay (...) of genetics, biological processes, and social and environmental mechanisms. As such, investment in obesity research has been considered an important tool to combat obesity and obesity-related diseases. Childhood obesity research, in particular, has drawn considerable attention, given the lower cost of prevention relative to treatment and the high potential for long-term benefits at a population level. (shrink)

Today's medicine is spiritually deflated and morally adrift; this book explains why and offers an ethical framework to renew and guide practitioners in fulfilling their profession to heal. What is medicine and what is it for? What does it mean to be a good doctor? Answers to these questions are essential both to the practice of medicine and to understanding the moral norms that shape that practice. The Way of Medicine articulates and defends an account of (...) medicine and medical ethics meant to challenge the reigning provider of services model, in which clinicians eschew any claim to know what is good for a patient and instead offer an array of "health care services" for the sake of the patient's subjective well-being. Against this trend, Farr Curlin and Christopher Tollefsen call for practitioners to recover what they call the Way of Medicine, which offers physicians both a path out of the provider of services model and also the moral resources necessary to resist the various political, institutional, and cultural forces that constantly push practitioners and patients into thinking of their relationship in terms of economic exchange. Curlin and Tollefsen offer an accessible account of the ancient ethical tradition from which contemporary medicine and bioethics has departed. Their investigation, drawing on the scholarship of Leon Kass, Alasdair MacIntyre, and John Finnis, leads them to explore the nature of medicine as a practice, health as the end of medicine, the doctor-patient relationship, the rule of double effect in medical practice, and a number of clinical ethical issues from the beginning of life to its end. In the final chapter, the authors take up debates about conscience in medicine, arguing that rather than pretending to not know what is good for patients, physicians should contend conscientiously for the patient's health and, in so doing, contend conscientiously for good medicine. The Way of Medicine is an intellectually serious yet accessible exploration of medical practice written for medical students, health care professionals, and students and scholars of bioethics and medical ethics. (shrink)

Public health law research reveals significant complexities underlying the use of law as an effective tool to improve health outcomes across populations. The challenges of applying public health law in practice are no easier. Attorneys, public health officials, and diverse partners in the public and private sectors collaborate on the front lines to forge pathways to advance population health through law. Meeting this objective amidst competing interests requires strong practice skills to shift through sensitive and sometimes urgent calls for action (...) to address known threats to the health of individuals and the community. It also necessitates objective, timely information and national and regional legal support. (shrink)

The study of professional ethics has a long tradition in the Soviet Union; medical ethics is a code of conduct as well as an academic discipline. The paper discusses the ethical issues in intensive care, the definition of death, abortion, euthanasia, and the moral aspects of medical mistakes.

Das normative Grundverständnis der kurativen Medizin und ein Trend, sich ihr zu entwinden, wird beschrieben. Durch systematische Betrachtung des Trends wird der Begriff einer „wunscherfüllenden Medizin“ eingeführt und mit der kurativen Medizin kontrastiert. Am Beispiel der Schönheitschirurgie und der Kritik des „Schönheitswahns“ wird deutlich gemacht, dass die Bewertung von Phänomenen wunscherfüllender Medizin in liberalen Gesellschaften sich nur auf schwache normative Ressourcen stützen kann. Nutzen-Risiko-Argumente und Kohärenzargumente, bezogen auf Lebensentwürfe, stellen die vergleichsweise stärksten dar. Wunscherfüllende Medizin erscheint zwiespältig, einerseits erhöht (...) sie die Klientenzentrierung und Responsivität des Medizinsystems, andererseits befördert sie Kommerzialisierungstendenzen. (shrink)

The extension of intellectual property rights into the realm of biology has emerged as an increasing focus of controversy in relation to science,2 biodiversity,3 agriculture,4 health,5 development,6 human rights7 and trade.8 This paper presents the results of a review of international trends in activity for patent protection between 1990-2000 and provisional data to 2004 and 2005 from over 70 national patent offices, four regional patent offices and the World Intellectual Property Organisation using the European Patent Office esp@cenet worldwide database.9 (...) The review employed patent publication counts as an indicator of activity for traditional medicines, pharmaceuticals, agriculture, and biotechnology. The research provides insights into the internationalisation of patent activity in multiple areas of biology. The review emphasises the need to combine the further development of quantitative methods with qualitative analysis of the implications of international patent activity in relation to biological and genetic material for science, society and policy. (shrink)

The extension of intellectual property rights into the realm of biology has emerged as an increasing focus of controversy in relation to science,2 biodiversity,3 agriculture,4 health,5 development,6 human rights7 and trade.8 This paper presents the results of a review of international trends in activity for patent protection between 1990-2000 and provisional data to 2004 and 2005 from over 70 national patent offices, four regional patent offices and the World Intellectual Property Organisation (WIPO) using the European Patent Office esp@cenet worldwide (...) database.9 The review employed patent publication counts as an indicator of activity for traditional medicines, pharmaceuticals, agriculture, and biotechnology. The research provides insights into the internationalisation of patent activity in multiple areas of biology. The review emphasises the need to combine the further development of quantitative methods with qualitative analysis of the implications of international patent activity in relation to biological and genetic material for science, society and policy. (shrink)

In this commentary on the article by Arthur L. Caplan [1] the philosophy of medicine is viewed from a medical perspective. Philosophical studies have a long tradition in medicine, especially during periods of paradigmatic unrest, and they serve the same goal as other medical activities: the prevention and treatment of disease. The medical profession needs the help of professional philosophers in much the same way as it needs the cooperation of basic scientists. Philosophy of medicine may not (...) deserve the status of a philosophical subspecialty or field, but it so closely linked to the main trends of contemporary medical thinking that it must be regarded as an emerging (or reemerging) medical subdiscipline. (shrink)

ObjectivesAcupuncture therapy has been used for cognitive impairment-related diseases, however, there are still few studies on the overall trend of acupuncture therapy on cognitive impairment based on bibliometric analysis. The purpose of this study was to explore the research trend of the impact of acupuncture on cognitive impairment in the past 15 years, analyze the research trends and hotspots, and provide new ideas and theoretical basis for future research directions.MethodsFrom the Web of Science Core Collection, the relevant literature on (...) the treatment of cognitive impairment with acupuncture from 2007 to 2022 was retrieved. Then, based on the CiteSpace and VOSviewer software of the Java platform, the cooperation between countries and institutions in this field, the co-citation of journals and documents, and the cooperation between authors and authors, etc. were analyzed. In addition, the co-occurrence and burst analysis of keywords are also carried out, and a visual knowledge map is drawn.ResultsAs of August 08, 2022, a total of 394 records related to the treatment of cognitive impairment with acupuncture were identified. The analysis results show: The number and rate of annual publications have steadily increased, with some fluctuations from year to year. The countries that contribute the most to this field are China and the USA. Among them, Beijing University of Chinese Medicine and Capital Medical University are tied for first place in terms of the number of published papers. Tao Jing is the most prolific author and the number one cited author.ConclusionsThe number of publications on acupuncture for cognitive impairment is expected to increase rapidly in future research, suggesting a bright future for the field. Future research hotspots will focus on pain, injury, protocol, diagnosis, guidelines, etc. It is also necessary to strengthen cross-regional and cross-country cooperation among various academic groups. (shrink)

The purpose of this paper is to review the rising influence of commercialism in American medicine and to examine some of the consequences of this trend. Increased competition subverts physician collegiality, draws hospitals into for-profit ownership and behavior, and leads clinical investigators into secrecy and possibly into bias and abuse. Medicine faces a deprofessionalization evidenced in loss of control over the clinical setting and over self-regulation. Health care becomes a commodity relying on cultivation of desires instead of satisfaction (...) of needs, even as many basic needs go unmet. Patients become consumers empowered with lawsuits and the connection of medicine to the relief of suffering is attenuated. Medical encounters are increasingly impersonal, dominated by specialization, technology, and bureaucracy. Patients are losing their physician-advocates to new conflicts of interests, physicians are losing their impulse to charity, and trust in the doctor-patient relationship and in medicine generally is eroding. (shrink)

The article discusses the challenges, benefits, and risks that, from a bioethical perspective, arise because of the the development of eHealth projects. The conceptual framework of the research is based on H. Jonas’ principles of the ethics of responsibility and B.G. Yudin’s anthropological ideas on human beings as agents who constantly change their own boundaries in the “zone of phase transitions.” The article focuses on the events taking place in the zone of phase transitions between humans and machines in eHealth. (...) It is shown that for innovative practices related to digitalization and datafication in medicine, it is needed to rethink central bioethical concepts of personal autonomy and informed consent. In particular, the concept of broad or open informed consent is discussed, which allows the idea of moral responsibility in the field of biomedical technologies to be extended to events of uncertain future. The authors draw attention to the problems associated with the emergence of new autonomous subjects/agents (machines with artificial intelligence) in relationship between doctors and patients. The humanization of machines occurring in eHealth is accompanied by a counter trend – the formation of conceptions and practices of the quantified self. There emerges the practices of self-care and bio-power (M. Foucault) caused by the datafication and digitization of personality. The authors conclude that bioethics should proactively develop norms for the evolving interaction between doctor and patients. (shrink)

Through this contribution I aim to explore the horizons and limits of digital medicine in light of an embodied approach to the issue of care. I will sketch the historical background of digital medicine and show the contemporary status of this interdisciplinary field, as well as its applications and outcomes. Then, I will address a critique of the computational theory of mind (CTM) upon which many contemporary mental health apps are designed. This approach to the mind is inscribed (...) into the modern trend of neuromania, which conceives the embodied, living human being as a mere series of data analyses and algorithms, with the brain as the seat of the person. Drawing on continental philosophy and classical phenomenology I will develop a notion of health conceived as a moral enterprise, showing how wellbeing and vitality are not reducible to a product made by technologies or doctors, but rather they are the results of an embodied encounter. As such, empathy and person-centered care cannot be achieved by digital medicine. They are the result of a journey into the regions of recognition, embodied presence and the aliveness constituting the person. Finally, I will show how the issue of care cannot be separated from an embodied encounter between people, especially in case of dementia. (shrink)

Personalized Medicine is an evolving and often missinterpreted concept and no agreement of personalization exist. We examined the PM discourse towards foucauldian archeological and genealogical analysis to understand the meaning of “personalization” in medicine. In the archaeological analysis, the historical evolution is characterized by the coexistence of two epistemologies: the holistic vision and the omic sciences. The genealogical analysis shows how these epistemologies may affect the meaning of “person” and, consequently, the ontology of patients. Additionally, substitutions/confusions of the (...) term PM are related to continuously evolving medical knowledge and new technologies; different etymological roots of “personalization” and “person”; and cultural differences. In conclusion, if the definition of “personalization” in medicine is not clear, patients might get wrong expectations about what is achievable for their health. Therefore, epistemological trends should not be separated as they drive same goals: providing accurate diagnosis and treatments based on large data to predict disease progression. (shrink)

Mindfulness based interventions are rapidly emerging in health care settings for their role in reducing stress and improving physical and mental health. In such settings, the religious roots and affiliations of MBIs are downplayed, and the possibilities for developing spiritual, even mystical, states of consciousness are minimized. This article helps rebalance this trend by using the tools of medical humanities and narrative medicine to explore MBI as a bridge between medical and spiritual approaches to health related suffering. My narrative (...) medicine method draws insights from the arts and humanities that are rarely used in standard clinical research but are increasingly common among medical humanities and narrative medicine scholars. The specific path I take will be to work through historical, linguistic, and philosophic dimensions of mindfulness and mysticism as relevant to illness, suffering, death, and dying. I close with two case examples in which mindfulness is used as an intentionally spiritual practice for health concerns. (shrink)

The puzzling case of the broken arm -- Hernias, diets, and drugs -- Why physicians cannot know what will benefit patients -- Sacrificing patient benefit to protect patient rights -- Societal interests and duties to others -- The new, limited, twenty-first-century role for physicians as patient assistants -- Abandoning modern medical concepts: doctor's "orders" and hospital "discharge" -- Medicine can't "indicate": so why do we talk that way? --"Treatments of choice" and "medical necessity": who is fooling whom? -- Abandoning (...) informed consent -- Why physicians get it wrong and the alternatives to consent: patient choice and deep value pairing -- The end of prescribing: why prescription writing is irrational -- The alternatives to prescribing -- Are fat people overweight? -- Beyond prettiness: death, disease, and being fat -- Universal but varied health insurance: only separate is equal -- Health insurance: the case for multiple lists -- Why hospice care should not be a part of ideal health care I: the history of the hospice -- Why hospice care should not be a part of ideal health care II: hospice in a postmodern era -- Randomized human experimentation: the modern dilemma -- Randomized human experimentation: a proposal for the new medicine -- Clinical practice guidelines and why they are wrong -- Outcomes research and how values sneak into finding of fact -- The consensus of medical experts and why it is wrong so often. (shrink)

The article discusses the challenges, benefits, and risks that, from a bioethical perspective, arise because of the the development of eHealth projects. The conceptual framework of the research is based on H. Jonas’ principles of the ethics of responsibility and B.G. Yudin’s anthropological ideas on human beings as agents who constantly change their own boundaries in the “zone of phase transitions.” The article focuses on the events taking place in the zone of phase transitions between humans and machines in eHealth. (...) It is shown that for innovative practices related to digitalization and datafication in medicine, it is needed to rethink central bioethical concepts of personal autonomy and informed consent. In particular, the concept of broad or open informed consent is discussed, which allows the idea of moral responsibility in the field of biomedical technologies to be extended to events of uncertain future. The authors draw attention to the problems associated with the emergence of new autonomous subjects/agents in relationship between doctors and patients. The humanization of machines occurring in eHealth is accompanied by a counter trend – the formation of conceptions and practices of the quantified self. There emerges the practices of self-care and bio-power caused by the datafication and digitization of personality. The authors conclude that bioethics should proactively develop norms for the evolving interaction between doctor and patients. (shrink)

The emerging concept of systems medicine (or ‘P4 medicine’—predictive, preventive, personalized and participatory) is at the vanguard of the post-genomic movement towards ‘precision medicine’. It is the medical application of systems biology, the biological study of wholes. Of particular interest, P4 systems medicine is currently promised as a revolutionary new biomedical approach that is holistic rather than reductionist. This article analyzes its concept of holism, both with regard to methods and conceptualization of health and disease. Rather (...) than representing a medical holism associated with basic humanistic ideas, we find a technoscientific holism resulting from altered technological and theoretical circumstances in biology. We argue that this holism, which is aimed at disease prevention and health optimization, points towards an expanded form of medicalization, which we call ‘holistic medicalization’: Each person’s whole life process is defined in biomedical, technoscientific terms as quantifiable and controllable and underlain a regime of medical control that is holistic in that it is all-encompassing. It is directed at all levels of functioning, from the molecular to the social, continual throughout life and aimed at managing the whole continuum from cure of disease to optimization of health. We argue that this medicalization is a very concrete materialization of a broader trend in medicine and society, which we call ‘the medicalization of health and life itself’. We explicate this holistic medicalization, discuss potential harms and conclude by calling for preventive measures aimed at avoiding eventual harmful effects of overmedicalization in systems medicine (quaternary prevention). (shrink)

The development of the philosophy of medicine in the Federal Republic of Germany since 1945 is presented in a thematic form. The first two decades were characterized by the evolution of an anthropological school of thought that aimed at relating physician and patient in a more personal and existential form than had hitherto been the case. In the last years, this tendency to demand deeper psychic and broader social involvement with medical problems had increased. Somatic disorders were considered to (...) be fundamentally caused by socially induced mental stress. After a brief period during which the theme of organisms in general and phenomenologically grasped living-body of human beings in particular were discussed, there followed since the mid-seventies an essential preoccupation with the methodology and epistemology of medicine. According to this trend, medicine is to be analyzed in terms of the theory of action, with its conceptual and strategic orientation towards practice and not, as generally believed, towards the standards of scientific truth. The concepts of disease, diagnosis and therapy are therefore relative and their validity is dependent on time, persons and circumstances involved. Thus, the highest criteria of utility for medical actions cannot but be the affected patient and society. (shrink)