We think we know what healers do: they build on patients' irrational beliefs and treat them in a 'symbolic' way. If they get results, it's thanks to their capacity to listen, rather than any influence on a clinical level. At the same time, we also think we know what modern medicine is: a highly technical and rational process, but one that scarcely listens to patients at all. In this book, ethnopsychiatrist Tobie Nathan and philosopher Isabelle Stengers argue that this commonly (...) posed opposition between traditional and modern medicine is misleading. They show instead that healers are interesting precisely because they don't listen to patients, using techniques of 'divination' rather than 'diagnosis'. Healers construct genuine therapeutic strategies by identifying the origins of symptoms in external forces, outside of the mind of the sufferer, and in this regard African healers are virtuosos. Though it may claim otherwise, modern medicine, for its part, is characterised by empiricism rather than rationality. What appears to be the pursuit of rationality is ultimately only a means to dismiss and exclude other forms of treatment. Blurring the distinctions between traditional and modern practices and drawing on perspectives from across the globe, this ethnopsychiatric manifesto encourages us to think in radically new ways about illness, challenging accepted notions on the relationship between sufferer and symptom. It will be of great interest to those working in medicine and healthcare, as well as anthropologists, social scientists and those in the humanities more broadly. (shrink)

Are there any characteristics by which we can reliably identify and distinguish quackery from genuine medicine? A commonly offered criterion for the distinction between medicine and quackery is science: genuine medicine is scientific; quackery is non-scientific. But it proves to be the case that at the boundary of science and non-science, there is an entanglement of considerations. Two cases are considered: that of homoeopathy and that of the Quantum Booster. In the first case, the degree to which (...) reported phenomena that question established theory should be doubted arises; in the second case, the status of pleomorphism as a scientifically plausible doctrine is discussed. The application of the criterion of being scientific to these cases reveals something of the nature and density of the entanglement. (shrink)

One striking observation in the history of rational choice models is that those models have not only been used in economics but spread widely across the social and behavioral sciences. How do such model transfers proceed? By closely studying the early efforts to transfer such models by William Riker – a major protagonist in pushing the adoption of game theoretic models in political science – this article examines the transfer process as one of ‘translation’ by which abstract and mathematical rational (...) choice models were constructed and modified such that they applied to a specific target system in a new domain. In this paper, we argue that to overcome a set of challenges that hampered the straightforward transfer of game theoretic models into political science, Riker complemented theoretical and conceptual modifications of von Neumann and Morgenstern’s game schemes with the use of narratives to turn them into applicable and testable models. As such, those narratives played a crucial role in enabling their transfer and ultimately facilitated the applicability of game theoretic models in political science. (shrink)

Recent research has brought to light substantial fragments in Egyptian demotic, Old Coptic and Greek of manuals of divination by means of drawing lots. Typically, the lots carry a number, and each is attributed to a particular deity. This article presents the documentation known today, including some strips of palm leaf which could have served as the actual lots. It also discusses the degree of variation between the different manuscripts, and possible specific links between the gods and the answers to (...) which they are linked. (shrink)

English summary: Ideas of man and concepts of the body are closely linked, and are a key factor in defining anthropological theories and problems. In addition, they are closely connected to the social structure of each cultural region, which itself has a continuous influence on human actions and attitudes, but which at the same time is also the result of human actions and attitudes. Scholars from various disciplines used this as their basis to explore the subject in their own cultural (...) field, each of them taking the perspective of their own methodological approach. The studies incorporate both, text and image sources. It is the authors' common goal to provide a precise description of specific anthropological developments which are dependent on time and culture and to include a discussion of basic issues of the conditio humana. German description: Menschenbilder und Korperkonzepte gehoren eng zusammen und bestimmen massgeblich anthropologische Lehren und Fragestellungen. Sie sind zudem eng mit der Sozialstruktur des jeweiligen Kulturraums verflochten, wobei dieselbe zwar ununterbrochen konditionierenden Einfluss auf menschliche Handlungen und Haltungen hat, sie aber zugleich auch das Ergebnis menschlicher Handlungen und Haltungen ist. Auf diesen Grundlagen haben sich Wissenschaftler unterschiedlicher Disziplinen zusammengefunden, um aus der Perspektive ihres jeweiligen methodischen Ansatzes dem Thema in ihrem jeweiligen Kulturbereich nachzugehen. Dabei werden Textquellen ebenso in die Untersuchungen mit einbezogen wie Bildquellen. Gemeinsames Ziel ist, zeit- und kulturgebundene Spezialentwicklungen prazise zu profilieren und Grundfragen der conditio humana in den Blick zu nehmen. (shrink)

Studies on societal path dependencies tend to focus on mechanisms that anchor and stabilize national trajectories while paying less attention to transnational interactions and multilevel governance. This paper explores processes of path transformation in societies that are presumed to have the characteristics of open systems. Two pairs of case studies are presented and compared. The first illustrates institutional change through collision, when a national path meets with another. The second describes the emergence of transnational institutional paths and the impact of (...) that process on national institutions and their (potential) transformation. The results indicate that path transformation often stems from a gradual succession and combination of incremental steps and junctures – change is gradual but consequential. They also point to increasing co-evolutionary interaction between national path transformation and transnational path creation. This implies a need for analytical tools that are adapted to the analysis of multi-level, nested processes of institutionalization and de-institutionalization. The paper suggests that the concept of path generation allows for a better specification of the conditions for change in existing societal paths and for the emergence of new paths in the case of open systems than the concept of path dependency. (shrink)

In the first half of the paper, it is argued that while the prospects for a criterion for demarcating scientific theories from pseudoscientific ones are exceedingly dim, it is a mistake to fall back to the position that these differ only with regard to how well they are confirmed. One may admit that different pseudoscientific theories are flawed in different ways yet still insist that their flaws are structural rather than empirical in character. In the second half of the paper, (...) this view is extended to cover the cases of pseudoscientific correlations and therapies, and it is suggested that the pseudosciences are best thought of as radically flawed practices. (shrink)

The American Journal of Bioethics, Volume 12, Issue 9, Page 51-53, September 2012.

Separate from the question of whether our patients believe us as doctors is the question of whether we ourselves believe in our healing ‘performances’. Borrowing from Bernard Williams’ model of truth based on the two irreducible virtues of sincerity and accuracy, this article describes a spectrum of states of self-belief, from the quack who does not believe in his acts to the fanatic who does not ‘dis-believe’, with ranges of pious fraud and bad faith in between and on either side (...) of a variable range of justified self-belief. I describe how as practitioners we move and are moved up and down this range throughout our careers and as a result of the behaviors of others. The model provides the basis for a critique of the marketing efforts of industries related to medical practice. (shrink)

This essay discusses the question of health in the Kingdom of Hungary during the Age of Enlightenment. It explores the relationships and tensions between central theories of medical police and the local expectations of government administrators, as well as those between academic or official knowledge and implicit or alternative knowledge about health. The reigns of Maria Theresia and Joseph II marked the moment at which particular kinds of folk and practical knowledge about healing became visible and above all legible. This (...) is to be seen in the enormous rise in book production, which in itself represented an ‘approved knowledge’ that found legitimation in new academic and bureaucratic institutions, such as the reformed medical faculty of the University of Vienna, the newly-founded medical faculty at Tyrnau, the establishment of a health department within the Hungarian Statthalterei, as well as in the emission of royal legislation supporting the agendas of the new enlightened science of ‘medical police’. (shrink)

Antipsychiatry : alternative psychiatry -- The doctor of irresponsibility -- The trickster and the tricked -- Antipsychiatry and anti-art -- Antipsychiatry abroad.

This article uses a reading of John Wesley's Primitive Physic, or An Easy and Natural Method of Curing Most Diseases (1747) to resist the common rejection—often as "quackery"—of Wesley's treatments for common maladies. We engage Wesley not because he was right but because his approach offers useful moments of pause in light of contemporary medical epistemology. Wesley's recommendations were primarily oriented towards the categories of personal responsibility and capability, but he also sought to empower individuals—especially the poor—with the knowledge (...) to safely and affordably treat maladies of their own. We leverage Primitive Physic to rethink contemporary medical knowledge production, especially as sanctioned by randomized clinical trials and legitimate views of experience and contemporary institutions such as the AMA. Ultimately, we suggest that the medical humanities has a key role to play in mining the discarded and dismissed for what they can tell scholars about medical knowledge. (shrink)

Ägypten zwischen innerem Zwist und äußerem Druck: Die Zeit Ptolemaios’ VI. bis VIII. Edited by Andrea Jördens and Joachim Friedrich Quack. Philippika, vol. 45. Wiesbaden: Harrassowitz Verlag, 2011. Pp. ix + 338, illus. €58.

Physicians expressing opinions on medical matters that run contrary to the consensus of experts pose a challenge to licensing bodies and regulatory authorities. While the right to express contrarian views feeds a robust marketplace of ideas that is essential for scientific progress, physicians advocating ineffective or dangerous cures, or actively opposing public health measures, pose a grave threat to societal welfare. Increasingly, a distinction has been made between professional speech that occurs during the physician-patient encounter and public speech that transpires (...) beyond the clinical setting, with physicians being afforded wide latitude to voice empirically false claims outside the context of patient care. This paper argues that such a bifurcated model does not sufficiently address the challenges of an age when mass communications and social media allow dissenting physicians to offer misleading medical advice to the general public on a mass scale. Instead, a three-tiered model that distinguishes between citizen speech, physician speech and clinical speech would best serve authorities when regulating physician expression. (shrink)

Background Continued advances in human microbiome research and technologies raise a number of ethical, legal, and social challenges. These challenges are associated not only with the conduct of the research, but also with broader implications, such as the production and distribution of commercial products promising maintenance or restoration of good physical health and disease prevention. In this article, we document several ethical, legal, and social challenges associated with the commercialization of human microbiome research, focusing particularly on how this research is (...) mobilized within economic markets for new public health uses. Methods We conducted in-depth, semi-structured interviews (2009–2010) with 63 scientists, researchers, and National Institutes of Health project leaders (“investigators”) involved with human microbiome research. Interviews explored a range of ethical, legal, and social dimensions of human microbiome research, including investigators’ perspectives on commercialization. Using thematic content analysis, we identified and analyzed emergent themes and patterns. Results Investigators discussed the commercialization of human microbiome research in terms of (1) commercialization, probiotics, and issues of safety, (2) public awareness of the benefits and risks of dietary supplements, and (3) regulation. Conclusion The prevailing theme of ethical, legal, social concern focused on the need to find a balance between the marketplace, scientific research, and the public’s health. The themes we identified are intended to serve as points for discussions about the relationship between scientific research and the manufacture and distribution of over-the-counter dietary supplements in the United States. (shrink)

After a crisis, broad and sweeping reforms are enacted to restore trust. Following the 2007-2008 Great Financial Crisis, the European Union has engaged in an ambitious overhaul of banking regulation. One of its centerpieces, the 2013 Fourth Capital Requirements Directive, tackles, amongst other things, the perceived pre-crisis failings in the governance of banks. We focus on the provisions that are aimed at reshaping bank boards’ composition, functioning, and their members’ liabilities, and argue that they are unlikely to improve bank boards’ (...) effectiveness or prevent excessive risk-taking. We criticize some of them for mandating solutions, like board diversity and the separation of chairman and CEO, that may be good for some banks but are bad for others, in the absence of any convincing argument that their overall effect is positive. We also criticize enhanced board liability by showing that it may increase the risk of herd behavior and lead to more serious harm in the event of managerial mistakes. We also highlight that the push towards unfriendly boards will negatively affect board dynamics and make boards as dysfunctional as when the CEO dominates them. We further argue that limits on directorships and diversity requirements will worsen the shortage of bank directors, while requirements for induction and training and board evaluation exercises will more likely lead to tick-the-box exercises than under the current situation in which they are just best practices. We conclude that European policymakers and supervisors should avoid using a heavy hand, respectively, when issuing rules implementing CRD IV provisions with regard to bank boards and when enforcing them. (shrink)

Discerning adaptations from by-products is a defining feature of evolutionary science. Mehr, Krasnow, Bryant, and Hagen posit that music is an adaptation that evolved to function as a credible signal. We counter this claim, as we are not convinced they have dispelled the possibility that music is an elaboration of extant features of language.

Summary This article discusses the intersection of science and culture in the marketplace and explores the ways in which radium quack and medicinal products were packaged and labelled in the early twentieth century US. Although there is an interesting growing body of literature by art historians on package design, historians of science and medicine have paid little to no attention to the ways scientific and medical objects that were turned into commodities were packaged and commercialized. Thinking about packages not as (...) mere containers but as multifunctional tools adds to historical accounts of science as a sociocultural enterprise and reminds us that science has always been part of consumer culture. This paper suggests that far from being receptacles that preserve their content and facilitate their transportation, bottles and boxes that contained radium products functioned as commercial and epistemic devices. It was the 1906 Pure Food and Drug Act that enforced such functions. Packages worked as commercial devices in the sense that they were used to boost sales. In addition, ‘epistemic’ points to the fact that the package is an artefact that ascribes meaning to and shapes its content while at the same time working as a device for distinguishing between patent and orthodox medicines. (shrink)

Kendler and Schaffner have written an exemplary case study of the rise of the dopamine hypothesis and, if not its fall, at least its stagnation and transmutation. They bring out well both the state of the science and the opportunities offered by the theory to consider some famous philosophical theories of scientific progress. So well, in fact, have they done this, that I do not have a lot to say about it. I will just mention one or two points that (...) I found interesting, and then say a little about what looks to me like an omission from the story that the two Kens recount.One point they raise is the importance of competitor theories: now, there is supposed to be an old story about a quack who was apprehended during .. (shrink)

DIVBased on a series of lectures delivered in 1840, Thomas Carlyle’s On Heroes, Hero-Worship, and the Heroic in History considers the creation of heroes and the ways they exert heroic leadership. From the divine and prophetic to the poetic to the religious to the political, Carlyle investigates the mysterious qualities that elevate humans to cultural significance. By situating the text in the context of six essays by distinguished scholars that reevaluate both Carlyle’s work and his ideas, David Sorensen and Brent (...) Kinser argue that Carlyle's concept of heroism stresses the hero’s spiritual dimension. In Carlyle’s engagement with various heroic personalities, he dislodges religiosity from religion, myth from history, and truth from “quackery” as he describes the wondrous ways in which these “flowing light-fountains” unlock the heroic potential of ordinary human beings. /div. (shrink)

Without question, UFOs are part of popular culture; indeed, one might even talk of them as a popular culture. Without question, Roswell is part of the UFO scene; but it is far from the whole thing, nor is it even the central issue. Still less did the Roswell “culture” spawn humankind's preoccupation with possible alien visitors from outer space or the literary genre of science fiction. Yet if this book is to be believed, Roswell has been the center from which (...) these and yet more matters arose: “through the early years, the single event of Roswell, even without a crumb of proof, augmented every image, word, and sound produced by the mass media” . To call this an enormous overstatement would be a large understatement.Little Gray Men is unfortunately full of such sweeping assertions, so broad as to be implausible on their face and yet unsupported by argument or evidence. Toby Smith even defines popular culture as “communication that may be informative but that principally provides pleasure for the participants” , a description that many scholars of culture or communication might find arguable. Some assertions are not only sweeping but puzzling as well—for example, reference to “the Pavlovian nature of popular culture” or a “rhomboidal, zinc‐tinted” television set . Many more examples can be found without venturing beyond the book's introduction.Chapter 1 asserts that Roswell is “a touchstone for our times.” Chapter 2 is about the rocket pioneer Robert Goddard, who does have a connection to Roswell “the Place” but a most tenuous connection to Roswell “the Incident,” which is supposedly the theme of the book. The UFO Encounter gathering at Roswell in 1997 is described in Chapter 3, and the allegation that Roswellian aliens were transported to Wright‐Patterson Air Force Base constitutes Chapter 4. Books about the Incident are mentioned in Chapter 5, films in Chapter 7, science fiction on television in Chapter 8; in between, Chapter 6 is about the science fiction writer Jack Williamson, whose connection to the Incident is less than noteworthy.The book has no formal bibliography or specific notes, though there is a short chapter entitled “Sources.” Thus, when one reads on page 2 “A book came out, in 1980,” there is no quick or easy way to find out what that book is. So Little Gray Men is not a scholarly book. It is in fact a grab bag of trivia connected, not substantively, but only semantically, through the name “Roswell.”As a piece of journalism, one might describe the book as impressionistic, were it not so misleading. No one could gather from Little Gray Men that the popular culture of ufology has a serious side to it, that competent scientists and social scientists have concerned themselves with issues arising from claims about UFOs in general and, in some small part, from claims about the Roswell incident. It is as though one chose to write about the popular culture of cancer by gathering trivia about cranks, quacks, and survivors while saying nothing about mainstream treatments or the underlying scientific knowledge.Ufology has a vast literature, some of it the give‐and‐take of quite disciplined controversy among competent and informed people. That this book has been entirely ignored by ufologists illustrates that it is, in Wolfgang Pauli's phrase, “not even wrong.”. (shrink)

In his classic, The Idea of a University, John Henry Cardinal Newman advanced three arguments for the inclusion of theology in the liberal arts curriculum. These include the very nature of a university in its profession to teach all subjects, the interdisciplinary value of theology, and the danger of academic quackery and usurpation, when a subject matter is not given its due place in the curriculum. The arguments for theology are intimately connected to Newman's high ideal of education, rightly (...) celebrated by educators today. The crisis in contemporary liberal education is reflected in a dispute between Edward O. Wilson and Richard Rorty over the concept of "consilience." Yet there are promising signs of a renewal of liberal education through a deeper appreciation of theology in the course of studies in higher education. (shrink)

It is doubtful that any feature of the American health care system in the last several decades has had as profound an effect on the way Americans pursue their perceived health needs as complementary and alternative medicine. Almost half of all Americans take care of some of their health care needs outside of contemporary scientific medicine. The number of visits to CAM practitioners was estimated 6 years ago to be 629 million a year, with expenditures of $27 billion a year. (...) The use of CAM has been expanding rapidly despite little objective evidence of its safety or effectiveness. Little more than a decade ago CAM was viewed by the traditional medical community as a nuisance that offered unproven treatments at best and as outright quackery at worst. In any case, alternative medicine, as it was known at that time, seemed unworthy of serious attention. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine by Laurence B. McCullough, John Gregory’s Writings on Medical Ethics and Philosophy of Medicine ed. by Laurence B. McCullough, Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush by Lisbeth HaakonssenHeiner F. KlemmeLaurence B. McCullough. John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine. Dordrecht, (...) Boston, London: Kluwer Academic Publishers, 1998. Pp. xv + 347. Cloth, $140.00.Laurence B. McCullough, editor. John Gregory’s Writings on Medical Ethics and Philosophy of Medicine. Dordrecht, Boston, London: Kluwer Academic Publishers, 1998. Pp. xi + 254. Cloth, $105.00.Lisbeth Haakonssen. Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush. Amsterdam, Atlanta: Rodopi, 1997. Pp. x + 247. Paper, $20.50.The Scottish Enlightenment is widely appreciated for its contributions to philosophy, economics, sociology, law, chemistry, and medicine. The ideas and theories advanced by Hume, Smith, Millar, and Ferguson are still widely debated. John Gregory (1724–1773), important in his own time, is not as well known as some of his friends and colleagues. He was professor of medicine at the University of Edinburgh from 1766 to 1773, where he taught introductory lectures on the theory and practice of medicine. A set of extensive student notes from these lectures, entitled Observations on the Duties and Offices of a Physician, appeared anonymously in 1770. Two years later, Gregory himself published a revised version of his lectures under the title Lectures on the Duties and Qualifications of a Physician. These two books are said to mark the beginnings of professional medical ethics in the English-speaking world. They are also sometimes characterized as having anticipated bioethics.McCullough’s comprehensive John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine is the first modern intellectual biography of Gregory. Based on extensive research into eighteenth-century institutional context and the study of hitherto unknown manuscripts, he gives a full account of Gregory’s education at Edinburgh and Leiden, and his practice and teaching of medicine at Aberdeen, London, and Edinburgh. He stresses the importance of Gregory’s membership in the Aberdeen Philosophical Society and his close contact with Mrs. Montagu and her Circle for the understanding of his medical ethics. McCullough also shows that Bacon’s experimental method had a decisive influence on Gregory. Gregory took over Bacon’s three offices or ends of medicine: preservation of health, prolonging of life, and curing of diseases. In 1772, perhaps anticipating his premature death from hereditary gout, he added a fourth office, namely easing the pain of dying. Gregory referred mainly to Bacon (and Reid) in his Lectures to make clear how we can enlarge our medical knowledge by the method of experience and observation, pointing out that the progress of medicine had been seriously retarded by the way in which it was taught since Hippocrates. He also thought it was handicapped by the view that only professionals [End Page 535] should practice it, and claimed that even quacks have their advantages because their interest and reputation seldom suffer from the failure of the experiments necessary for the improvement of the medical profession.Gregory also argued that we should regard medicine not as a trade but as an art. In this context the principle of sympathy (or humanity) became important for him. Sympathy was the basis of the central duties in his Lectures. In a time of extreme instability of manners, when medicine was regarded more as a trade than an art, there was no physician-patient relationship based on the epistemological and moral authority of the physician. According to McCullough, it was Gregory who created “the physician-patient relationship as fiduciary. The virtues of the physician as fiduciary—openness to conviction, tenderness, and steadiness—provided for him the moral causes that would gather physicians together into a group worthy of the name, ‘profession,’ in its intellectual and moral senses” (265). The physician should no longer view his patients as moral strangers.McCullough claims that Gregory’s medical ethics is not just of historical interest, providing bioethics with its own history. It is also of... (shrink)

Based on a series of lectures delivered in 1840, Thomas Carlyle’s_ On Heroes, Hero-Worship, and the Heroic in History_ considers the creation of heroes and the ways they exert heroic leadership. From the divine and prophetic to the poetic to the religious to the political, Carlyle investigates the mysterious qualities that elevate humans to cultural significance. By situating the text in the context of six essays by distinguished scholars that reevaluate both Carlyle’s work and his ideas, David Sorensen and Brent (...) Kinser argue that Carlyle's concept of heroism stresses the hero’s spiritual dimension. In Carlyle’s engagement with various heroic personalities, he dislodges religiosity from religion, myth from history, and truth from “quackery” as he describes the wondrous ways in which these “flowing light-fountains” unlock the heroic potential of ordinary human beings. (shrink)

This essay uses the case of the fin-de-siècle Vienna embryologist Samuel Leopold Schenk to analyze the factors at play in allegations of misconduct. In 1898, Schenk published a book titled Theorie Schenk. Einfluss auf das Geschlechtsverhältnis. The book argued that, by changing their diet, women trying to conceive could influence egg maturation and consequently select the sex of their offspring. This cross between a scientific monograph and a popular advice book received enormous publicity but also spurred first the Vienna Medical (...) Association and then the Senate of the University of Vienna to accuse Schenk of poor science, self-advertisement, quack medical practice, and wrong publisher choice. Formal proceedings against Schenk ended in 1900 with the unusually harsh punishment of early retirement. Schenk died two years later. I examine the elements of the case, from the science of sex determination and selection, to the growth of print media and advertising within the changing demographic and political landscape of Vienna. I argue that the influence of the public, via the growing media, upon science was the main driver of the case against Schenk, but also that the case would have had a more limited impact were it not for the volatile political moment rife with anti-Semitism, nationalism, and xenophobia. I draw the attention to the importance of setting cases of misconduct in the broader political history and against the key social concerns of the moment. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine by Laurence B. McCullough, John Gregory’s Writings on Medical Ethics and Philosophy of Medicine ed. by Laurence B. McCullough, Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush by Lisbeth HaakonssenHeiner F. KlemmeLaurence B. McCullough. John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine. Dordrecht, (...) Boston, London: Kluwer Academic Publishers, 1998. Pp. xv + 347. Cloth, $140.00.Laurence B. McCullough, editor. John Gregory’s Writings on Medical Ethics and Philosophy of Medicine. Dordrecht, Boston, London: Kluwer Academic Publishers, 1998. Pp. xi + 254. Cloth, $105.00.Lisbeth Haakonssen. Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush. Amsterdam, Atlanta: Rodopi, 1997. Pp. x + 247. Paper, $20.50.The Scottish Enlightenment is widely appreciated for its contributions to philosophy, economics, sociology, law, chemistry, and medicine. The ideas and theories advanced by Hume, Smith, Millar, and Ferguson are still widely debated. John Gregory (1724–1773), important in his own time, is not as well known as some of his friends and colleagues. He was professor of medicine at the University of Edinburgh from 1766 to 1773, where he taught introductory lectures on the theory and practice of medicine. A set of extensive student notes from these lectures, entitled Observations on the Duties and Offices of a Physician, appeared anonymously in 1770. Two years later, Gregory himself published a revised version of his lectures under the title Lectures on the Duties and Qualifications of a Physician. These two books are said to mark the beginnings of professional medical ethics in the English-speaking world. They are also sometimes characterized as having anticipated bioethics.McCullough’s comprehensive John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine is the first modern intellectual biography of Gregory. Based on extensive research into eighteenth-century institutional context and the study of hitherto unknown manuscripts, he gives a full account of Gregory’s education at Edinburgh and Leiden, and his practice and teaching of medicine at Aberdeen, London, and Edinburgh. He stresses the importance of Gregory’s membership in the Aberdeen Philosophical Society and his close contact with Mrs. Montagu and her Circle for the understanding of his medical ethics. McCullough also shows that Bacon’s experimental method had a decisive influence on Gregory. Gregory took over Bacon’s three offices or ends of medicine: preservation of health, prolonging of life, and curing of diseases. In 1772, perhaps anticipating his premature death from hereditary gout, he added a fourth office, namely easing the pain of dying. Gregory referred mainly to Bacon (and Reid) in his Lectures to make clear how we can enlarge our medical knowledge by the method of experience and observation, pointing out that the progress of medicine had been seriously retarded by the way in which it was taught since Hippocrates. He also thought it was handicapped by the view that only professionals [End Page 535] should practice it, and claimed that even quacks have their advantages because their interest and reputation seldom suffer from the failure of the experiments necessary for the improvement of the medical profession.Gregory also argued that we should regard medicine not as a trade but as an art. In this context the principle of sympathy (or humanity) became important for him. Sympathy was the basis of the central duties in his Lectures. In a time of extreme instability of manners, when medicine was regarded more as a trade than an art, there was no physician-patient relationship based on the epistemological and moral authority of the physician. According to McCullough, it was Gregory who created “the physician-patient relationship as fiduciary. The virtues of the physician as fiduciary—openness to conviction, tenderness, and steadiness—provided for him the moral causes that would gather physicians together into a group worthy of the name, ‘profession,’ in its intellectual and moral senses” (265). The physician should no longer view his patients as moral strangers.McCullough claims that Gregory’s medical ethics is not just of historical interest, providing bioethics with its own history. It is also of... (shrink)

The discussion about complementary and alternative medicine is sometimes rather heated. “Quackery!” the cry goes. A large proportion “of unconventional practices entail theories that are patently unscientific.” “It is time for the scientific community to stop giving alternative medicine a free ride. There cannot be two kinds of medicine — conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work.” “I submit (...) that if these treatments cannot withstand the test of empirical research, … then we have wasted a lot of time and effort. The time has been wasted on all the people who have spent years learning falsehoods about acupuncture points and the principles of homeopathy. And the patients have wasted their time, money, and efforts receiving treatments that were not what they were represented to be or were harmful.”. (shrink)

At least as important as a particular item of medical knowledge itself is to know something about the relationships of that knowledge to the experiential world it is talking about. The reason is that the patients the physician is concerned with are parts of that experiential world. So, when using any knowledge in her practice, e.g., some knowledge on infectious diseases, a morally conscientious doctor will be interested in whether, and in what way, this knowledge relates to the ‘world out (...) there’. Does the medical knowledge she employs bear any relevance to the bodies and souls of her patients? Does it enable her to understand the patient’s suffering, illness experience, and illness narrative? Will it help her find useful diagnoses and treatments? Are there in fact any indicators of such qualities of medical knowledge? Why not use astrology, Ayurveda, or exorcism instead of the theory of infectious diseases? A prerequisite for dealing with such questions is the awareness of the relationships between medical knowledge and its referent, i.e., of the semantics of medical knowledge, on the one hand; and of the pragmatic factors beyond this semantics, which influence the role medical knowledge plays in health care, on the other, e.g., social and economic processes. In the present chapter, we shall look at these issues with an eye toward understanding why some particular information is allowed to enter the medical world as knowledge, whereas other information is considered unacceptable or quackery. Is there a clear line of demarcation between medical knowledge and self-deception? To begin with, we will discuss the issues of truth and justification because, as pointed out in Section 10.1 on page 402, knowledge is traditionally defined as justified true belief . These two defining features of knowledge, truth and justifiedness, are due to the classical conception of knowledge as the representation of some ‘reality’. This ancient, representational postulate brings with it that the predominant view on the semantics of medical knowledge is realism, i.e., the view that medical knowledge is concerned with and represents ‘the real world out there’. We shall therefore need to inquire into the philosophy and medical relevance of this doctrine before we proceed to alternative views. Our discussion thus divides into the following five parts: 12.1 Justified True Belief; 12.2 Realism; 12.3 Anti-Realism; 12.4 Beyond Realism and Anti-Realism in Medicine; 12.5 Social Epistemology. (shrink)

The discussion about complementary and alternative medicine is sometimes rather heated. “Quackery!” the cry goes. A large proportion “of unconventional practices entail theories that are patently unscientific.” “It is time for the scientific community to stop giving alternative medicine a free ride. There cannot be two kinds of medicine — conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work.” “I submit (...) that if these treatments cannot withstand the test of empirical research, … then we have wasted a lot of time and effort. The time has been wasted on all the people who have spent years learning falsehoods about acupuncture points and the principles of homeopathy. And the patients have wasted their time, money, and efforts receiving treatments that were not what they were represented to be or were harmful.”. (shrink)

It is doubtful that any feature of the American health care system in the last several decades has had as profound an effect on the way Americans pursue their perceived health needs as complementary and alternative medicine. Almost half of all Americans take care of some of their health care needs outside of contemporary scientific medicine. The number of visits to CAM practitioners was estimated 6 years ago to be 629 million a year, with expenditures of $27 billion a year. (...) The use of CAM has been expanding rapidly despite little objective evidence of its safety or effectiveness. Little more than a decade ago CAM was viewed by the traditional medical community as a nuisance that offered unproven treatments at best and as outright quackery at worst. In any case, alternative medicine, as it was known at that time, seemed unworthy of serious attention. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine by Laurence B. McCullough, John Gregory’s Writings on Medical Ethics and Philosophy of Medicine ed. by Laurence B. McCullough, Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush by Lisbeth HaakonssenHeiner F. KlemmeLaurence B. McCullough. John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine. Dordrecht, (...) Boston, London: Kluwer Academic Publishers, 1998. Pp. xv + 347. Cloth, $140.00.Laurence B. McCullough, editor. John Gregory’s Writings on Medical Ethics and Philosophy of Medicine. Dordrecht, Boston, London: Kluwer Academic Publishers, 1998. Pp. xi + 254. Cloth, $105.00.Lisbeth Haakonssen. Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush. Amsterdam, Atlanta: Rodopi, 1997. Pp. x + 247. Paper, $20.50.The Scottish Enlightenment is widely appreciated for its contributions to philosophy, economics, sociology, law, chemistry, and medicine. The ideas and theories advanced by Hume, Smith, Millar, and Ferguson are still widely debated. John Gregory (1724–1773), important in his own time, is not as well known as some of his friends and colleagues. He was professor of medicine at the University of Edinburgh from 1766 to 1773, where he taught introductory lectures on the theory and practice of medicine. A set of extensive student notes from these lectures, entitled Observations on the Duties and Offices of a Physician, appeared anonymously in 1770. Two years later, Gregory himself published a revised version of his lectures under the title Lectures on the Duties and Qualifications of a Physician. These two books are said to mark the beginnings of professional medical ethics in the English-speaking world. They are also sometimes characterized as having anticipated bioethics.McCullough’s comprehensive John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine is the first modern intellectual biography of Gregory. Based on extensive research into eighteenth-century institutional context and the study of hitherto unknown manuscripts, he gives a full account of Gregory’s education at Edinburgh and Leiden, and his practice and teaching of medicine at Aberdeen, London, and Edinburgh. He stresses the importance of Gregory’s membership in the Aberdeen Philosophical Society and his close contact with Mrs. Montagu and her Circle for the understanding of his medical ethics. McCullough also shows that Bacon’s experimental method had a decisive influence on Gregory. Gregory took over Bacon’s three offices or ends of medicine: preservation of health, prolonging of life, and curing of diseases. In 1772, perhaps anticipating his premature death from hereditary gout, he added a fourth office, namely easing the pain of dying. Gregory referred mainly to Bacon (and Reid) in his Lectures to make clear how we can enlarge our medical knowledge by the method of experience and observation, pointing out that the progress of medicine had been seriously retarded by the way in which it was taught since Hippocrates. He also thought it was handicapped by the view that only professionals [End Page 535] should practice it, and claimed that even quacks have their advantages because their interest and reputation seldom suffer from the failure of the experiments necessary for the improvement of the medical profession.Gregory also argued that we should regard medicine not as a trade but as an art. In this context the principle of sympathy (or humanity) became important for him. Sympathy was the basis of the central duties in his Lectures. In a time of extreme instability of manners, when medicine was regarded more as a trade than an art, there was no physician-patient relationship based on the epistemological and moral authority of the physician. According to McCullough, it was Gregory who created “the physician-patient relationship as fiduciary. The virtues of the physician as fiduciary—openness to conviction, tenderness, and steadiness—provided for him the moral causes that would gather physicians together into a group worthy of the name, ‘profession,’ in its intellectual and moral senses” (265). The physician should no longer view his patients as moral strangers.McCullough claims that Gregory’s medical ethics is not just of historical interest, providing bioethics with its own history. It is also of... (shrink)

In A Dentist and a Gentleman the sociologist Tracey Adams retells a familiar professionalization story, this time about elite dental practitioners in nineteenth‐century Ontario who launched a status‐enhancement project to reshape their self‐ and public image into “professional gentlemen” and establish monopoly control over dental practice. Dentists secured legislation in 1868 giving them authority to set entrance requirements, test and license practitioners, and establish a college. In subsequent decades they campaigned against those they called “quacks” who practiced without a (...) license, advertised, charged low fees, maintained dirty offices, misled patients about pain, or brought the gentlemanly status of dentistry into disrepute.Despite early resistance, the project had mostly succeeded by 1918, as dentists skillfully linked their expertise to emerging public health concerns and a professional image subtly reoriented toward an ideal of public service. By 1900 dental rhetoric was warning Canadians of an impending crisis of tooth decay and dental disease that would bring physical deterioration and mass feeblemindedness in its wake. Racial degeneracy, dentists warned, began in the mouth; the advance of civilization produced too much soft food and sugar, too little chewing, and too many high‐strung and overindulgent mothers. Only dentists, as “sentinels at the portal of the alimentary tract” , could stand against this threat to Anglo‐Saxon civilization. Rhetoric like this, combined with doses of guilt heaped on mothers, teachers, school boards, and public health agencies, resulted by 1915 in regular dental inspections of schoolchildren, free dental clinics, and the creation of the army dental corps.Dentistry brought unique twists to this familiar professionalization story. Prior to 1860 dentistry was an especially low‐status craft, associated with uneducated, itinerant tooth‐drawers or craftsmen like blacksmiths and gunsmiths . Professionalizing dentists therefore felt a special imperative to recast themselves as “gentlemen”; this image also reassured the upper‐middle‐class women who were dentists' main clientele. Unexpectedly, as Adams shows in an intriguing analysis, dentists benefited from an invaluable social alliance with physicians, who offered no opposition of the sort they raised against other rival groups of healers to dentists' professional aspirations.The study deals extensively with how gender shapes professions. Dentistry's professionalization, Adams insists, involved the adoption of a new ideal of personal masculinity, as seen in admonitions to dentists to establish firm, courteous, expert authority over their clients and in dentists' efforts to shape the imagined persona of the ideal dental assistant as uniquely female and wifelike. This masculine crafting of the profession notwithstanding, Ontario dentists evinced less overt opposition to women aspirants than did doctors or lawyers. Nevertheless, the proportion of female practitioners was much lower in dentistry than in medicine or law and remains substantially lower today. Adams brings considerable insight to her discussion of these facts and their causes, and she presents useful comparisons among the professions.This study has a few limitations. Perhaps because the author's sources are mainly professional journals, her account mostly mirrors the outlook of the professionalizing elite and her prose occasionally adopts their moralizing and improving tone. Regrettably, the book deals scarcely at all with what dentists actually did. One learns little about how changing scientific and medical ideas affected dentists' work, how dentists utilized anaesthesia and coped with the problem of pain, and what controversies over diagnostics and treatment animated the profession or about dentists' training and income. This is a history of dentistry's professionalization, not of dental medicine per se. But Isis readers impressed by this solid and modest study will hope that a history of dental practice will be Tracey Adams's next project. (shrink)