Objective: To identify problem solving strategies in general practice. Basic procedures: Three styles of scientific reasoning were defined and modelled on the medical environment. These models were tested in a simulated doctor-patient encounter.

This book describes how one can use The Scientific Method to solve everyday problems including medical ailments, health issues, money management, traveling, shopping, cooking, household chores, etc. It illustrates how to exploit the information collected from our five senses, how to solve problems when no information is available for the present problem situation, how to increase our chances of success by redefining a problem, and how to extrapolate our capabilities by seeing a relationship among heretofore unrelated concepts.One (...) should formulate a hypothesis as early as possible in order to have a sense of direction regarding which path to follow. Occasionally, by making wild conjectures, creative solutions can transpire. However, hypotheses need to be well-tested. Through this way, The Scientific Method can help readers solve problems in both familiar and unfamiliar situations. Containing real-life examples of how various problems are solved — for instance, how some observant patients cure their own illnesses when medical experts have failed — this book will train readers to observe what others may have missed and conceive what others may not have contemplated. With practice, they will be able to solve more problems than they could previously imagine.In this second edition, the authors have added some more theories which they hope can help in solving everyday problems. At the same time, they have updated the book by including quite a few examples which they think are interesting. (shrink)

Parkinson's disease patients receiving dopaminergic treatment may experience bursts of creativity. Although this phenomenon is sometimes recognized among patients and their clinicians, the association between dopamine replacement therapy in PD patients and creativity remains underexplored. It is unclear, for instance, whether DRT affects creativity through convergent or divergent thinking, idea generation, or a general lack of inhibition. It is also unclear whether DRT only augments pre-existing creative attributes or generates creativity de novo. Here, we tested a group of PD patients (...) when “on” and “off” dopaminergic treatment on a series of tests of creative problem-solving, and related their performance to a group of matched healthy controls as well as to their pre-PD creative skills and measures of inhibition/impulsivity. Results did not provide strong evidence that DRT improved creative thinking in PD patients. Rather, PD patients “on” medication showed less flexibility in divergent thinking, generated fewer ideas via insight, and showed worse performance in convergent thinking overall than healthy controls. Pre-PD creative skills predicted enhanced flexibility and fluency in divergent thinking when PD patients were “on” medication. However, results on convergent thinking were mixed. Finally, PD patients who exhibited deficits in a measure of inhibitory control showed weaker convergent thinking while “on” medication, supporting previous evidence on the importance of inhibitory control in creative problem-solving. Altogether, results do not support the hypothesis that DRT promotes creative thinking in PD. We speculate that bursts of artistic production in PD are perhaps conflated with creativity due to lay conceptions of creativity. (shrink)

This essay provides a medical theory that could clarify enigmas surrounding the historical Socrates. It offers textual evidence that Socrates had temporal lobe epilepsy and that its two types of seizure manifested as recurrent voices and peculiar behaviour, both of which were notorious hallmarks of Socrates. Common and immediate criticisms against the methodology of retrospective diagnosis are addressed first. Next, the diagnostic reasoning is presented in detail. The possibility of temporal lobe personality in Socrates is also considered. The important (...) implication of this theory is that one of the charges against Socrates, introducing new divinities, was a now well-known neurologic symptom. (shrink)

The first main purpose of this paper is to identify and to distinguish between a number of problems and conflicts of interest in the area where medical personal registers are used in research, particularly when the registers are computerized. The second main purpose is to suggest and comment upon a method for solving or minimizing such conflicts of interest.

In this response to Neil Manson’s latest intervention in our debate about the best consent model for biobank research we show, contra Manson that the ‘expiry problem’ that affects broad consent models because of changes over time in methods, purposes, types of data used and governance structures is a real and significant problem. We further show that our preferred implementation of meta consent as a national consent platform solves this problem and is not subject to the cost (...) and burden objections that Manson raises. (shrink)

A globe-spanning investigation into the Transhumanist movement, considering the tech billionaires, scientific luminaries, and DIY body-hackers attempting to prolong, improve, and ultimately transcend the limits of human life.

This article presents an analysis of contractual relations in sport from the standpoint of the Croatian legislative system. Due to the complexity of the subject matter, the author considers only a small fragment of it - the significance and the role of sport in Croatian society and the law of contracts „as a cornerstone on which „sports law“ has been built and which is of primary importance in most areas where there is an interface between sport and the law, irrespective (...) of whether the sport is being played at an elite level or at a more humble one“. Bearing in mind the limited extent of this article, the autor tries to provide some clarifications and some guidance on how to deal with the designation and the determination of the applicable law for contracts in the sporting context. Considering that there are different legal regimes which may come into play with regard to the designation of the law applicable to contracts in the sporting context, the author first presents the determination of the applicable law according to the Rome I Regulation and then according to the Croatian Arbitration Act, Swiss Private International Law Act and the CAS Code of Sports-related Arbitration, as the most common in sports practice. Then, the author deals with contracts concluded with minor athletes and the determination of the law applicable to some preliminary questions. Finally, the author presents her perception of the problems encountered and some suggestions for the improvement of the existing legal framework. (shrink)

The legal doctrine of informed consent has overwhelmingly failed to assure that the medical treatment patients get is the treatment patients want. This Article describes and defends an ongoing shift toward shared decision making processes incorporating the use of certified patient decision aids.

In this article, we use the principlist approach to identify, analyse and attempt to solve the ethical problem raised by a pregnant woman's request for cesarean delivery in absence of medical indications.We use two different types of premises: factual (facts about cesarean delivery and specifically attitudes of obstetricians as derived from the EUROBS European study) and value premises (principles of beneficence and non-maleficence, respect for autonomy and justice).Beneficence/non-maleficence entails physicians' responsibility to minimise harms and maximise benefits. Avoiding its (...) inherent risks makes a prima facie case against cesarean section without medical indication. However, as vaginal delivery can have unintended consequences, there is a need to balance the somewhat dissimilar risks and benefits. The principle of autonomy poses a challenge in case of disagreement between the pregnant woman and the physician. Improved communication aimed to enable better informed choice may overcome some instances of disagreement. The principle of justice prohibits unfair discrimination, and broadly favours optimising resource utilisation.Available evidence supports vaginal birth in uncomplicated term pregnancies as the standard of care. The principlist approach offered a useful framework for ethical analysis of cesarean delivery on maternal request, identified the rights and duties of those involved, and helped reach a conclusion, although conflict at the individual level may remain challenging. (shrink)

Preimplantation genetic diagnosis (PIGD) goes some way to meeting the clinical, psychological and ethical problems of antenatal testing. We should guard, however, against the assumption that PIGD is the answer to all our problems. It also presents some new problems and leaves some old problems untouched. This paper will provide an overview of how PIGD meets some of the old problems but will concentrate on two new challenges for ethics (and, indeed, law). First we look at whether we should always (...) suppose that it is wrong for a clinician to implant a genetically abnormal zygote. The second concern is particularly important in the UK. The Human Fertilisation and Embryology Act (1990) gives clinicians a statutory obligation to consider the interests of the future children they help to create using in vitro fertilisation (IVF) techniques. Does this mean that because PIGD is based on IVF techniques the balance of power for determining the best interests of the future child shifts from the mother to the clinician? (shrink)

This book challenges the World Medical Associationâ (TM)s (WMA) International Code of Ethics statement in 2004, which declared that â ~medical ethics in armed conflict is identical to medical ethics in times of peaceâ (TM). This is achieved by examining the professional, ethical, and legal conflicts in British Military healthcare practice that occur in three distinct military environments. These are (i) the battlefield, (ii) the operational environment and (iii) the non-operational environment. As this conflict is exacerbated by (...) the need to achieve Operational Effectiveness, this book also explores the dual loyalty conflict that Military Health Care Professionals (MHCPs) encounter between following military orders and professional codes of practice. The method used to challenge the WMAâ (TM)s statement and explore these conflicts is the use of real-life problem-solving vignettes, which mirror actual ethical and professional conflicts and dilemmas that may occur in the three environments. The areas of law analysed similarly reflect the difficulties that MHCPs face when caring for the sick and wounded in violent locations when under attack. In particular, the book questions whether it is right for a MHCP to owe their patients a duty of care in hostile environments. This leads on to questioning if any MHCP could be protected by combat immunity where no duty of care is owed to fellow soldiers in the battlefield. The book also questions whether the standard of care should be variable in hostile environments. It also explores the dual loyalty conflict of a wounded senior officer refusing treatment from a junior officer. In addition, it examines the difficulties of a doctor maintaining patient confidentiality when a soldier refuses treatment for a psychological injury but wishes to redeploy to the battlefield. The book successfully challenges the WMAâ (TM)s statement. It also concludes by suggesting that neither a military-focused approach nor a professional healthcare-focused approach towards military healthcare is the best way to solve the dual loyalty conflict. (shrink)

The evidence-based medicine movement advocates basing all medical decisions on certain types of quantitative research data and has stimulated protracted controversy and debate since its inception. Evidence-based medicine presupposes an inaccurate and deficient view of medical knowledge. Michael Polanyi’s theory of tacit knowledge both explains this deficiency and suggests remedies for it. Polanyi shows how all explicit human knowledge depends on a wealth of tacit knowledge which accrues from experience and is essential for problem solving. Edmund (...) Pellegrino’s classic treatment of clinical judgment is examined, and a Polanyian critique of this position demonstrates that tacit knowledge is necessary for understanding how clinical judgment and medical decisions involve persons. An adequate medical epistemology requires much more qualitative research relevant to the clinical encounter and medical decision making than is currently being done. This research is necessary for preventing an uncritical application of evidence-based medicine by health care managers that erodes good clinical practice. Polanyi’s epistemology shows the need for this work and provides the structural core for building an adequate and robust medical epistemology that moves beyond evidence-based medicine. (shrink)

Is medicalization always harmful? When does medicine overstep its proper boundaries? The aim of this article is to outline the pragmatic criteria for distinguishing between medicalization and over-medicalization. The consequences of considering a phenomenon to be a medical problem may take radically different forms depending on whether the problem in question is correctly or incorrectly perceived as a medical issue. Neither indiscriminate acceptance of medicalization of subsequent areas of human existence, nor criticizing new medicalization cases just (...) because they are medicalization can be justified. The article: (i) identifies various consequences of both well-founded medicalization and over-medicalization; (ii) demonstrates that the issue of defining appropriate limits of medicine cannot be solved by creating an optimum model of health; (iii) proposes four guiding questions to help distinguish medicalization from over-medicalization. The article should foster a normative analysis of the phenomenon of medicalization and contribute to the bioethical reflection on the boundaries of medicine. (shrink)

Contemporary medical education must train skilled and compassionate health care professionals who are rigorous in their approach to patient care and their pursuit of knowledge and solutions. Problem-based learning has been widely introduced, but there is no evidence that it leads to better outcomes than more traditional programs, and fundamental gaps in conceptual knowledge may result. Recently, emphasis has been placed on a solid grounding in underlying concepts combined with a systems-based approach, and ability to transfer information and (...) solve problems. Integrating traditional scientific and clinical disciplines with progressive and continuous assessment, may be a better means of achieving the combined aims of clinically relevant curriculum design, vertical integration of medical knowledge, and facilitation of the continuum of training. Being adaptable and flexible, cognisant of costs, and driven by evidence are key features of delivering medical education and contemporary medical practice. Educational research should lead to continuous improvement, but innovation without evaluation and attention to costs may create as many, or more, problems as are solved. (shrink)

The current model of technology assessment treats ethics itself as just another problem‐solving technology. Ethics should resist this model to play a more critical role in technology assessment by better understanding the complex relationship between society, medicine, and technology—and by recasting how problems are defined.

The current model of technology assessment treats ethics itself as just another problem‐solving technology. Ethics should resist this model to play a more critical role in technology assessment by better understanding the complex relationship between society, medicine, and technology—and by recasting how problems are defined.

In lieu of an abstract, here is a brief excerpt of the content:Solving the Jigsaw PuzzlePeggy CadetIn my medical record, there is an enigmatic note. It was written as a consultation request from a pediatric endocrinologist to a plastic surgeon while I was hospitalized at age 13 (in the late 1960s) for mastectomy. The note reads:You have seen this unfortunate teenager with the feminizing testis [older name for androgen insensitivity] syndrome on several occasions in the past in reference (...) to the construction of a penis. Would appreciate your seeing him again to evaluate the problem. He is firmly fixed in the male gender role despite efforts on the part of his father to persuade him of the logic of a change.The surgeon’s response (also in my notes) was:The prospect of creating an acceptable penis in this patient seems to me very remote. There is nothing there except an enlarged clitoris. This could be mobilized and might project a few cm but cannot be made into a male organ of normal dimensions. The hair distribution and the perineum is also feminine which compounds the reconstruction problem.Since the decision has been made to go along with the male gender I suppose that mobilization of the penis–clitoris is reasonable. Urethral reconstruction will be possible only much later....I saw this note for the first time at age 21 but didn’t think it was particularly significant until many years later. At the time I had other, much more pressing concerns, as I had reached the conclusion by then that I had been mis–assigned as a boy and that the only way for me to have a reasonable and happy life would be for me to change to living as a girl. It was not a surprise that my doctors had been completely on the wrong track about my “gender”. I was also not about to bring this up with the endocrinologist, a person who had terrified me as a child and whom I still found a bit intimidating.I do remember the surgeon stopping by and examining me briefly without explaining who he was or why he was there. I had a somewhat longer, but equally uninformative (for me) visit from a child psychiatrist. The note requesting a consultation from the psychiatrist reads:Would you see while he is here recovering from his mastectomy? Since he began to show mammary growth 18 months ago his father has put him under considerable pressure to undergo another change in gender role. has resisted but he is quite depressed. We would appreciate any suggestions you may have.I actually have no recollection at all of anything like pressure from my father to change to living as a girl. What I actually experienced was more like 180 degrees away from that—the expectation that I should try to be more masculine. As I remember, my father was bothered by my having breasts and was the one who initiated the physician contacts that led to mastectomy. (My mother had died when I was five, leaving him to rear me as a single parent.)As my father recollected to me many years later, he had asked the pediatric endocrinologist to explain all of my treatment options and alternatives to me. I can only guess, but possibly the pediatric endocrinologist interpreted this as my father wanting me to change to living as a girl. As a young [End Page E1] adult, I got the impression that this particular doctor tended to mistake asking for information about possible treatments for requesting treatment. The idea of a patient gathering information and making informed decisions may not have figured prominently in his thinking. On the office visit when I was 21 and first mentioned to him that I might want to live as a girl, he told me that gender identity was “an unshakable conviction,” so perhaps his idea was that gender was just not something a person could make an ordinary decision about, weighing the pros and cons.My father knew—but at age 13 I didn’t—that the original decision for me to grow up as a boy had been made in a somewhat haphazard way. I had entered... (shrink)

This paper presents a preliminary analysis of homeopathy from the perspective of the demarcation problem in the philosophy of science. In this context, Popper, Kuhn and Feyerabend’s solution to the problem will be given respectively and their criteria will be applied to homeopathy, aiming to shed some light on the controversy over its scientific status. It then examines homeopathy under the lens of demarcation criteria to conclude that homeopathy is regarded as science by Feyerabend and is considered as (...) pseudoscience by Popper and Kuhn. By offering adequate tools for the analysis of the foundations, structure and implications of homeopathy, demarcation issue can help to clarify this medical controversy. The main argument of this article is that a final decision on homeopathy, whose scientific status changes depending on the criteria of the philosophers mentioned, cannot be given. (shrink)

In medical diagnostic examination three main stages may be distinguished: (a) initial exploration, (b) hypothesis-directed investigation, and (c) final diagnosis making. The purpose of this work is to study some methodological problems concerning the second of the above stages of the diagnosis and to prepare a background for a mathematical model [30] of this process.In diagnostic problem solving, the reasoning proceeds along the main lines traced by some initial suggestions and passes through various intermediate elements which are (...) connected with one another forming ramifying chains and nets of inferences and hypotheses. Such a complex mental construction is based on laws which form medical knowledge and reflect various regularities and relations, causal, structural, functional, and others. (shrink)

BACKGROUND AND RATIONALE: Evidence based medicine is the present backbone of rational and objective, modern medical problem solving and is a meeting ground for quantitative and qualitative researchers alike as it culminates into applying the fruits of clinical research to the individual patient. A systematic enquiry into the evolving paradigms in EBM is a need of the hour. AIMS AND METHODS: A qualitative enquiry examining the impact of different methodologies in EBM and their role in generating meaning (...) interpretable at individual levels. RESULTS: Present day outcome based research deals less with patients as individuals than as populations. Evidence based medicine struggles to apply the fruits of population based research to individuals who are often not as predictable as linear quantitative research would like them to be. The present EBM literature neglects a lot of events it doesn't believe to be statistically significant and perhaps here is an area that needs to be improved on - it assumes that because associations are demonstrated between interventions and outcomes in RCTs/meta-analysis, these associations are linear and causal in the real world. While they may be demonstrated repeatedly in highly controlled environments, in the real 'uncontrolled' world of clinical practice with real people, their validity breaks down. CONCLUSIONS: One needs to make the EBM standard model patient-individual (a projection of collective patient event data) resemble the real human individual patient so that optimal EBM individual data that matches our query can be easily and quickly spotted from the dense jungle of information that has grown over the years. This hints at rethinking our entire research methodology and modifying it to suit the needs of the individual patient. (shrink)

In the present paper some formal aspects of the hypothesis-directed stage of medical diagnosis are studied and an algorithm of the diagnostic problem solving process is described. A given field of medical knowledge is represented by a pair of graphs. The sentences describing observed symptoms and signs constitute the data on which the algorithm is based. In the first step, the set of true judgments is determined and the hypotheses which are impossible in a given situation (...) are rejected. In consequence the model of knowledge is modified and working hypotheses are chosen. Further steps consist in selection of hypotheses in view of testing. The set of expected symptoms is determined and these are classified according to their diagnostic value. The process ends when the conditions of arriving at a useful solution of a given problem are fulfilled. The description of the algorithm is based on a clinical example. The model aims at reflecting some of the most important structural features of the diagnosis and does not embrace the probability evaluation problems. (shrink)

Time travel is a solved problem. Einstein showed that if you travel in a spaceship for months at speeds close to the speed of light, you can return to earth centuries in the future.

ABSTRACT The paper gives an analytical synopsis of the problem of developing medical ethics in the early half of the 1990s in China, as perceived by Chinese scholars and medical professionals interested in medical ethics. The views captured and analyzed here were expressed in one of the two major journals on medical ethics in China: Chinese Medical Ethics. The economic reform unleashed profound changes in Chinese society, including in the medical field, creating irregularities (...) and improprieties in the profession. Furthermore, the market reform also created new values that were in tension with existing values. In this transitional period, Chinese medical ethicists saw the need to rebuild medical morality for the new era. Using the code of conduct promulgated by the Chinese Ministry of Health in 1989 as a basis, assessment and e ducation aspects of the institutionalization of medical ethics are dis‐ cussed. In addition to institutional problems of institutionalising ethics, there are philosophical and methodological issues that are not easy to solve. After all, to institutionalize medical ethics is no easy task for a country as old and as big as China. Chinese medical ethicists seem ready to confront these difficulties in their effort to develop medical ethics in Reform China. (shrink)

ABSTRACTThe paper gives an analytical synopsis of the problem of developing medical ethics in the early half of the 1990s in China, as perceived by Chinese scholars and medical professionals interested in medical ethics. The views captured and analyzed here were expressed in one of the two major journals on medical ethics in China: Chinese Medical Ethics. The economic reform unleashed profound changes in Chinese society, including in the medical field, creating irregularities and (...) improprieties in the profession. Furthermore, the market reform also created new values that were in tension with existing values. In this transitional period, Chinese medical ethicists saw the need to rebuild medical morality for the new era. Using the code of conduct promulgated by the Chinese Ministry of Health in 1989 as a basis, assessment and e ducation aspects of the institutionalization of medical ethics are dis‐ cussed. In addition to institutional problems of institutionalising ethics, there are philosophical and methodological issues that are not easy to solve. After all, to institutionalize medical ethics is no easy task for a country as old and as big as China. Chinese medical ethicists seem ready to confront these difficulties in their effort to develop medical ethics in Reform China. (shrink)

This book provides a detailed insight into the amalgamation of the healthcare and hospitality sector, which brought forward the concept of healthcare tourism or medical tourism. There have not been comprehensive resources in this particular area. The available quality resources focus on the Western world. Countries like India are an upcoming and one of the most favored destinations for medical tourism, and this trend is going to increase exponentially in the coming years. This book is developed in a (...) very simple and lucid manner to enable even a layman to grasp the key components of the healthcare and hospitality sector at different levels and gradually link it to the present scenario where factors like accreditation, health insurance, corporatization, and public policy make an impact. Scholars in these sectors attempt to provide the recent trends and prospects supported with updated information. Therefore, it can solve the problem of a single source of detailed information relevant to different yet interconnected industries with a focus on developing countries. (shrink)

Definition of the problemThe upcoming reforms according to the specifications of the Master Plan 2020 provide for a competency-oriented restructuring of medical studies. This article aims to develop perspectives on how teaching ethics in medical studies can be more strongly oriented at building competencies. In this way, it pursues the goal of making the concept of competency more tangible for medical ethics and usable for the design of medical ethics education.ArgumentsWe understand competencies as dispositions for actions (...) that enable problem solving. By transferring the concept of moral intelligence to the moral actions of physicians in patient care, we specify five ethical–moral competencies that must be present for morally appropriate, ethically reflected actions by future physicians: (1) the ability to form a professional moral compass, (2) the willingness to align oneself with professional ethical norms and values, (3) the ability to perceive moral dimensions of medical action, (4) the ability to make moral judgments based on ethical considerations about the right action, and (5) the willingness to realize ethically justified action. We illustrate their importance for teaching medical ethics using the example of teaching clinical ethics in medical studies.ConclusionOur conceptualization of moral–ethical competencies can be used to design concrete courses in a competency-oriented way. Our approach could be applied analogously to other areas of teaching ethics in health care. (shrink)

As reproductive freedoms in the U.S. undergo significant rollbacks, vital reproductive health services — and the care teams delivering them — face escalating legal threats and complexity. This qualitative case-control community-based participatory research study describes how legal problem-solving supports for reproductive care teams serving mothers with opioid use disorder are protective for both patients and care team members. We describe how medical legal partnerships (MLPs) can promote Reproductive Justice and argue for wider adoption of care-team facing legal (...) supports. (shrink)

Genetic discrimination is becoming an increasingly important problem in the United States. Information acquired from genetic tests has been used by insurance companies to reject applications for insurance policies and to refuse payment for the treatment of illnesses. Numerous states and the United States Congress have passed or are considering passage of laws that would forbid such use of genetic information by health insurance companies. Here we argue that much of this legislation is severely flawed because of the difficulty (...) in distinguishing genetic from nongenetic tests. In addition, barring the use by insurance companies of a genetic test but not a nongenetic test (conceivably for the same multifactorial disease) raises issues of fairness in health insurance. These arguments suggest that ultimately the problems arising from genetic discrimination cannot be solved by narrowly focused legislation but only by a modification of the entire health care system. (shrink)

In the course of daily life we solve problems often enough that there is a special term to characterize the activity and the right to expect a scientific theory to explain its dynamics. The classical view in psychology is that to solve a problem a subject must frame it by creating an internal representation of the problem’s structure, usually called a problem space. This space is an internally generable representation that is mathematically identical to a graph structure (...) with nodes and links. The nodes can be annotated with useful information, and the whole representation can be distributed over internal and external structures such as symbolic notations on paper or diagrams. If the representation is distributed across internal and external structures the subject must be able to keep track of activity in the distributed structure. Problem solving proceeds as the subject works from an initial state in mentally supported space, actively constructing possible solution paths, evaluating them and heuristically choosing the best. Control of this exploratory process is not well understood, as it is not always systematic, but various heuristic search algorithms have been proposed and some experimental support has been provided for them. (shrink)

This book addresses the moral, social and political problems emerging from the practice of healing and caring, biomedical research and the provision of health care services. The primary aim of many professional bioethicists is, of late, to solve as efficiently as possible, the problems encountered by health care providers and scientists in clinical, laboratory and administrative settings. Seen from the viewpoint of applied philosophy, however, this is a dangerous tendency if the grounds for the suggested solutions are not properly examined. (...) Even choices which are harmless and seem to involve no immoralities can be indirectly hazardous if those making choices appeal to dubious ethical principles or inaccurate data. This is why this book is dedicated to the examination of the reasons that people can and should have for their health care related decisions as well as to the formulation of good solutions to difficult problems. It covers criterial in life and death decisions, voluntary euthanasia and medical paternalism, wrongful medical authoritarianism, health education, preventive medicine and the welfare of the population, AIDS, discrimination and legal restrictions, and health care policy-making. (shrink)

Genetic discrimination is becoming an increasingly important problem in the United States. Information acquired from genetic tests has been used by insurance companies to reject applications for insurance policies and to refuse payment for the treatment of illnesses. Numerous states and the United States Congress have passed or are considering passage of laws that would forbid such use of genetic information by health insurance companies. Here we argue that much of this legislation is severely flawed because of the difficulty (...) in distinguishing genetic from nongenetic tests. In addition, barring the use by insurance companies of a genetic test but not a nongenetic test (conceivably for the same multifactorial disease) raises issues of fairness in health insurance. These arguments suggest that ultimately the problems arising from genetic discrimination cannot be solved by narrowly focused legislation but only by a modification of the entire health care system. (shrink)

The debate about medical futility is no longer in its infancy. Scholarly literature on this seemingly intractable problem is voluminous. The list of widely publicized cases in which physicians have wanted to discontinue life-sustaining medical treatment that families demand has grown to include not just Helga Wanglie, but also Baby Rena, Baby L, Jane Doe, Joseph Finelli, Baby K, and Teresa Hamilton. A futility case has now been decided at the appellate court level.Commentators have generated three kinds (...) of proposals for resolving these conflicts. One group contends that the problem can be solved within the physician-patient-family relationship. While some in this group view professional authority broadly enough to warrant unilateral judgments by physicians that interventions desired by the patient or family should not be provided, others contend that physician authority does not extend that far, and that any resolution must be constrained by informed consent requirements. (shrink)

The debate about medical futility is no longer in its infancy. Scholarly literature on this seemingly intractable problem is voluminous. The list of widely publicized cases in which physicians have wanted to discontinue life-sustaining medical treatment that families demand has grown to include not just Helga Wanglie, but also Baby Rena, Baby L, Jane Doe, Joseph Finelli, Baby K, and Teresa Hamilton. A futility case has now been decided at the appellate court level.Commentators have generated three kinds (...) of proposals for resolving these conflicts. One group contends that the problem can be solved within the physician-patient-family relationship. While some in this group view professional authority broadly enough to warrant unilateral judgments by physicians that interventions desired by the patient or family should not be provided, others contend that physician authority does not extend that far, and that any resolution must be constrained by informed consent requirements. (shrink)

When Flexner wrote about medical education at the beginning of the 20th century, he articulated and amplified the emerging view that medical education and the practice of medicine should be grounded in scientific method and that medical education belonged in the province of the university, an environment dedicated to original scholarship and investigation (Cooke et al. 2006; Flexner 1910; Ludmerer 2010). To learn to treat medical uncertainty the way a scientist frames hypotheses, medical students, he (...) argued, required participatory, hands-on experience, as well as a focus on the development of independent problem-solving and critical-thinking skills. The intimate linkage between research (which moves the frontier .. (shrink)

In 1973, Rittel and Webber coined the term ‘wicked problems’, which they viewed as pervasive in the context of social and policy planning.1 Wicked problems have 10 defining characteristics: they are not amenable to definitive formulation; it is not obvious when they have been solved; solutions are not true or false, but good or bad; there is no immediate, or ultimate, test of a solution; every implemented solution is consequential, it leaves traces that cannot be undone; there are no criteria (...) to prove that all potential solutions have been identified and considered; every wicked problem is essentially unique; every wicked problem can be considered to be a symptom of another problem; a wicked problem can be explained in numerous ways and the choice of explanation determines what will count as a solution and the actors are liable for the consequences of the actions they generate.1 One needs only a passing familiarity with the history of HIV prevention research, and with the intellectual traditions of research ethics, to appreciate that the perils and opportunities arising from proposals to conduct research with people who inject drugs in some of the most precarious social and political circumstances around the world and the challenges associated with implementing the findings satisfy Rittel's and Webber's criteria for ‘wicked problems’. HIV prevention research has contributed important new knowledge about the feasibility, efficacy or relative efficacy of various prevention strategies in a variety of contexts around the world. But the pathways and timelines for how this knowledge has contributed to improvements in public health practice and/or the establishment of policies that ensure unfettered access to appropriate healthcare services for PWID are less clear and decidedly non-linear. One account of the transition from trial to policy …. (shrink)

In 1973, Rittel and Webber coined the term ‘wicked problems’, which they viewed as pervasive in the context of social and policy planning. 1 Wicked problems have 10 defining characteristics: they are not amenable to definitive formulation; it is not obvious when they have been solved; solutions are not true or false, but good or bad; there is no immediate, or ultimate, test of a solution; every implemented solution is consequential, it leaves traces that cannot be undone; there are no (...) criteria to prove that all potential solutions have been identified and considered; every wicked problem is essentially unique; every wicked problem can be considered to be a symptom of another problem; a wicked problem can be explained in numerous ways and the choice of explanation determines what will count as a solution and the actors are liable... (shrink)

Complex problem solving (CPS) emerged in the last 30 years in Europe as a new part of the psychology of thinking and problem solving. This paper introduces into the field and provides a personal view. Also, related concepts like macrocognition or operative intelligence will be explained in this context. Two examples for the assessment of CPS, Tailorshop and MicroDYN, are presented to illustrate the concept by means of their measurement devices. Also, the relation of complex cognition (...) and emotion in the CPS context is discussed. The question if CPS requires complex cognition is answered with a tentative “yes.”. (shrink)

Medicine interacts with the social, legal and political elements of life. For example, UK homelessness leads to a reduction in life-expectancy of around 30 years.1 This issue is a daily reality for practicising clinicians. In research and research ethics, vulnerable groups, including the socially vulnerable, are frequently excluded from research. While there are good reasons for this, it can mean exclusion from benefits as well as from risks. In our feature article this month, Dawson et al make a compelling and (...) nuanced case — and a practical proposal — for designing research protocols for HIV prevention measures that allow for the inclusion of people who inject drugs without compromising their safety from a legal and social perspective as well as a medical one. Along the way, they reference some of the public health damage caused by legal and social policy. To take one example: ‘if police beatings were eliminated in Odessa, Ukraine, HIV incidence among PWID would decrease up to 19% over a 5 year period’.2 For those of us in the university sector, measuring ‘impact’ has become a major, and sometimes controversial, way that our output is judged. This paper highlights the real-world importance of research impact as well as the kinds of difficulties researchers face. A series of commentaries probe the practical proposal put forward in the paper by Dawson et al. Lavery applies Rittel and Webber’s concept of ‘wicked problems’ to the dilemmas facing researchers in this context: > Wicked problems have 10 defining characteristics: they are not amenable to definitive formulation; it is not obvious when they have been solved; solutions are not true or false, but good or bad; there is no immediate, or ultimate, test of a solution; every implemented solution is consequential, it leaves traces that cannot be undone; there …. (shrink)

“Wicked” problems are characterized by intractable complexity, uncertainty, and conflict between individuals or institutions, and they inhabit almost every corner of medical ethics. Despite wide acceptance of the same ethical principles, we nevertheless disagree about how to formulate such problems, how to solve them, what would _count_ as solving them, or even what the possible solutions _are_. That is, we don’t always know how best to implement ethical ideals in messy real-world contexts. I sketch an implementation framework for (...) medical ethics that can help clarify wicked problems and organize further ethics research toward their resolutions. This framework describes the procedural variables that work alongside substantive ethical ideals to deliver ethical decisions in complex real-world situations. Using controversial GM mosquito research as an example, I illustrate how the generalizable relationships between the variables clarify emerging ethical guidelines of research governance and provide a pathway to extend these guidelines in a way consistent with our ethical intuitions across a wide range of research and public health ethics. (shrink)

The popularity of surgical modifications of race-typical features among Asian women has generated debates on the ethical implications of the practice. Focusing on blepharoplasty as a representative racial surgery, this article frames the ethical discussion by viewing Asian cosmetic surgery as an example of medicalization, which can be interpreted in two forms: treatment versus enhancement. In the treatment form, medicalization occurs by considering cosmetic surgery as remedy for pathologized Asian features; the pathologization usually occurs in reference to western features as (...) the norm. In the enhancement form, medicalization occurs by using medical means to improve physical features to achieve a certain type of beauty or physical appearance. Each type of medicalization raises slightly different ethical concerns. The problem with treatment medicalization lies in the pathologization of Asian features, which is oppressive as it continues to reinforce racial norms of appearance and negative stereotypes. Enhancement medicalization is ethically problematic because cosmetic surgery tends to conflate beauty and health as medical goals of surgery, overemphasizing the value of appearance that can further displace women’s control over their own bodies. I conclude that in both forms of medicalization, cosmetic surgery seems to narrowly frame a complex psychosocial issue involving physical appearance as a matter that can be simply solved through surgical means. (shrink)

The main theses of the papers by Dr Illich and Dr Leach are compared. Both writers, says Mr Horobin, a sociologist by training and profession, discuss the uses and abuses of medical expertise in the modern world. In his view, the problems so created must be solved for the good of those they treat; doctors must rediscover the old skills of treating the whole patient.

A study is reported which focused on the problem-solving strategies employed by expert electronics engineers pursuing a real-world task: integrated-circuit design. Verbal protocol data were analysed so as to reveal aspects of the organisation and sequencing of ongoing design activity. These analyses indicated that the designers were implementing a highly systematic solution-development strategy which deviated only a small degree from a normatively optimal top-down and breadth-first method. Although some of the observed deviation could be described as opportunistic in (...) nature, much of it reflected the rapid depth-first exploration of tentative solution ideas. We argue that switches from a predominantly breadth-first mode of problem solving to depth-first or opportunistic modes may be an important aspect of the expert's strategic knowledge about how to conduct the design process effectively when faced with difficulties, uncertainties, and design impasses. (shrink)

Computer-simulated scenarios have been part of psychological research on problem solving for more than 40 years. The shift in emphasis from simple toy problems to complex, more real-life oriented problems has been accompanied by discussions about the best ways to assess the process of solving complex problems. Psychometric issues such as reliable assessments and addressing correlations with other instruments have been in the foreground of these discussions and have left the content validity of complex problem (...) class='Hi'>solving in the background. In this paper, we return the focus to content issues and address the important features that define complex problems. (shrink)