小儿肾脏替代疗法发展方向的思考

慢性肾功能衰竭目前主要依靠透析或肾移植替代疗法来延长生命,但二者并未彻底解决问题并且代价昂贵.体外干细胞研究的兴起,为解决慢性肾功能衰竭的治疗带来了一丝曙光,但获得成功恐怕还需要一个相当长的时间.只有契合了整体辩证统一原则的再生医学,通过在肾脏原位重建生理环境,激发机体本身潜能,使肾脏修复到自然的完美状态,才能实现与人体生命一体化的有机结合,才是小儿肾脏替代疗法中有光明前景的发展方向.     

现代移植医学与再生医学的差异和互补

人体克隆技术的医学应用,产生了现代移植医学和再生医学两种不同医学模式.二者的医学思路、医疗学术技术、投入产出比、医疗和社会经济效益以及伦理法律等都有显著差异,优劣长短各异而有很强的互补性.     

The specificity triad: notions of disease and therapeutic specificity in biomedical reasoning

Biomedicine is typically defined as the branch of medicine that is based on the principles of biology and biochemistry. A central tenet for biomedicine is the notion of disease and therapeutic specificity, i.e. the idea of tailored treatments for discrete disorders underpinned by specific pathologies. The present paper is concerned with how notions of disease and therapeutic specificity guide biomedical reasoning. To that end, the author proposes a model – the specificity triad – that draws on late philosopher and physician Ludwik Fleck’s concept of “style of thought” to offer a frame for investigating the intricate process through which links between disorders, mechanisms, and therapeutics are established by biomedicine. Next by applying the specificity triad model to scrutinize research efforts in two discrete areas of medicine—psychiatry and regenerative medicine—this paper seeks to stimulate pertinent discussions in and about biomedicine. These include discussions on the ambiguous epistemic status of psychiatry within contemporary biomedicine, as well as the relationship between developmental biology — historically relatively disjointed from biomedical enterprise — and the burgeoning field of regenerative medicine.     

Standards,Harmonization and Cultural Differences: Examining the Implementation of a European Stem Cell Clinical Trial

ABSTRACT

A complex set of European regulations aims to facilitate regenerative medicine, harmonizing good clinical and manufacturing standards and streamlining ethical approval procedures. The sociology of standardization has elaborated some of the effects of regulation but little is known about how such implementation works in practice across institutions and countries in regenerative medicine. The effects of transnational harmonization of clinical trial conduct are complex. A long-term ethnographic study alongside a multinational clinical trial finds a range of obstacles. Harmonization standardizes at one level, but implementing the standards brings to the fore new layers of difference between countries. Europe-wide harmonization of regulations currently disadvantages low-cost clinician-lead research in comparison to industry-sponsored clinical trials. Moreover, harmonized standards must be aligned with the cultural variations in everyday practice across European countries. Each clinical team must find its own way of bridging harmonized compulsory practice with how things are done where they are, respecting expectations from both patients and the local hospital ethics committee. Established ways of working must further be adapted to a range of institutional and cultural conventions that affect the clinical trial such as insurance practices and understandings of patient autonomy. An additional finding is that the specific practical roles of team members in the trial affect their evaluation of the importance of these challenges. Our findings lead to conclusions of wider significance for the sociology of standards concerning how regulation works and for medical sociology about how trial funding and research directions in stem cell medicine intersect.     

Social and Gendered Readings of Illness Narratives

This essay recognizes that the interactions that define medical care are problematic and that narrative is invoked to overcome these strains. Being grounded in science, medicine, too, might be influenced by a particular world-view that arose in the natural philosophy of the Scientific Revolution. If narrative responds to this sort of medicine, it may retain traces of this mindset. A feminist approach responds to this viewpoint and may used beneficially to analyze both the story of medicine and the stories within medicine. Tensions discussed from this perspective are those between sickness and health and those between patient and provider; also questioned are suitable form(s) of narrative and whose narratives are valued. Suggestions for broadening narrative to address these issues include letting the body speak for itself, overcoming the power differential in the patient/provider interaction and using standpoints to foster a more equal and just medical system.     

Science and the Art of Healing: A Contribution to the History of Life Science

In conventional medicine, healing is effected mainly by treating the symptoms of the physical body disease, while in mind–body medicine the cure is performed by the mind itself (thoughts and emotions). In fact, the holographic mind theory claims that the mind could be either the healer or the slayer. Thus, this article is a contribution toward a more in-depth study of this theme of conventional medicine versus mind–body medicine, particularly to understand the gifts of quantum physics to life science and the art of healing, so that we might find an integrative medicine model (a holistic approach to health) that could explain some “incurable” diseases.     

Pa/enser bien le corps: Cognitive and Curative Language in Montaigne’s <Emphasis Type="Italic">Essais</Emphasis>

Montaigne’s writings on medicine and the body have always been seen as part of a larger project about knowing ourselves. Responding to medical developments that seemed to privilege the anatomical body over the mind or the emotions, Montaigne defended the humoral link between mind and body. His essays make use of word play, puns, and anecdotes based on his own experience and reports from antiquity to counter what he perceived to be an increasingly one-sided approach to medicine. The result is a witty but nuanced argument for a more balanced outlook to what is now known as psychosomatic medicine.     

American Medicine as Religious Practice: Care of the Sick as a Sacred Obligation and the Unholy Descent into Secularization

Modern medicine serves a religious function for modern Americans as a conduit through which science can be applied directly to the human body. The first half of this paper will focus on the theoretical foundations for viewing medicine as a religious practice arguing that just as a hierarchical structured authoritarian church historically mediated access to God, contemporary Western medicine provides a conduit by which the universalizable truths of science can be applied to the human being thereby functioning as a new established religion. I will then illustrate the many parallels between medicine and religion through an analysis of rituals and symbols surrounding and embedded within the modern practice of medicine. This analysis will pay special attention to the primacy placed on secret interior knowledge of the human body. I will end by responding to the hope for a “secularization of American medicine,” exploring some of the negative consequences of secularization, and arguing that, rather than seeking to secularize, American medicine should strive to use its religious features to offer hope and healing to the sick, in keeping with its historically religious legacy.     

现代医学存在自身缺陷的依据、原因、现象及其后果

目的 探讨现代医学理论体系存在的自身缺陷、根本原因和现象以及由此而产生的后果。方法 明确指出现代医学的理论主体就是实验医学,指出现代医学理论体系所存在的自身缺陷是由于过于依赖实验医学的研究方法而造成的,通过对世界医学发展史上医学与哲学之间关系上的变化进行深入分析,全面阐述了现代医学在对人体研究上的片面性和不完整性,指出现代医学理论之所以存在自身缺陷的根本原因就是没有科学地认识实验医学和经验医学各自的优点并加以合理地利用,列举了现代医学理论存在自身缺陷在基础与临床方面的具体现象及其后果。结论 现代医学理论体系存在着难以自我完善的自身缺陷,并使其发展举步维艰。     

The Maternal–Foetal Interface and Gestational Chimerism: The Emerging Importance of Chimeric Bodies

The science of gestational cell transfer—research into the transfer of cells between a pregnant woman and foetus during gestation—and subsequent mingling of transferred cells, or microchimerism, is bringing new attention to the maternal/foetal interface. These findings challenge previous biological understandings of a barrier between the body of a pregnant woman and developing foetus, a barrier maintaining the identity integrity as it were, of two beings, two separate subjects. In this sense, the maternal–foetal interface is an interesting bio-political object, predicated upon understandings of individuals as discrete and bounded organisms, an understanding that has been strongly implicated in immunology, as Donna Haraway, Emily Martin and others have argued. Findings of cellular transfer across this interface raise questions about intermingling and permeability of human organism boundaries. However, these findings are important not only for insight into gestational biology, but because they are emerging in a broader biomedical context of the development of cellular therapies and regenerative medicine. These therapeutic strategies call attention to chimerism as a naturally occurring and iatrogenic biological state, highlighting the permeability and permissiveness of bodies to the intermingling of cells, an idea that runs counter to biological, political and social understandings of selves as individuated, discrete and purely self. A theoretical framework of immuno-politics raises implications of trouble at the maternal/foetal interface, and suggests that chimeric, permeable bodies are of increasing value as cellular therapeutic strategies gain in importance for human health.     

Reckoning with the last enemy

Developing the ethics of palliative sedation, particularly in contrast to terminal sedation, requires consideration of the relation between body and soul and of the nature of death and dying. Christianly considered, it also requires attention to the human vocation to immortality and hence to the relation between medicine (as aid for the body) and discipline (as aid to the soul). Leaning on Augustine’s rendering of the latter, this paper provides a larger anthropological and soteriological frame of reference for the ethics of palliative sedation, organized by way of nine briefly expounded theses. It argues that palliative sedation, like other elements of medicine, is appropriate where, and only where, it properly orders care for the body to the requirements of care for the soul.     

从灾难医学的发展看生命的生态文化性——关于医学的“人学”本质的追问

围绕近年来备受瞩目的灾难医学的快速发展,从哲学、文化学的角度出发,就灾难医学的诞生与发展,以及其未来的发展趋势进行了概括和展望;在此基础上,就医学的本质给予理性的反思与论证,提出医学的本质乃“人学”的观点;并就“人学”的三个层次分别给予了阐释,得出医学中“人的知识”不仅是躯体的,而且是复杂的、文化的,医学应回归对生命的终极关怀的文化追求的结论。     

Via Kundalini: Psychosomatic excursions in transpersonal psychology

Abstract

A model of psychosomatic mysticism (PM) is proposed that reintroduces the body into transpersonal psychology. The argument for PM develops links between transpersonal psychology and neuroimmunology and includes scientific notions of the mind as embodied not just in the brain but more widely throughout the body, as well as the comparative analyses of perspectives on the body in various spiritual traditions. PM is used to examine how transpersonal psychology can integrate the body, thus meeting the goals of the clinician, the standards of the researcher, and the emerging needs of psychosomatic medicine. The core principles of PM are explicated, such as: 1) decentralized consciousness, 2) structural phenomenological correlations between the psyche and the body, 3) in‐depth understanding of energy as intentionality, and 4) the possibility of actualizing cosmic awareness in the individual psyche. Examples of the clinical use of psychospiritual practices of PM show practical applications of these principles. It is concluded that the studies of the embodied consciousness and subtle energies through PM can help to develop both transpersonal theory and applications.     

The ‘Medical Body’ As Philosophy's Arena

Medicine, as Byron Good argues, reconstitutes thehuman body of our daily experience as a medical body,unfamiliar outside medicine. This reconstitution can be seen intwo ways: (i) as a salutary reminder of the extent to which thereality even of the human body is constructed; and (ii) as anarena for what Stephen Toulmin distinguishes as theintersection of natural science and history, in which many ofphilosophy's traditional (and traditionally abstract) questionsare given concrete and urgent form.This paper begins by examining a number of dualities between themedical body and the body familiar in daily experience. Toulmin's epistemological analysis of clinical medicine ascombining both universal and existential knowledge is thenconsidered. Their expression, in terms of attention,respectively, to natural science and to personal history, isexplored through the epistemological contrasts between themedical body and the familiar body, noting the traditionalphilosophical questions which they in turn illustrate.     

Phenomenology and its application in medicine

Phenomenology is a useful methodology for describing and ordering experience. As such, phenomenology can be specifically applied to the first person experience of illness in order to illuminate this experience and enable health care providers to enhance their understanding of it. However, this approach has been underutilized in the philosophy of medicine as well as in medical training and practice. This paper demonstrates the usefulness of phenomenology to clinical medicine. In order to describe the experience of illness, we need a phenomenological approach that gives the body a central role and acknowledges the primacy of perception. I present such a phenomenological method and show how it could usefully illuminate the experience of illness through a set of concepts taken from Merleau-Ponty. His distinction between the biological body and the body as lived, analysis of the habitual body, and the notions of motor intentionality and intentional arc are used to capture the experience of illness. I then discuss the applications this approach could have in medicine. These include narrowing the gap between objective assessments of well-being in illness and subjective experiences which are varied and diverse; developing a more attuned dialogue between physicians and patients based on a thick understanding of illness; developing research methods that are informed by phenomenology and thus go beyond existing qualitative methods; and providing medical staff with a concrete understanding of the impact of illness on the life-world of patients.     

A Black Theological Response to Race-Based Medicine: Reconciliation in Minority Communities

The harm race-based medicine inflicts on minority bodies through race-based experimentation and the false solutions a race-based drug ensues within minority communities provokes concern. Such areas analyze the minority patient in a physical proxy. Though the mind and body are important entities, we cannot forget about the spirit. Healing is not just a physical practice; it includes spiritual practice. Efficient medicine includes the holistic elements of the mind, body, and spirit. Therefore, the spiritual discipline of black theology can be used as a tool to mend the harms of race-based medicine. It can be an avenue of research to further particular concerns for justice in medical care . Such theology contributes to the discussion of race-based medicine indicating the need for the voice, participation, and interdependence of minorities. Black theology can be used as a tool of healing and empowerment for health equity and awareness by exploring black theology’s response to race-based medicine, analyzing race in biblical literature, using biblical literature as a tool for minority patient empowerment, building on past and current black church health advocacy with personal leadership in health advocacy.

     

The relevance of Heidegger’s philosophy of technology for biomedical ethics

Heidegger’s thoughts on modern technology have received much attention in many disciplines and fields, but, with a few exceptions, the influence has been sparse in biomedical ethics. The reason for this might be that Heidegger’s position has been misinterpreted as being generally hostile towards modern science and technology, and the fact that Heidegger himself never subjected medical technologies to scrutiny but was concerned rather with industrial technology and information technology. In this paper, Heidegger’s philosophy of modern technology is introduced and then brought to bear on medical technology. Its main relevance for biomedical ethics is found to be that the field needs to focus upon epistemological and ontological questions in the philosophy of medicine related to the structure and goal of medical practice. Heidegger’s philosophy can help us to see how the scientific attitude in medicine must always be balanced by and integrated into a phenomenological way of understanding the life-world concerns of patients. The difference between the scientific and the phenomenological method in medicine is articulated by Heidegger as two different ways of studying the human body: as biological organism and as lived body. Medicine needs to acknowledge the priority of the lived body in addressing health as a way of being-in-the-world and not as the absence of disease only. A critical development of Heidegger’s position can provide us with a criterion for distinguishing the uses of medical technologies that are compatible with such an endeavor from the technological projects that are not.     

Medicine and the Cartesian image of man

The contemporary philosophy of medicine may be characterized as a continuous struggle with the Cartesian heritage, in order to reach a more satisfying image of man. This paper outlines the influence of Cartesian dualism on the foundations of medicine. The notion of a real distinction between the mental and physical, particularly the mechanistic conception of the human body, made possible the development of the natural sciences as well as scientific medicine, not hampered any longer by the risk of colliding with religion or Church. The Cartesian machine model of man immediately appealed to seventeenth century physicians: Dutch Cartesians (Regius, Craanen) and followers of the iatrophysical school (Santorio, Borelli). Dichotomizing between mind and body, subject and object, self and world, self and other, knower and knowledge is constitutive for modern medicine conceiving itself as a natural science.     

Ontology and ethics in the foundation of medicine and the relevance of Levinas' view

The search for an ontological basis of medical practice is questioned from the viewpoint that ontologies are always related to the interpreting person in his situation, and that the definition of medicine includes a certain choice. This choice-character comes into greater play when ethical proposals are made. A foundation of medical ethics on an ontology of the healthy body or the factual medical practice is a naturalistic fallacy. Prior to an ontological basis, the ethical event of responsibility for the suffering and transcendent other (Levinas) is constitutive for medicine. This event with its dimension of infinity of the other can only be ontologized by a totalitarian act. A philosophy of medicine should start with the ‘heteronomy’ of the other.