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Switankowsky I 《Theoretical medicine and bioethics》2000,21(6):567-580
Cartesian dualism has been viewed by medical theorists to be oneof the chief causes of a reductionist/mechanistic treatment ofthe patient. Although I aver that Cartesian dualism is one culprit for the misapprehension of the genuine treatment of patients in termsof both mind and body, I argue that interactive dualism whichstresses the interaction of mind and body is essential to treatpatients with dignity and compassion. Thus, adequate medical carethat is humanistic in nature is difficult (if not impossible)to achieve without physicians adhering to a dualistic frameworkin which the body and person is treated during illness. 相似文献
25.
A review of the debate on the Empirically Supported Treatment Program is presented. It is argued that underlying the specifics of the debate are fundamentally incompatible paradigms: a meaning vs. a medical model. The findings from two gold standard multi-site studies are reviewed to conclude that the control condition meets requirements for an empirically supported treatment. The empirical finding of the failure of clinical training to improve treatment outcomes is explained by the focus on rational factors in training. It is recommended that training of therapists focus on enhancing experiential capacity rather than mastery of manualized treatment approaches. 相似文献
26.
This article portrays a model of family therapy clinical supervision using change theory that is most appropriate for use with the videotape, audiotape, case presentation and debriefing from the live session. The most powerful tool during this process is that of communication and assessment of change theorys tools of confidence and conviction. The concepts presented are meant to add an additional dimension to family therapy supervision in cooperation of other theories, not as an end in themselves.Special thanks to Ms. Geri Koncilja of the Informational Technology Center at Colorado State University, Pueblo for illustration and graphic assistance. 相似文献
27.
Jones TC 《Science and engineering ethics》2005,11(4):575-587
The history of drug/vaccine development has included major advances guided primarily by risk/benefit analyses concerning the
innovative agent, not by evidence-based clinical trials (Phase I–IV). Because the approval for new drugs is hindered under
the present process, the system requires restructuring.
The Phase I/II study period should be more flexible, using the “environment of knowledge” about the new agent, plus risk/benefit
assessments. Phase III, as presently constructed, does not add new adverse events data, it provides a narrower profile of
drug efficacy than properly done Phase II studies, and placebo-controlled trials continue to raise unresolved ethical and
social issues. Phase III studies should be abandoned for most drugs, and substituted with properly powered Phase II doseranging
studies plus careful post-marketing surveillance. Phase III should be a penalty for poor drug development, not a regulatory
requirement.
To accomplish efficient drug development, greater cooperation between pharmaceutical companies and governments in developing
clinical trials is needed rather than over-regulation. These changes will synchronize the drug development and regulatory
process with the current rapid drug discovery process, reduce drug development time and cost, and improve patient care.
The author is Adjunct Professor of Medicine, Weill Medical College of Cornell University, New York, New York, USA. 相似文献
28.
Marshall MF 《Science and engineering ethics》2004,10(1):37-42
This paper gives an overview of the placebo effect in popular culture, especially as it pertains to the work of authors Patrick
O’Brian and Sinclair Lewis. The beloved physician as placebo, and the clinician scientist as villain are themes that respectively
inform the novels, The Hundred Days and Arrowsmith. Excerpts from the novels, and from film show how the placebo effect, and the randomized clinical trial, have emerged into
popular culture, and evolved over time.
An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research
Today,” held in Warsaw, Poland on 12–13 April, 2003. 相似文献
29.
The concept of informed consent was one of the most fruitful ideas that deeply changed the relationships between physicians
and their patients from paternalism to respect for the personal autonomy of subjects needing professional medical care. The
great progress in medicine, also involving the pharmaceutical industry, has created an increasing need to perform different
clinical and experimental trials. The evolution of clinical research in the last decades has influenced strongly the design
of these studies. One of the most important changes in this field has been the use of placebo groups in double-blind controlled
studies. The controversies have involved not only the use of placebo when standard or proven treatment was available, but
also some specific problems concerning the procedure of obtaining informed consent in such trials. This paper briefly presents
the evolution of informed consent in Poland as well as different ethical and legal problems concerning informed consent and
the use of placebo controls in clinical trials.
An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research
Today,” held in Warsaw, Poland on 12–13 April, 2003. 相似文献
30.
Walter N. Stone 《Group》2001,25(3):225-232
The author focuses on the application of Hopper's proposal of an additional basic assumption (I:A/M) using a model of clinicians' theories: bridging theory, psychological theory, and clinical theory (Michels, 1999). This paper will describe the potential for advances in understanding particular group formations seen in clinical practice and other settings. 相似文献