女性主义对现代医学的政治批判二题

以两本西方女性主义代表性著作中的观点为例,简要地讨论了女性主义学者们对于西方当代医学的政治批判,来自女性主义这样一个新兴的学术领域中的这种不同的声音,对于人们思考未来医学的发展方式,将具有可能的借鉴作用。     

Solidarity in Perinatal Medicine

In this paper it is argued that questions in perinatal medicine concerning treatment or non-treatment of severely handicapped children, after or before birth, cannot be answered solely by referring to the general aims and objectives of medical treatment and its specific deontology. Justifications of decisions about treatment and non-treatment need to be placed in a broader context of discussions about social justice and the social significance of medical practice as a whole.     

宫腔镜对不典型滋养细胞肿瘤辅助诊断的哲学观

滋养细胞肿瘤恶性程度高,破坏力极强,但是对化疗高度敏感,所以早期诊断和及时化疗是治疗成功的关键。本文初步探讨了宫腔镜作为一种对不典型滋养细胞肿瘤的辅助检查手段,有助于早期明确诊断,提示我们在运用宫腔镜的过程中应该遵循个体化原则,在循证医学的指导下,充分体现对病患的人文关怀。     

三叉神经痛药物治疗的循证医学分析

原发性三叉神经痛是一种严重的颌面部神经疼痛,其病因未明,目前的主要治疗措施是通过各种药物进行控制,但很多药物存在副作用、长期使用疗效降低等问题。本文应用循证医学思想,通过检索和评价国内外文献,综合高质量的临床研究结论,为三叉神经痛的药物治疗提供循证医学证据。     

亚低温在重型颅脑损伤患者救治中的应用与思考

重型颅脑损伤是致死、致残的主要原因之一。亚低温（MHT）的应用为重型颅脑损伤患者的救治提供了新的思路和方法,国内外多个临床试验证实了其在救治中的有效性和实用性。本文结合国内外相关诊疗指南、循证医学证据和文献,辩证探讨了MHT在重型颅脑损伤患者救治中的适应证及机制、操作方法及时间窗、并发症及临床决策问题。     

活血化瘀药物和抗肿瘤血管生成治疗——中西医对肿瘤血管生成治疗认识的分歧与统一

从“饿死肿瘤细胞”的理论出发,产生了血管抑制剂;瘀血证见于肿瘤患者,活血化瘀方法常用于中医肿瘤的临床治疗;可是活血化瘀治疗可以疏通血液循环,这和抑制肿瘤血管生成、减少血供相矛盾。血管正常化的理论使中西医在抗肿瘤血管治疗上达成一致,这为活血化瘀中药更好应用于肿瘤临床治疗,提供了理论基础。     

循证医学与实事求是

循证医学主张“慎重、准确和明智地应用当前所能获得的最好的研究依据;结合临床医生的个人专业技能和多年临床经验;考虑患者的价值和愿望,将三者完美地结合制定出患者的治疗措施。”贯穿着临床医学对患者进行“以人为本”科学救死扶伤的实事求是理念。要使“循证医学”卓有成效,应当抓住二大关键：实事求是,维护“证据”的真实性,提高医术的可靠性。     

The epistemically virtuous clinician

Today, modern Western medicine is facing a quality-of-care crisis that is undermining the patient–physician relationship. In this paper, a notion of the epistemically virtuous clinician is proposed in terms of both the reliabilist and responsibilist versions of virtue epistemology, in order to help address this crisis. To that end, a clinical case study from the literature is first reconstructed. The reliabilist intellectual virtues, including the perceptual and conceptual virtues, are then discussed and applied to the case study. Next, a similar method is employed to examine the responsibilist intellectual virtues, including curiosity, courage, honesty, and humility, and to apply them to the case study. To round out the discussion, the love of knowledge and both theoretical and practical wisdom are explored and applied to the case study. The paper concludes with a brief discussion of how the notion of an epistemically virtuous clinician addresses the quality-of-care crisis, in terms of the connection between ethical and intellectual virtues, and of the notion’s implications for medical education.

Clinical intuition versus statistics: different modes of tacit knowledge in clinical epidemiology and evidence-based medicine

Despite its phenomenal success since its inception in the early nineteen-nineties, the evidence-based medicine movement has not succeeded in shaking off an epistemological critique derived from the experiential or tacit dimensions of clinical reasoning about particular individuals. This critique claims that the evidence-based medicine model does not take account of tacit knowing as developed by the philosopher Michael Polanyi. However, the epistemology of evidence-based medicine is premised on the elimination of the tacit dimension from clinical judgment. This is demonstrated through analyzing the dichotomy between clinical and statistical intuition in evidence-based medicine’s epistemology of clinical reasoning. I argue that clinical epidemiology presents a more nuanced epistemological model for the application of statistical epidemiology to the clinical context. Polanyi’s theory of tacit knowing is compatible with the model of clinical reasoning associated with clinical epidemiology, but not evidence-based medicine.

Quackademia? Mass-Media Delegitimation of Homeopathy Education

In response to concerns about the standards of training for non-medically qualified homeopathic practitioners, between 1999 and 2009 a number of UK universities taught Bachelor of Science (BSc) degrees in homeopathy. All the courses were subsequently closed following media coverage of a vigorous campaign from scientists against the degree courses. A boundary-work analysis of 65 articles published in the UK print media reveals the use of metaphors from a number of different fields as rhetorical strategies to malign homeopathy education. As well as the commonly used contrasts of profit versus academic integrity, rationality versus faith and logic versus magic, media reports associated homeopathy with new universities and Mickey Mouse degrees, both of which had been denigrated in the press previously. In the press coverage, much attention was also drawn to the fact that the method of repeatedly diluting homeopathic medicines defies both logic and common sense, and the plausibility argument became a decisive blow in the debate over the legitimacy of teaching homeopathy as a science degree. It seems that the boundary work sought to protect the authority of both science and medicine by expelling homeopathy from higher education. These findings contrast with previous studies that suggest that orthodox medicine has occasionally expanded to incorporate desirable aspects of complementary and alternative therapies. Scientists carry out boundary work not just to demarcate the boundaries of science and directly defend their own interests, but also to protect the authority of other allied professions.