Philosophy of medicine — From a medical perspective

In this commentary on the article by Arthur L. Caplan [1] the philosophy of medicine is viewed from a medical perspective. Philosophical studies have a long tradition in medicine, especially during periods of paradigmatic unrest, and they serve the same goal as other medical activities: the prevention and treatment of disease. The medical profession needs the help of professional philosophers in much the same way as it needs the cooperation of basic scientists. Philosophy of medicine may not deserve the status of a philosophical subspecialty or field, but it so closely linked to the main trends of contemporary medical thinking that it must be regarded as an emerging (or reemerging) medical subdiscipline.     

THE DEVELOPMENT OF CORRECT TOOTHBRUSHING TECHNIQUE IN PRESCHOOL CHILDREN

This study examined the effects of an intensive training program on the toothbrushing skills of three preschool children, using both performance measures and outcome (plaque level) indicators. Toothbrushing was broken into 16 steps that involved actual manipulation of the brush in the mouth. Correct brushing included four criteria: (a) appropriate angle of bristles, (b) appropriate motion of brush, (c) appropriate tooth surface, and (d) minimum duration of brushing. Training included instructions, a three-phase modeling procedure, physical guidance, and reinforcement. Results of a multiple baseline design across subjects showed that the children completed an average of 8.6% of the steps prior to training, as compared with an average of 95.8% of the steps following training. Plaque levels decreased from an average of 58% during baseline to 24.6% after training. Follow-up measures revealed that 86.6% of the steps were maintained. The study demonstrated that the effectiveness of the procedures in teaching very young children a complex motor skill that is essential to their future health.     

试论医学的社会意识

医学的社会意识是一个重要的理论概念,研究医学的社会意识的内涵和作用有重要的理论与实践的意义。同时,强化卫生决策者,医务人员和社会公众的医学社会意识,对于医学的正确发展和卫生事业的进步也同样是重要的。     

21世纪的中西医结合

自本世纪６０年代以来,中西医结合取得了重要进展,中西医结合的经验与成果已经引起国内外重视。２１世纪,在“中西医并重”的方针指引下,将会迎来更好的发展机遇。兼客、互补与结合创新是主要的三种结合形式,其中结合创新占有更重要的地位。我们应增强创新意识,选好创新目标,改善临床与研究工作条件,为取得更快的发展而努力。     

Nosology and Causal Necessity; The Relation BetweenDefining a Disease and Discovering its Necessary Cause

The problem of disease definition is related to theproblem of proving that a certain agent is thenecessary cause of a certain disease. Natural kindterms like rheumatoid arthritis and AIDS refer toessences which are discoverable rather thanpredeterminate. No statement about such diseases isa priori necessarily true. Because theories onnecessary causes involve natural kind semantics,Koch's postulates cannot be used to falsify or verifysuch theories. Instead of proving that agent A is thenecessary cause of disease D, we include A in atheoretical definition of D, take this to representthe real meaning of D, and discard thepretheoretical definition. This is illustrated byKoch's own attempt to prove he had discovered thenecessary cause of tuberculosis. Methodologicalarguments about disease causation require a clear viewof our use of diagnostic terms. Medical lexicographersshould do more to provide such a view.     

The Limits of Medical Practice

Theoretical Medicine and Bioethics - Should medicine be defined as the enterprise in charge of the health problems of society? If so, then any problem (individual, public, social or political) that...     

Increasing accuracy and decreasing latency during clean intermittent self-catheterization procedures with young children.

We examined the effects of simulation training on performance of clean intermittent self-catheterization procedures with 2 young girls. Simulation training was conducted, after which independent performance was assessed within a multiple baseline design. The training resulted in increased accuracy and decreased latency for both girls.     

BEHAVIORAL MANAGEMENT OF EXERCISE: CONTRACTING FOR AEROBIC POINTS

Behavioral contracting was used to encourage physical exercise among college students in a multiple-baseline design. Subjects deposited items of personal value with the experimenters, which they could earn back on fulfillment of two types of contract contingencies. Subjects selected weekly aerobic point criteria, which they could fulfill by exercising in the presence of other subjects. In addition, subjects contracted to observe and record the exercise of other subjects and to perform an independent reliability observation once each week, with both of these activities monitored by the experimenters. Results indicated that the contract contingencies produced increases in the number of aerobic points earned per week for seven of eight subjects, that the aerobic point system possesses several advantages as a dependent variable for behavioral research on exercise, and that inexperienced observers could be quickly trained to observe exercise behavior and to translate those observations into their aerobic point equivalents. Finally, in a followup questionnaire completed 12 months after the end of the study, seven of the eight subjects reported that they were earning more aerobic points per week than had been the case during the baseline condition of this experiment.     

BEHAVIORAL CONTROL OF MEDICINE COMPLIANCE

This study examined the effectiveness of several behavioral techniques on compliance of college students taking vitamin C on q.i.d. regimen. Compliance was assessed by a new technique using a variation of the urine tracer procedure designed specifically for this study. Subjects were provided vitamin C tablets, with three tablets per week containing phenazopyridine, a drug that produces a bright red-orange urine discoloration. Subjects were requested to indicate when urine discolorations occurred, and compliance was assessed by comparing the time of their report to the time predicted on the basis of the scheduled sequence of vitamin C and phenazopyridine tablets. Baseline compliance was assessed for 72 subjects over a three-week period, with the 40 most noncompliant subjects randomly assigned to four groups for Treatment I. The groups were: self-monitoring, taste, taste and self-monitoring, and a no-treatment control group. The self-monitoring procedure involved recording the time medicine was taken; the taste procedure involved providing the subjects with flavored tablets to increase the saliency of tablet taking; and the self-monitoring and taste procedure involved providing subjects with flavored tablets and asking them to record the flavor of each tablet they ingested. At the end of six weeks, half the subjects in each of these groups participated in response-cost procedures while the remaining subjects continued with their previous procedures. Response-cost procedures were implemented by returning a portion of the subjects' deposit only if a preset compliance criterion was met. Treatment II procedures were implemented for an additional three weeks. Results indicated the self-monitoring and taste plus self-monitoring procedures were superior during Treatment I. The implementation of response cost during Treatment II was associated with a marked improvement in compliance, independent of the history of noncompliance. The effects of the taste plus self-monitoring procedure were maintained during Treatment II and results obtained by this procedure were not significantly different from effects of response cost.     

The I Ching and the psyche-body connection

Carl G. Jung's fateful meeting with Richard Wilhelm in 1929 has helped to build a bridge of depth psychological understanding between the East and the West. When Jung emerged from his 'confrontation with the unconscious', he felt validated by Wilhelm in his discovery of the healing power of medieval alchemical symbolism for the European psyche. Analytical psychology however offers a scientific, psychological understanding of Chinese wisdom as contained in the I Ching and Taoist alchemy. The Taoist alchemical tradition (also known as the Inner Elixir tradition of which 'The Secret of the Golden Flower' is a sample text) is based on the premise that psychological experience of the Tao can be achieved through mental and physiological means such as breathing and meditative techniques, gymnastics, dietary regimens such as fasting, consumption of medicinal herbs and minerals, and special sexual practices. This tradition incorporates the I Ching and traditional Chinese medicine in the alchemical opus. Taoist alchemy assumes the primacy of the physical body in the process of self-realization. The psychological and cosmic forces of the trigrams of the I Ching are stored in the internal organs of the body and are the basic material for the experience of Tao. The internal organs are the foundation of the material and subtle bodies and through cultivation, the body becomes spiritualized as the spirits are embodied. The body as a reflection of the entire cosmos becomes the residence of the gods. The realization of a new consciousness is symbolized by the hexagram Fu, meaning rebirth. The Chinese notion of Tao coincides with Jung's postulation of the unus mundus, the unity of existence which underlies the duality of psyche and matter, the psycho-physical background of existence. In this light, in the world of inner experience, East and West follow similar paths symbolically.