Prudent medicine in imprudent times (Miguel Kottow, 25 January 2011)
Hardly anyone could fail to honor Edmund Pellegrino as an erudite, prolific and grand initiator of bioethical thought, persistently stressing the importance of ¿preserving the humanity of medicine¿ as recalled in Foni phronimos. Professor Pellegrino has repeatedly emphasized the distinction between philosophy of medicine and philosophy in medicine. Of the latter, he has insisted that the ¿dominant focus of philosophy in medicine has been on medical ethics and bioethics.¿ His contributions to medical ethics centered on ¿beneficence-in-trust¿ and the virtuous commitment to the common good are well known and firmly enmeshed in contemporary bioethics. As for philosophy of medicine, Pellegrino has set the scenario and invited thorough and on-going debate on such issues as health, illness...
read full comment
Comment on: Giordano Philosophy, Ethics, and Humanities in Medicine, 5:16
Reponse by OP Wiggins and MA Schwartz to Schlimme, Bonnemann and Mishara (Michael Schwartz, 01 November 2010)
Response to "No departure to Pandora: Using critical phenomenology to differentiate 'naive' from 'reflective'experience in psychiatry and psychosomatic medicine (A comment on Schwartz and Wiggins, 2010).
Osborne P Wiggins and Michael A Schwartz
Schlimme, Bonnemann, and Mishara develop several criticisms of our article, “Psychosomatic Medicine and the Philosophy of Life” [1]. We shall not address all of their criticisms here, however. We shall rather attempt to show how their main ones are misdirected.
Schlimme et al draw a phenomenological distinction between “naïve” and “reflective” experience which they think carries numerous methodological implications and which they see us as failing to respect. This...
read full comment
Comment on: Schlimme et al. Philosophy, Ethics, and Humanities in Medicine, 5:15
Surmounting dualism (Fernando Ruiz, 01 November 2010)
Surmounting dualism
The theory of polarities presented by Schwartz and Wiggins seems to be basically a description of the totality of living organisms according basic biological characteristics that unify them. Naturally, this totality includes human beings, in consonance with the theory of evolution. This theory is an ‘external’ vision of the organisms; therefore the mind in human beings is only an inference of subjectivity. The conscience and its intentionality is an internal phenomenon, a phenomenon that appears in the private interiority; in the subjective space of man. Science is not able to gain direct access to human subjectivity. The third person world of science can only infer it However, the authors claim: “The “polarities” which we...
read full comment
Comment on: Schwartz et al. Philosophy, Ethics, and Humanities in Medicine, 5:2
Appreciation for review (Ray Greek, 02 September 2010)
We thank Dr Wolpert for taking his time and applying his considerable intellect to review our book Animal Models in Light of Evolution. We are honored that Dr Wolpert reviewed our book.
We wrote the book in order to prove one point: that animals cannot predict human response to drugs and disease. We state:
"The purpose of this book is to address the ability, or lack thereof, of animals to predict human response and to see what other roles they may have in research and testing. We will argue that claims concerning the great utility of animals as predictive models of human biomedical phenomena are unsupported by evidence and are compromised by both methodological issues and issues arising from basic biological theory." p24
Comment on: Wolpert Philosophy, Ethics, and Humanities in Medicine, 5:12
Bottom Line: Patient Choice is Paramount (Phyllis Mervine, 17 July 2010)
The Infectious Diseases Society of America (IDSA) Lyme guidelines place commercial interests above quality of patient care, leaving seriously ill patients without effective treatment options. The narrow IDSA diagnostic criteria miss half the cases of Lyme disease, and up to half or more of the patients treated according to these guidelines remain ill. This is not acceptable.
The IDSA guidelines understate the seriousness of chronic Lyme disease, comparing ongoing Lyme symptoms to the "aches and pains of daily living." In contrast, peer-reviewed published studies show that people with chronic Lyme disease have disability and pain comparable to that of people with congestive heart failure and post-surgical pain, respectively. Schoolchildren with Lyme disease are...
read full comment
Comment on: Johnson et al. Philosophy, Ethics, and Humanities in Medicine, 5:9
Insufficient Evidence and Poor Outcomes: IDSA Treatment Recommendations Rightly Ignored (Elizabeth Maloney, 10 July 2010)
Comments from IDSA president, Dr. Richard J. Whitley, suggest that he fully believes that “the best defense is a good offense”. Instead of addressing the shortcomings of the IDSA guidelines on Lyme disease, of which there are many, he assails Dr. Stricker and Ms. Johnson for not providing evidence that long-term treatments are valid.[1] He also tries to distract readers from considering the weak scientific underpinnings of the IDSA guidelines by raising the specter of unending courses of IV antibiotics and “life-threatening drug-resistant superbugs”; readers should not be fooled by such tactics.
Organizations which create treatment guidelines are obligated to prove the validity of their recommendations. This requires them to disclose the strength of...
read full comment
Comment on: Johnson et al. Philosophy, Ethics, and Humanities in Medicine, 5:9
IDSA Response to Stricker and Johnson (Diana Olson, 01 July 2010)
The Infectious Diseases Society of America's primary concern is to enhance the care of children and adults based on sound scientific evidence. IDSA develops treatment guidelines through an extensive, thoughtful review of all of the evidence of a disease or condition, and its treatment options. We have published more than 60 practice guidelines for a range of infectious diseases, and our guidelines for Lyme disease are the only ones that have been challenged. Those guidelines were found to be valid by an extraordinary independent review, the results of which were made public in April 2010.
It is notable that Dr. Stricker and Ms. Johnson choose to criticize IDSA and its Lyme disease guidelines, rather than provide solid, scientific evidence that the treatments they espouse are...
read full comment
Comment on: Johnson et al. Philosophy, Ethics, and Humanities in Medicine, 5:9
Clinical practice guidelines need to be the best medicine (lou overman, 14 June 2010)
If professional societies like the IDSA can continue to use flawed guidelines, even when presented with irrefutable evidence that the guidelines are not good medicine, then this will result in a decline in public confidence in medicine as a whole. The public expects and deserves high standards.
No profession is above question, and bad behavior by some needs some outside enforcement action. Where is that action going to come from? Do we have to have class action lawsuits to get honest medicine?
read full comment
Comment on: Johnson et al. Philosophy, Ethics, and Humanities in Medicine, 5:9
Reply to David Kelly’s comment, “On the nature of the good.” (Michael Schwartz, 05 April 2010)
In his comment on our article, “Pscyhosomatic Medicine and the Philosophy of Life,” David Kelly poses questions about our all-too-brief discussion of some basic values as inherent in life itself. His questions offer us an opportunity to articulate more clearly the point of our remarks and to circumscribe their implications. Our point about value was a metaphysical one. We certainly did not intend there to propound an ethical theory, i.e., a philosophical ethics that would adequately delineate moral duties and obligations. The sort of egoistic ethics to which Kelly suspects we may be committed is far from our purpose. The metaphysical point about values and life that we rather sought to make was related to our opening sketch of the mind/body dualism that historically issued...
read full comment
Comment on: Schwartz et al. Philosophy, Ethics, and Humanities in Medicine, 5:2
Embodiment, Values, and Dis-ease (Ronald Pies, 25 March 2010)
I very much enjoyed this paper from Drs. Schwartz and Oz. Their discussion of how "...living beings are both enclosed within themselves...[and also] ceaselessly reaching out to their environment..." reminds me of Merleau-Ponty's concept of "embodiment", as another reader already noted.
In their chapter on this topic, Gallagher & Zahavi write, "The phenomenological emphasis on the body obviously entails a rejection of Cartesian mind-body dualism. But it should be just as obvious that this does not entail an endorsement of some kind of Cartesian materialism." (p. 135, The Phenomenological Mind).
I also liked the discussion of Canguilhem's thesis that "...the positive value of health and negative value of illness" is "...posited by the organism itself and...
read full comment
Comment on: Schwartz et al. Philosophy, Ethics, and Humanities in Medicine, 5:2
On the nature of the good (David Kelly, 19 March 2010)
I do have a couple of questions. If the good for me is the continuation of my own life, doesn't that mean that it is moral for me to do anything to preserve it? What moral principle prohibits me from doing just anything to preserve it?
Then, again, if preservation of my own life is the good for me, why would the preservation of the lives of others be of concern to me? Is there a moral principle in this philosophy of life that obligates me in any way to work to preserve the lives of others? read full comment
Comment on: Schwartz et al. Philosophy, Ethics, and Humanities in Medicine, 5:2
Correction of typographical errors (Abraham Halpern, 19 March 2010)
Dear Reader, I would like to correct several typographical errors, mostly minor. It is my understanding that it is not possible to make corrections in the article on the internet. If you should print out a copy, I would appreciate it very much if you would insert the corrections in your printed copy. Please forgive me for causing you this inconvenience. Thank you.
Background Line 1: Trustee (not "Director")
The amendment of the position statement Second paragraph, line 15: these actions seem (not "seems") Fourth paragraph, line 2: we (not "We")
The ticking time-bomb scenario First paragraph, line 3: that the author (not "that author") First paragraph, line 8: mention that it is beyond (not "mention beyond")
Comment on: Halpern et al. Philosophy, Ethics, and Humanities in Medicine, 3:21
Reply to Thomas Huddle’s comments on our article, “Psychosomatic Medicine and the Philosophy of Life” (Michael Schwartz, 19 March 2010)
T. Huddle raises some important questions that must be more fully addressed than we for reasons of space were able to do in our article. Since these questions pertain to large areas, we shall here be able merely to indicate the direction in which we would approach them.
Huddle wonders why we think a psychosomatic medicine of the sort that we sketch is needed by medicine, and he points out that, “Medicine has been successfully practiced by dualists, monists, and those who have never given the matter any thought at all.” However, it is precisely this uncritical approach to patients and the doctor-patient relationship that we question. Lurking in that uncritical approach lie assumptions taken over from one’s culture and one’s profession that, despite...
read full comment
Comment on: Schwartz et al. Philosophy, Ethics, and Humanities in Medicine, 5:2
Reply to M.H. Kottow's comment on our article, “Psychosomatic Medicine and the Philosophy of Life.” (Michael Schwartz, 16 March 2010)
We are grateful to M.H. Kottow for his kind and very insightful comments on our article, “Psychosomatic Medicine and the Philosophy of Life.” He is correct to emphasize that one of the main aims of our essay is to try to re-unite, through re-conceiving, the realities of the “physical organism” (Korper) as explained by natural science and the “lived body” (Leib) as described primarily by phenomenologists. Phenomenologists recognize that the mind/body dualism is more adequately explicated as a physical organism/lived body dualism because in our everyday non-scientific lives we do not experience ourselves as pure minds but rather as thoroughly embodied minds. Hence philosophers like Merleau-Ponty focus on the experiencing, embodied subject engaged in the...
read full comment
Comment on: Schwartz et al. Philosophy, Ethics, and Humanities in Medicine, 5:2
value and organic life (Thomas Huddle, 13 March 2010)
Michael Schwartz and Osborne Wiggins propose to offer an account of reality better than any presupposed by mind-body dualism. They claim that psychosomatic medicine demands such an account, but why this is so is unclear. Medicine has been successfully practiced by dualists, monists, and those who have never given the matter any thought at all. Must we indeed have any particular philosophy of life to practice medicine and practice it well? Let alone the correct one?
Schwartz and Wiggins go on to describe some aspects of organic life and conclude that “value is built into the reality of organic life”. From the propensity of living things (presumably including non-sentient living things) to seek their own continuation and reproduction, we must proceed to grant a...
read full comment
Comment on: Schwartz et al. Philosophy, Ethics, and Humanities in Medicine, 5:2
Duality, polarity in medicine (Michael H. Kottow, 01 March 2010)
MA. Schwartz and O.P. Wiggins thoughtful article is an audacious attempt to deal with the mind-body problem, and the first question that comes to mind is whether Descartes’ dualism can ever be solved, or perhaps dissolved at least for medical purposes. Psychosomatic’s valiant effort finally backfired because it could not avoid thinking about the integration and mutual influence of two components –psyche and soma-. Hans Jonas taught us that subjectivity runs through most animal species, but only humans are aware of it and therefore bound to be ethical. Awareness recreates a duality, in that human beings are their own observers as they dislocate their conscious self from their body: our subjectivity is eccentric to our body, as H. Plessner remarked. Merleau...
read full comment
Comment on: Schwartz et al. Philosophy, Ethics, and Humanities in Medicine, 5:2
Georges Canguilhem (Michael Schwartz, 18 February 2010)
Regretfully, we have misspelled the name of the French philosopher and physician Georges Canguilhem (1904-1995) throughout this manuscript. Veuillez nous excuser!
Comment on: Schwartz et al. Philosophy, Ethics, and Humanities in Medicine, 5:2
Problems with principlism (Daniel Goldberg, 15 January 2010)
On the kind advice of Michael Schwartz, I am cross-posting this comment from my weblog, Medical Humanities Blog.
"A couple of thoughts spring to mind. First, one can be dubious of the implication that the proliferation of codes of ethics is either necessary or sufficient to produce virtuous behavior. Second, one can be equally if not more dubious of the idea that a consensus on the importance of certain principles is either necessary or sufficient to produce virtuous behavior. My problem with principlism, per se, is that it seems either false or thin. As Mackie argued, the stunning diversity of...
read full comment
Comment on: Lakhan et al. Philosophy, Ethics, and Humanities in Medicine, 4:13
Abuse of Antidepressant Medications (jacob ross, 06 September 2009)
In many instances individuals who are suffering from depression often turn to drugs or alcohol instead of seeking proper antidepressant medications. In some instances individuals may abuse the antidepressant medications prescribed to them. This is done in order to help cope with the illness and can lead to a drug addiction. Drug addiction requires immediate attention in centers specifically designed to help those with any number of addictions and addictive behaviors.
Comment on: Ioannidis Philosophy, Ethics, and Humanities in Medicine, 3:14
Erratum (Ray Greek, 28 August 2009)
Dr Andrew Knight was kind enough to notify us of several errors we made in quoting from Knight et al. cited as reference 43 in our in our section entitled Carcinogenesis (pp. 8-9). We apologize to Drs Knight, Bailey, and Balcombe and wish to correct the errors at this time.
On page 8 of the paper we state:
"According to Knight et al. [43] as of 1 January 2004, IRIS was unable to classify the carcinogenic status of 93 out of 160 chemicals that had been evaluated only by animal tests."
Concerning this claim Dr Knight has made the following comments (email communication):
"Unfortunately, this statement is actually incorrect. The EPA did indeed provide a human carcinogenic classification for many of these chemicals, and I did...
read full comment
Comment on: Shanks et al. Philosophy, Ethics, and Humanities in Medicine, 4:2
proposed difinition of MIND (PRAMOD KUMAR, 10 April 2009)
Mind may be explained as M.I.N.D where M= denotes memory, I= mean intelligence, and N= represents all neural activities and lastly D= represents, drive / movements.<br> Here, we propose the protocol for study of MIND as part of neurobehavioral studies which includes all parameters representing the outcome/details of MIND.<br>PRAMOD
read full comment
Comment on: Spitzer Philosophy, Ethics, and Humanities in Medicine, 3:7
Clarification re: complicated grief (Ronald Pies, 11 March 2009)
Addendum: After several discussions with Dr. Naomi Simon and Dr. Sidney Zisook, it has emerged that the category known as "complicated grief" [CG]remains somewhat murky, vis-a-vis the affective continuum I propose in my article. For example, some elements of CG resemble post-traumatic stress disorder, or overlap with PTSD. Nonetheless, I believe there are compelling reasons, at present, for keeping CG on the affective disorders continuum (e.g., its association with suicidal ideation and apparent responsiveness to antidepressants, as per Dr. Simon's case reports-- see Am J Psychiatry. 2007 Nov;164(11):1760-1.)
I also wanted to clarify that, in addition to Dr. Simon, several other investigators pioneered the concept of "complicated grief", including but not limited to...
read full comment
Comment on: Pies Philosophy, Ethics, and Humanities in Medicine, 3:17
The interface of worldwide religions and the ideology behind the practice of end-of-life organ donation for transplantation (Mohamed Rady, 20 February 2009)
The interface of worldwide religions and the ideology behind the practice of end-of-life organ donation for transplantation
Mohamed Y Rady; Joseph L Verheijde; Catherine Friederich-Murray Departments of Critical Care Medicine,Physical Medicine and Rehabilitation, and Biomedical Ethics, Mayo Clinic Hospital, Phoenix, Arizona, USA. Bioethics, Policy, and Law Program, Arizona State University, Tempe, Arizona, USA.
For more than 40 years, the end-of-life practice of heart-beating (called brain death) or non–heart-beating (called cardiac or circulatory death) organ procurement for transplantation has thrived on an ideology based on concepts of “altruism,” “gift of life,” or “saving human life” without scrutiny of that...
read full comment
Comment on: Schweda et al. Philosophy, Ethics, and Humanities in Medicine, 4:4
The Dec. 11, 2008, Levin-McCain Report on the Treatment of Detainees in U.S. Custody (Abraham Halpern, 25 December 2008)
I note that the unanimous report by the commission headed by Senators Carl Levin and John McCain validates the comments made in our article (by Halpern, Halpern & Doherty) concerning the aggressive interrogation techniques used in violation of U.S. and international law.
read full comment
Comment on: Halpern et al. Philosophy, Ethics, and Humanities in Medicine, 3:21
The Need for Transparency of Clinical Trials (Jeffrey Bridge, 24 November 2008)
The article by Dr. Ioannidis provides a thought-provoking discussion of two recently published meta-analyses—the results of which call into question the apparent efficacy of antidepressant medications—and offers some practical suggestions for ways to improve the evidence base for antidepressants going forward: pre-registration of fully transparent protocols, strict adherence to a priori defined data analysis plans, and public availability of individual patient-level trial data for prospective meta-analyses. The use of “mega-trials” to answer pressing questions about the clinical utility of antidepressant medications is also an attractive proposition as these types of studies use randomization to avoid selection bias, simple designs to reduce investigator and...
read full comment
Comment on: Ioannidis Philosophy, Ethics, and Humanities in Medicine, 3:14
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Latest comments
Prudent medicine in imprudent times (Miguel Kottow, 25 January 2011)
Hardly anyone could fail to honor Edmund Pellegrino as an erudite, prolific and grand initiator of bioethical thought, persistently stressing the importance of ¿preserving the humanity of medicine¿ as recalled in Foni phronimos. Professor Pellegrino has repeatedly emphasized the distinction between philosophy of medicine and philosophy in medicine. Of the latter, he has insisted that the ¿dominant focus of philosophy in medicine has been on medical ethics and bioethics.¿ His contributions to medical ethics centered on ¿beneficence-in-trust¿ and the virtuous commitment to the common good are well known and firmly enmeshed in contemporary bioethics. As for philosophy of medicine, Pellegrino has set the scenario and invited thorough and on-going debate on such issues as health, illness... read full comment
Comment on: Giordano Philosophy, Ethics, and Humanities in Medicine, 5:16
Reponse by OP Wiggins and MA Schwartz to Schlimme, Bonnemann and Mishara (Michael Schwartz, 01 November 2010)
Response to "No departure to Pandora: Using critical phenomenology to differentiate 'naive' from 'reflective'experience in psychiatry and psychosomatic medicine (A comment on Schwartz and Wiggins, 2010).
Osborne P Wiggins and Michael A Schwartz
Schlimme, Bonnemann, and Mishara develop several criticisms of our article, “Psychosomatic Medicine and the Philosophy of Life” [1]. We shall not address all of their criticisms here, however. We shall rather attempt to show how their main ones are misdirected.
Schlimme et al draw a phenomenological distinction between “naïve” and “reflective” experience which they think carries numerous methodological implications and which they see us as failing to respect. This... read full comment
Comment on: Schlimme et al. Philosophy, Ethics, and Humanities in Medicine, 5:15
Surmounting dualism (Fernando Ruiz, 01 November 2010)
Surmounting dualism
The theory of polarities presented by Schwartz and Wiggins seems to be basically a description of the totality of living organisms according basic biological characteristics that unify them. Naturally, this totality includes human beings, in consonance with the theory of evolution. This theory is an ‘external’ vision of the organisms; therefore the mind in human beings is only an inference of subjectivity. The conscience and its intentionality is an internal phenomenon, a phenomenon that appears in the private interiority; in the subjective space of man. Science is not able to gain direct access to human subjectivity. The third person world of science can only infer it
However, the authors claim: “The “polarities” which we... read full comment
Comment on: Schwartz et al. Philosophy, Ethics, and Humanities in Medicine, 5:2
Appreciation for review (Ray Greek, 02 September 2010)
We thank Dr Wolpert for taking his time and applying his considerable intellect to review our book Animal Models in Light of Evolution. We are honored that Dr Wolpert reviewed our book.
We wrote the book in order to prove one point: that animals cannot predict human response to drugs and disease. We state:
"The purpose of this book is to address the ability, or lack thereof, of animals to predict human response and to see what other roles they may have in research and testing. We will argue that claims concerning the great utility of animals as predictive models of human biomedical phenomena are unsupported by evidence and are compromised by both methodological issues and issues arising from basic biological theory." p24
Therefore we are very... read full comment
Comment on: Wolpert Philosophy, Ethics, and Humanities in Medicine, 5:12
Bottom Line: Patient Choice is Paramount (Phyllis Mervine, 17 July 2010)
The Infectious Diseases Society of America (IDSA) Lyme guidelines place commercial interests above quality of patient care, leaving seriously ill patients without effective treatment options. The narrow IDSA diagnostic criteria miss half the cases of Lyme disease, and up to half or more of the patients treated according to these guidelines remain ill. This is not acceptable.
The IDSA guidelines understate the seriousness of chronic Lyme disease, comparing ongoing Lyme symptoms to the "aches and pains of daily living." In contrast, peer-reviewed published studies show that people with chronic Lyme disease have disability and pain comparable to that of people with congestive heart failure and post-surgical pain, respectively. Schoolchildren with Lyme disease are... read full comment
Comment on: Johnson et al. Philosophy, Ethics, and Humanities in Medicine, 5:9
Insufficient Evidence and Poor Outcomes: IDSA Treatment Recommendations Rightly Ignored (Elizabeth Maloney, 10 July 2010)
Comments from IDSA president, Dr. Richard J. Whitley, suggest that he fully believes that “the best defense is a good offense”. Instead of addressing the shortcomings of the IDSA guidelines on Lyme disease, of which there are many, he assails Dr. Stricker and Ms. Johnson for not providing evidence that long-term treatments are valid.[1] He also tries to distract readers from considering the weak scientific underpinnings of the IDSA guidelines by raising the specter of unending courses of IV antibiotics and “life-threatening drug-resistant superbugs”; readers should not be fooled by such tactics.
Organizations which create treatment guidelines are obligated to prove the validity of their recommendations. This requires them to disclose the strength of... read full comment
Comment on: Johnson et al. Philosophy, Ethics, and Humanities in Medicine, 5:9
IDSA Response to Stricker and Johnson (Diana Olson, 01 July 2010)
The Infectious Diseases Society of America's primary concern is to enhance the care of children and adults based on sound scientific evidence. IDSA develops treatment guidelines through an extensive, thoughtful review of all of the evidence of a disease or condition, and its treatment options. We have published more than 60 practice guidelines for a range of infectious diseases, and our guidelines for Lyme disease are the only ones that have been challenged. Those guidelines were found to be valid by an extraordinary independent review, the results of which were made public in April 2010.
It is notable that Dr. Stricker and Ms. Johnson choose to criticize IDSA and its Lyme disease guidelines, rather than provide solid, scientific evidence that the treatments they espouse are... read full comment
Comment on: Johnson et al. Philosophy, Ethics, and Humanities in Medicine, 5:9
Clinical practice guidelines need to be the best medicine (lou overman, 14 June 2010)
If professional societies like the IDSA can continue to use flawed guidelines, even when presented with irrefutable evidence that the guidelines are not good medicine, then this will result in a decline in public confidence in medicine as a whole. The public expects and deserves high standards.
No profession is above question, and bad behavior by some needs some outside enforcement action. Where is that action going to come from? Do we have to have class action lawsuits to get honest medicine? read full comment
Comment on: Johnson et al. Philosophy, Ethics, and Humanities in Medicine, 5:9
Reply to David Kelly’s comment, “On the nature of the good.” (Michael Schwartz, 05 April 2010)
In his comment on our article, “Pscyhosomatic Medicine and the Philosophy of Life,” David Kelly poses questions about our all-too-brief discussion of some basic values as inherent in life itself. His questions offer us an opportunity to articulate more clearly the point of our remarks and to circumscribe their implications. Our point about value was a metaphysical one. We certainly did not intend there to propound an ethical theory, i.e., a philosophical ethics that would adequately delineate moral duties and obligations. The sort of egoistic ethics to which Kelly suspects we may be committed is far from our purpose. The metaphysical point about values and life that we rather sought to make was related to our opening sketch of the mind/body dualism that historically issued... read full comment
Comment on: Schwartz et al. Philosophy, Ethics, and Humanities in Medicine, 5:2
Embodiment, Values, and Dis-ease (Ronald Pies, 25 March 2010)
I very much enjoyed this paper from Drs. Schwartz and Oz. Their discussion of how "...living beings are both enclosed within themselves...[and also] ceaselessly reaching out to their environment..." reminds me of Merleau-Ponty's concept of "embodiment", as another reader already noted.
In their chapter on this topic, Gallagher & Zahavi write, "The phenomenological emphasis on the body obviously entails a rejection of Cartesian mind-body dualism. But it should be just as obvious that this does not entail an endorsement of some kind of Cartesian materialism." (p. 135, The Phenomenological Mind).
I also liked the discussion of Canguilhem's thesis that "...the positive value of health and negative value of illness" is "...posited by the organism itself and... read full comment
Comment on: Schwartz et al. Philosophy, Ethics, and Humanities in Medicine, 5:2
On the nature of the good (David Kelly, 19 March 2010)
I do have a couple of questions. If the good for me is the continuation of my own life, doesn't that mean that it is moral for me to do anything to preserve it? What moral principle prohibits me from doing just anything to preserve it?
Then, again, if preservation of my own life is the good for me, why would the preservation of the lives of others be of concern to me? Is there a moral principle in this philosophy of life that obligates me in any way to work to preserve the lives of others?
read full comment
Comment on: Schwartz et al. Philosophy, Ethics, and Humanities in Medicine, 5:2
Correction of typographical errors (Abraham Halpern, 19 March 2010)
Dear Reader,
I would like to correct several typographical errors, mostly minor. It is my understanding that it is not possible to make corrections in the article on the internet. If you should print out a copy, I would appreciate it very much if you would insert the corrections in your printed copy. Please forgive me for causing you this inconvenience. Thank you.
Background
Line 1: Trustee (not "Director")
The amendment of the position statement
Second paragraph, line 15: these actions seem (not "seems")
Fourth paragraph, line 2: we (not "We")
The ticking time-bomb scenario
First paragraph, line 3: that the author (not "that author")
First paragraph, line 8: mention that it is beyond (not "mention beyond")
c) The... read full comment
Comment on: Halpern et al. Philosophy, Ethics, and Humanities in Medicine, 3:21
Reply to Thomas Huddle’s comments on our article, “Psychosomatic Medicine and the Philosophy of Life” (Michael Schwartz, 19 March 2010)
T. Huddle raises some important questions that must be more fully addressed than we for reasons of space were able to do in our article. Since these questions pertain to large areas, we shall here be able merely to indicate the direction in which we would approach them.
Huddle wonders why we think a psychosomatic medicine of the sort that we sketch is needed by medicine, and he points out that, “Medicine has been successfully practiced by dualists, monists, and those who have never given the matter any thought at all.” However, it is precisely this uncritical approach to patients and the doctor-patient relationship that we question. Lurking in that uncritical approach lie assumptions taken over from one’s culture and one’s profession that, despite... read full comment
Comment on: Schwartz et al. Philosophy, Ethics, and Humanities in Medicine, 5:2
Reply to M.H. Kottow's comment on our article, “Psychosomatic Medicine and the Philosophy of Life.” (Michael Schwartz, 16 March 2010)
We are grateful to M.H. Kottow for his kind and very insightful comments on our article, “Psychosomatic Medicine and the Philosophy of Life.” He is correct to emphasize that one of the main aims of our essay is to try to re-unite, through re-conceiving, the realities of the “physical organism” (Korper) as explained by natural science and the “lived body” (Leib) as described primarily by phenomenologists. Phenomenologists recognize that the mind/body dualism is more adequately explicated as a physical organism/lived body dualism because in our everyday non-scientific lives we do not experience ourselves as pure minds but rather as thoroughly embodied minds. Hence philosophers like Merleau-Ponty focus on the experiencing, embodied subject engaged in the... read full comment
Comment on: Schwartz et al. Philosophy, Ethics, and Humanities in Medicine, 5:2
value and organic life (Thomas Huddle, 13 March 2010)
Michael Schwartz and Osborne Wiggins propose to offer an account of reality better than any presupposed by mind-body dualism. They claim that psychosomatic medicine demands such an account, but why this is so is unclear. Medicine has been successfully practiced by dualists, monists, and those who have never given the matter any thought at all. Must we indeed have any particular philosophy of life to practice medicine and practice it well? Let alone the correct one?
Schwartz and Wiggins go on to describe some aspects of organic life and conclude that “value is built into the reality of organic life”. From the propensity of living things (presumably including non-sentient living things) to seek their own continuation and reproduction, we must proceed to grant a... read full comment
Comment on: Schwartz et al. Philosophy, Ethics, and Humanities in Medicine, 5:2
Duality, polarity in medicine (Michael H. Kottow, 01 March 2010)
MA. Schwartz and O.P. Wiggins thoughtful article is an audacious attempt to deal with the mind-body problem, and the first question that comes to mind is whether Descartes’ dualism can ever be solved, or perhaps dissolved at least for medical purposes. Psychosomatic’s valiant effort finally backfired because it could not avoid thinking about the integration and mutual influence of two components –psyche and soma-. Hans Jonas taught us that subjectivity runs through most animal species, but only humans are aware of it and therefore bound to be ethical. Awareness recreates a duality, in that human beings are their own observers as they dislocate their conscious self from their body: our subjectivity is eccentric to our body, as H. Plessner remarked.
Merleau... read full comment
Comment on: Schwartz et al. Philosophy, Ethics, and Humanities in Medicine, 5:2
Georges Canguilhem (Michael Schwartz, 18 February 2010)
Regretfully, we have misspelled the name of the French philosopher and physician Georges Canguilhem (1904-1995) throughout this manuscript. Veuillez nous excuser!
Michael Schwartz and Osborne Wiggins read full comment
Comment on: Schwartz et al. Philosophy, Ethics, and Humanities in Medicine, 5:2
Problems with principlism (Daniel Goldberg, 15 January 2010)
On the kind advice of Michael Schwartz, I am cross-posting this comment from my weblog, Medical Humanities Blog.
"A couple of thoughts spring to mind. First, one can be dubious of the implication that the proliferation of codes of ethics is either necessary or sufficient to produce virtuous behavior. Second, one can be equally if not more dubious of the idea that a consensus on the importance of certain principles is either necessary or sufficient to produce virtuous behavior. My problem with principlism, per se, is that it seems either false or thin. As Mackie argued, the stunning diversity of... read full comment
Comment on: Lakhan et al. Philosophy, Ethics, and Humanities in Medicine, 4:13
Abuse of Antidepressant Medications (jacob ross, 06 September 2009)
In many instances individuals who are suffering from depression often turn to drugs or alcohol instead of seeking proper antidepressant medications. In some instances individuals may abuse the antidepressant medications prescribed to them. This is done in order to help cope with the illness and can lead to a drug addiction. Drug addiction requires immediate attention in centers specifically designed to help those with any number of addictions and addictive behaviors.
malibu prescription drug rehab read full comment
Comment on: Ioannidis Philosophy, Ethics, and Humanities in Medicine, 3:14
Erratum (Ray Greek, 28 August 2009)
Dr Andrew Knight was kind enough to notify us of several errors we made in quoting from Knight et al. cited as reference 43 in our in our section entitled Carcinogenesis (pp. 8-9). We apologize to Drs Knight, Bailey, and Balcombe and wish to correct the errors at this time.
On page 8 of the paper we state:
"According to Knight et al. [43] as of 1 January 2004, IRIS was unable to classify the carcinogenic status of 93 out of 160 chemicals that had been evaluated only by animal tests."
Concerning this claim Dr Knight has made the following comments (email communication):
"Unfortunately, this statement is actually incorrect. The EPA did indeed provide a human carcinogenic classification for many of these chemicals, and I did... read full comment
Comment on: Shanks et al. Philosophy, Ethics, and Humanities in Medicine, 4:2
proposed difinition of MIND (PRAMOD KUMAR, 10 April 2009)
Mind may be explained as M.I.N.D where M= denotes memory, I= mean intelligence, and N= represents all neural activities and lastly D= represents, drive / movements.<br> Here, we propose the protocol for study of MIND as part of neurobehavioral studies which includes all parameters representing the outcome/details of MIND.<br>PRAMOD read full comment
Comment on: Spitzer Philosophy, Ethics, and Humanities in Medicine, 3:7
Clarification re: complicated grief (Ronald Pies, 11 March 2009)
Addendum: After several discussions with Dr. Naomi Simon and Dr. Sidney Zisook, it has emerged that the category known as "complicated grief" [CG]remains somewhat murky, vis-a-vis the affective continuum I propose in my article. For example, some elements of CG resemble post-traumatic stress disorder, or overlap with PTSD. Nonetheless, I believe there are compelling reasons, at present, for keeping CG on the affective disorders continuum (e.g., its association with suicidal ideation and apparent responsiveness to antidepressants, as per Dr. Simon's case reports--
see Am J Psychiatry. 2007 Nov;164(11):1760-1.)
I also wanted to clarify that, in addition to Dr. Simon, several other investigators pioneered the concept of "complicated grief", including but not limited to... read full comment
Comment on: Pies Philosophy, Ethics, and Humanities in Medicine, 3:17
The interface of worldwide religions and the ideology behind the practice of end-of-life organ donation for transplantation (Mohamed Rady, 20 February 2009)
The interface of worldwide religions and the ideology behind the practice of end-of-life organ donation for transplantation
Mohamed Y Rady; Joseph L Verheijde; Catherine Friederich-Murray
Departments of Critical Care Medicine,Physical Medicine and Rehabilitation, and Biomedical Ethics, Mayo Clinic Hospital, Phoenix, Arizona, USA. Bioethics, Policy, and Law Program, Arizona State University, Tempe, Arizona, USA.
For more than 40 years, the end-of-life practice of heart-beating (called brain death) or non–heart-beating (called cardiac or circulatory death) organ procurement for transplantation has thrived on an ideology based on concepts of “altruism,” “gift of life,” or “saving human life” without scrutiny of that... read full comment
Comment on: Schweda et al. Philosophy, Ethics, and Humanities in Medicine, 4:4
The Dec. 11, 2008, Levin-McCain Report on the Treatment of Detainees in U.S. Custody (Abraham Halpern, 25 December 2008)
I note that the unanimous report by the commission headed by Senators Carl Levin and John McCain validates the comments made in our article (by Halpern, Halpern & Doherty) concerning the aggressive interrogation techniques used in violation of U.S. and international law. read full comment
Comment on: Halpern et al. Philosophy, Ethics, and Humanities in Medicine, 3:21
The Need for Transparency of Clinical Trials (Jeffrey Bridge, 24 November 2008)
The article by Dr. Ioannidis provides a thought-provoking discussion of two recently published meta-analyses—the results of which call into question the apparent efficacy of antidepressant medications—and offers some practical suggestions for ways to improve the evidence base for antidepressants going forward: pre-registration of fully transparent protocols, strict adherence to a priori defined data analysis plans, and public availability of individual patient-level trial data for prospective meta-analyses. The use of “mega-trials” to answer pressing questions about the clinical utility of antidepressant medications is also an attractive proposition as these types of studies use randomization to avoid selection bias, simple designs to reduce investigator and... read full comment
Comment on: Ioannidis Philosophy, Ethics, and Humanities in Medicine, 3:14