http://www.peh-med.com The most accessed research articles published by Philosophy, Ethics, and Humanities in Medicine 2012-04-18T00:00:00Z In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. http://www.peh-med.com/content/7/1/8 James Phillips Allen Frances Michael Cerullo John Chardavoyne Hannah Decker Michael First Nassir Ghaemi Gary Greenberg Andrew Hinderliter Warren Kinghorn Steven LoBello Elliott Martin Aaron Mishara Joel Paris Joseph Pierre Ronald Pies Harold Pincus Douglas Porter Claire Pouncey Michael Schwartz Thomas Szasz Jerome Wakefield G Scott Waterman Owen Whooley Peter Zachar Philosophy, Ethics, and Humanities in Medicine 2012, null:8 2012-04-18T00:00:00Z doi:10.1186/1747-5341-7-8 /content/figures/1747-5341-7-8-toc.gif Philosophy, Ethics, and Humanities in Medicine 1747-5341 ${item.volume} 8 2012-04-18T00:00:00Z PDF Over 45 million Americans are uninsured or underinsured. Those living in poverty exhibit the worst health status. Employment, education, income, and race are important factors in a person's ability to acquire healthcare access. Having established that there are people lacking healthcare access due to multi-factorial etiologies, the question arises as to whether the intervention necessary to assist them in obtaining such access should be considered a privilege, or a right. The right to healthcare access is examined from the perspective of Western thought. Specifically through the works of Aristotle, Immanuel Kant, Thomas Hobbes, Thomas Paine, Hannah Arendt, James Rawls, and Norman Daniels, which are accompanied by a contemporary example of intervention on behalf of the medically needy by the The Johns Hopkins Urban Health Institute.As human beings we are all valuable social entities whereby, through the force of morality, through implicitly forged covenants among us as individuals and between us and our governments, and through the natural rights we maintain as individuals and those we collectively surrender to the common good, it has been determined by nature, natural laws, and natural rights that human beings have the right, not the privilege, to healthcare access. http://www.peh-med.com/content/2/1/2 Thomas Papadimos Philosophy, Ethics, and Humanities in Medicine 2007, null:2 2007-03-28T00:00:00Z doi:10.1186/1747-5341-2-2 /content/figures/1747-5341-2-2-toc.gif Philosophy, Ethics, and Humanities in Medicine 1747-5341 ${item.volume} 2 2007-03-28T00:00:00Z XML In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. http://www.peh-med.com/content/7/1/3 James Phillips Allen Frances Michael Cerullo John Chardavoyne Hannah Decker Michael First Nassir Ghaemi Gary Greenberg Andrew Hinderliter Warren Kinghorn Steven LoBello Elliott Martin Aaron Mishara Joel Paris Joseph Pierre Ronald Pies Harold Pincus Douglas Porter Claire Pouncey Michael Schwartz Thomas Szasz Jerome Wakefield G Scott Waterman Owen Whooley Peter Zachar Philosophy, Ethics, and Humanities in Medicine 2012, null:3 2012-01-13T00:00:00Z doi:10.1186/1747-5341-7-3 /content/figures/1747-5341-7-3-toc.gif Philosophy, Ethics, and Humanities in Medicine 1747-5341 ${item.volume} 3 2012-01-13T00:00:00Z XML It is one of the central aims of the philosophy of science to elucidate the meanings of scientific terms and also to think critically about their application. The focus of this essay is the scientific term predict and whether there is credible evidence that animal models, especially in toxicology and pathophysiology, can be used to predict human outcomes. Whether animals can be used to predict human response to drugs and other chemicals is apparently a contentious issue. However, when one empirically analyzes animal models using scientific tools they fall far short of being able to predict human responses. This is not surprising considering what we have learned from fields such evolutionary and developmental biology, gene regulation and expression, epigenetics, complexity theory, and comparative genomics. http://www.peh-med.com/content/4/1/2 Niall Shanks Ray Greek Jean Greek Philosophy, Ethics, and Humanities in Medicine 2009, null:2 2009-01-15T00:00:00Z doi:10.1186/1747-5341-4-2 /content/figures/1747-5341-4-2-toc.gif Philosophy, Ethics, and Humanities in Medicine 1747-5341 ${item.volume} 2 2009-01-15T00:00:00Z XML We compare astronomers' removal of Pluto from the listing of planets and psychiatrists' removal of homosexuality from the listing of mental disorders. Although the political maneuverings that emerged in both controversies are less than scientifically ideal, we argue that competition for "scientific authority" among competing groups is a normal part of scientific progress. In both cases, a complicated relationship between abstract constructs and evidence made the classification problem thorny. http://www.peh-med.com/content/7/1/4 Peter Zachar Kenneth Kendler Philosophy, Ethics, and Humanities in Medicine 2012, null:4 2012-01-13T00:00:00Z doi:10.1186/1747-5341-7-4 /content/figures/1747-5341-7-4-toc.gif Philosophy, Ethics, and Humanities in Medicine 1747-5341 ${item.volume} 4 2012-01-13T00:00:00Z XML Antidepressants, in particular newer agents, are among the most widely prescribed medications worldwide with annual sales of billions of dollars. The introduction of these agents in the market has passed through seemingly strict regulatory control. Over a thousand randomized trials have been conducted with antidepressants. Statistically significant benefits have been repeatedly demonstrated and the medical literature is flooded with several hundreds of "positive" trials (both pre-approval and post-approval). However, two recent meta-analyses question this picture. The first meta-analysis used data that were submitted to FDA for the approval of 12 antidepressant drugs. While only half of these trials had formally significant effectiveness, published reports almost ubiquitously claimed significant results. "Negative" trials were either left unpublished or were distorted to present "positive" results. The average benefit of these drugs based on the FDA data was of small magnitude, while the published literature suggested larger benefits. A second meta-analysis using also FDA-submitted data examined the relationship between treatment effect and baseline severity of depression. Drug-placebo differences increased with increasing baseline severity and the difference became large enough to be clinically important only in the very small minority of patient populations with severe major depression. In severe major depression, antidepressants did not become more effective, simply placebo lost effectiveness. These data suggest that antidepressants may be less effective than their wide marketing suggests. Short-term benefits are small and long-term balance of benefits and harms is understudied. I discuss how the use of many small randomized trials with clinically non-relevant outcomes, improper interpretation of statistical significance, manipulated study design, biased selection of study populations, short follow-up, and selective and distorted reporting of results has built and nourished a seemingly evidence-based myth on antidepressant effectiveness and how higher evidence standards, with very large long-term trials and careful prospective meta-analyses of individual-level data may reach closer to the truth and clinically useful evidence. http://www.peh-med.com/content/3/1/14 John Ioannidis Philosophy, Ethics, and Humanities in Medicine 2008, null:14 2008-05-27T00:00:00Z doi:10.1186/1747-5341-3-14 /content/figures/1747-5341-3-14-toc.gif Philosophy, Ethics, and Humanities in Medicine 1747-5341 ${item.volume} 14 2008-05-27T00:00:00Z XML The Psychological Ethics and National Security (PENS) task force was assembled by the American Psychological Association (APA) to guide policy on the role of psychologists in interrogations at foreign detention centers for the purpose of U.S. national security. The task force met briefly in 2005, and its report was quickly accepted by the APA Board of Directors and deemed consistent with the APA Ethics Code by the APA Ethics Committee. This rapid acceptance was unusual for a number of reasons but primarily because of the APA's long-standing tradition of taking great care in developing ethical policies that protected anyone who might be impacted by the work of psychologists. Many psychological and non-governmental organizations (NGOs), as well as reputable journalists, believed the risk of harm associated with psychologist participation in interrogations at these detention centers was not adequately addressed by the report. The present critique analyzes the assumptions of the PENS report and its interpretations of the APA Ethics Code. We demonstrate that it presents only one (and not particularly representative) side of a complex set of ethical issues. We conclude with a discussion of more appropriate psychological contributions to national security and world peace that better respect and preserve human rights. http://www.peh-med.com/content/3/1/3 Brad Olson Stephen Soldz Martha Davis Philosophy, Ethics, and Humanities in Medicine 2008, null:3 2008-01-29T00:00:00Z doi:10.1186/1747-5341-3-3 /content/figures/1747-5341-3-3-toc.gif Philosophy, Ethics, and Humanities in Medicine 1747-5341 ${item.volume} 3 2008-01-29T00:00:00Z XML One argument used by detractors of human embryonic stem cell research (hESCR) invokes Kant's formula of humanity, which proscribes treating persons solely as a means to an end, rather than as ends in themselves. According to Fuat S. Oduncu, for example, adhering to this imperative entails that human embryos should not be disaggregated to obtain pluripotent stem cells for hESCR. Given that human embryos are Kantian persons from the time of their conception, killing them to obtain their cells for research fails to treat them as ends in themselves.This argument assumes two points that are rather contentious given a Kantian framework. First, the argument assumes that when Kant maintains that humanity must be treated as an end in itself, he means to argue that all members of the species Homo sapiens must be treated as ends in themselves; that is, that Kant regards personhood as co-extensive with belonging to the species Homo sapiens. Second, the argument assumes that the event of conception is causally responsible for the genesis of a Kantian person and that, therefore, an embryo is a Kantian person from the time of its conception.In this paper, I will present challenges against these two assumptions by engaging in an exegetical study of some of Kant's works. First, I will illustrate that Kant did not use the term "humanity" to denote a biological species, but rather the capacity to set ends according to reason. Second, I will illustrate that it is difficult given a Kantian framework to denote conception (indeed any biological event) as causally responsible for the creation of a person. Kant ascribed to a dualistic view of human agency, and personhood, according to him, was derived from the supersensible capacity for reason. To argue that a Kantian person is generated due to the event of conception ignores Kant's insistence in various aspects of his work that it is not possible to understand the generation of a person qua a physical operation. Finally, I will end the paper by drawing from Allen Wood's work in Kantian philosophy in order to generate an argument in favor of hESCR. http://www.peh-med.com/content/3/1/4 Bertha Alvarez Manninen Philosophy, Ethics, and Humanities in Medicine 2008, null:4 2008-01-31T00:00:00Z doi:10.1186/1747-5341-3-4 /content/figures/1747-5341-3-4-toc.gif Philosophy, Ethics, and Humanities in Medicine 1747-5341 ${item.volume} 4 2008-01-31T00:00:00Z XML In this article we examine four objections to the genetic modification of human beings: the freedom argument, the giftedness argument, the authenticity argument, and the uniqueness argument. We then demonstrate that each of these arguments against genetic modification assumes a strong version of genetic determinism. Since these strong deterministic assumptions are false, the arguments against genetic modification, which assume and depend upon these assumptions, are therefore unsound. Serious discussion of the morality of genetic modification, and the development of sound science policy, should be driven by arguments that address the actual consequences of genetic modification for individuals and society, not by ones propped up by false or misleading biological assumptions. http://www.peh-med.com/content/1/1/9 David Resnik Daniel Vorhaus Philosophy, Ethics, and Humanities in Medicine 2006, null:9 2006-06-26T00:00:00Z doi:10.1186/1747-5341-1-9 /content/figures/1747-5341-1-9-toc.gif Philosophy, Ethics, and Humanities in Medicine 1747-5341 ${item.volume} 9 2006-06-26T00:00:00Z XML Kafka's writings are frequently interpreted as representing the historical period of modernism in which he was writing. Little attention has been paid, however, to the possibility that his writings may reflect neural mechanisms in the processing of self during hypnagogic (i.e., between waking and sleep) states. Kafka suffered from dream-like, hypnagogic hallucinations during a sleep-deprived state while writing. This paper discusses reasons (phenomenological and neurobiological) why the self projects an imaginary double (autoscopy) in its spontaneous hallucinations and how Kafka's writings help to elucidate the underlying cognitive and neural mechanisms. I further discuss how the proposed mechanisms may be relevant to understanding paranoid delusions in schizophrenia. Literature documents and records cognitive and neural processes of self with an intimacy that may be otherwise unavailable to neuroscience. To elucidate this approach, I contrast it with the apparently popularizing view that the symptoms of schizophrenia result from what has been called an operative (i.e., pre-reflective) hyper-reflexivity. The latter approach claims that pre-reflective self-awareness (diminished in schizophrenia) pervades all conscious experience (however, in a manner that remains unverifiable for both phenomenological and experimental methods). This contribution argues the opposite: the "self" informs our hypnagogic imagery precisely to the extent that we are not self-aware. http://www.peh-med.com/content/5/1/13 Aaron Mishara Philosophy, Ethics, and Humanities in Medicine 2010, null:13 2010-08-20T00:00:00Z doi:10.1186/1747-5341-5-13 /content/figures/1747-5341-5-13-toc.gif Philosophy, Ethics, and Humanities in Medicine 1747-5341 ${item.volume} 13 2010-08-20T00:00:00Z XML