Perspectives in biology and medicine
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Perspect. Biol. Med. · Jan 2009
Historical ArticleKawasaki disease in India: increasing awareness or increased incidence?
Reports of Kawasaki disease (KD) throughout India are increasing. This article addresses the question of whether the increased diagnosis of KD in India represents the emerging recognition of an illness that had been previously obscured by misdiagnosis, or whether KD is new to India and is increasing in incidence. Whichever answer turns out to be correct, the burden of KD is likely to pose a significant challenge to the health-care system in India in the coming years, due to the high cost of treatment and the potential for lifelong cardiovascular sequelae. Moreover, elucidating the factors that have contributed to the increased recognition of KD in India may provide useful insights for the continuing search for the etiology of KD worldwide.
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Perspect. Biol. Med. · Jan 2009
Historical ArticleRevisiting the beginning of bioethics: the contribution of Fritz Jahr (1927).
Van Rensselaer Potter is usually credited with coining the term bioethics and with founding this field. However, the rediscovery of the article "Bioethics: A Panorama of the Human Being's Ethical Relations with Animals and Plants," published in 1927 by Fritz Jahr in the German magazine Kosmos, necessitates a revision of this history of the foundation of bioethics. While Potter made significant contributions to this field, the importance of Jahr to the founding of bioethics should be recognized.
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Perspect. Biol. Med. · Jan 2009
In sickness and in health care: a student's thoughts before beginning his medical training.
This essay is a "prespective"-the musings of a soon-to-be MD/PhD student on various aspects of the practice of medicine, written just before he began his training in the fall of 2008. It discusses some of the issues-genomic medicine, healthcare reform, and evidence-based medicine-that will likely impact medicine and medical care during his career. These thoughts are interwoven with the personal story of his grandfather's fight against disease and the complications of diagnosis and treatment.
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Suffering is the experience of distress or disharmony caused by the loss, or threatened loss, of what we most cherish. Such losses may strip away the beliefs by which we construct a meaningful narrative of human life in general and our own in particular. The vocation of physicians and other health professionals is to relieve suffering caused by illness, trauma, and bodily degeneration. ⋯ Unfortunately, however, medical pedagogy encourages "detached concern," which devalues subjectivity, emotion, relationship, and solidarity. The term "compassionate solidarity" summarizes an alternative model, which begins with empathic listening and responding, requires reflectivity and self-understanding, and is in itself a healing act. Poetry, along with other imaginative writing, may help physicians and other health professionals grow in self-awareness and gain deeper understanding of suffering, empathy, compassion, and symbolic healing.
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Despite evidence-based medicine's (EBM's) significant evolution and maturation from its revolutionary origins to its current form as the preeminent means of practicing medicine, there are still good reasons to be unsatisfied with EBM. This essay explores two important new developments in EBM: recently articulated accounts of the scientific basis of EBM, and the related writings of the GRADE Working Group to create standards for interpretation of the medical literature and evaluation of recommendations. ⋯ These recent developments in EBM reveal that if the clinical research literature is to be informative or foundational to the enterprise of health care, much work needs to be done to secure its trustworthiness and integrity. An agenda for examining trust and trustworthiness in the context of health research is proposed.