Debate In Medicine Research Articles

The essential drugs concept is needed now more than ever

The debate on access to essential medicines, which was live in the late 1970s and 1980s when strong pressure from public health advocates led the pharmaceutical industry to accept the concept, is now back on the international health policy agenda. Currently, the Essential Drugs List (EDL) forms an integral part of national drug policies in 146 countries, guiding the selection of drugs on the basis of public health relevance, efficacy, safety and cost. The essential medicines debate is back on the agenda as part of the access to medicines debate. The Trade Related Aspects on Intellectual Property Rights agreement has caused concern among public health advocates in terms of its impact on access to essential medicines. This article reviews the concept of essential medicines in the light of the changing political context and recommends that the EDL is supported as a crucial public policy tool in all countries.

Social medicine then and now: lessons from Latin America.

The accomplishments of Latin American social medicine remain little known in the English-speaking world. In Latin America, social medicine differs from public health in its definitions of populations and social institutions, its dialectic vision of "health-illness," and its stance on causal inference. A "golden age" occurred during the 1930s, when Salvador Allende, a pathologist and future president of Chile, played a key role. Later influences included the Cuban revolution, the failed peaceful transition to socialism in Chile, the Nicaraguan revolution, liberation theology, and empowerment strategies in education. Most of the leaders of Latin American social medicine have experienced political repression, partly because they have tried to combine theory and political practice--a combination known as "praxis." Theoretic debates in social medicine take their bearings from historical materialism and recent trends in European philosophy. Methodologically, differing historical, quantitative, and qualitative approaches aim to avoid perceived problems of positivism and reductionism in traditional public health and clinical methods. Key themes emphasize the effects of broad social policies on health and health care; the social determinants of illness and death; the relationships between work, reproduction, and the environment; and the impact of violence and trauma.

Doctors and Patent Medicines in Modern Britain: Professionalism and Consumerism

In the late nineteenth century professionalism and consumerism collided in a vociferous debate over the commodification of health. In medical journals, before government panels and through independent publications, doctors condemned “quackery,” especially patent medicines—the Victorian appellation for over-the-counter drugs. They dismissed myriad pills, tonics and appliances as addictive, dangerous, or useless. This professional critique, doctors claimed, was an altruistic defence of patients. Their commercial opponents, patent medicine men (and frequently the press), countered that the professional critique was rooted in a pecuniary struggle to achieve monopoly. While ascribing different motivations to each other, both sides assumed that medical professionals were unanimous in their condemnation of so-called “secret remedies.” Peter Bartrip has shown, though, that professional opposition to patent medicines was far more complex and muddied by self-interest. TheBritish Medical Journal, while criticizing patent medicines, carried ads for them, which made the BMA the focus of allegations of hypocrisy in theJournal of the American Medical Associationand before the Select Committee on Patent Medicines (1912). At the organizational level, Bartrip has established that the financial interests of the British Medical Association undercut its opposition to patent medicines. This compromised position, I will argue, permeated the profession. If the British Medical Association could not resist the advertising revenue derived from patent medicines, it was equally true that many doctors could not resist recommending patent medicines to patients. Far from epitomizing professional altruism, the patent medicine question demonstrates the reluctance of doctors to abandon individual self-interest in the wake of consumerist challenges that would ultimately transform twentieth-century medical practice. In doing so, the patent medicine debate engages and complicates arguments about the role of collective social mobility in the history of the professions.

On this we agree: The value of healthy debate in medicine

On this we agree: The value of healthy debate in medicine

Consensus report on quality control of quantitative measurements of renal function obtained from the renogram: International consensus committee from the scientific committee of radionuclides in nephrourology

Among all the physiological indices that can be quantified using renography, measurement of renal function is the most basic. These measurements are used to make critical clinical management decisions and, as such, their reliability needs to be quality assured. This article seeks to address each aspect of the renography procedure, with particular emphasis on the effect on measurement of relative renal function. Estimation of individual kidney function is mentioned, but only briefly. A consensus approach was adopted, overseen, and directed by a chairman appointed by the Scientific Committee of the International Radionuclides in Nephro-Urology Group. The chairman selected the panel of experts from eight different countries based on their practical experience in the field. Where evidence exists to support the various recommendations it is given. Otherwise, the stated guidance represents the considered opinion of a body of experts, based on long experience and unpublished data. Some necessary compromises were made to account for the fact that renography is seldom performed solely with the purpose of measuring relative renal function. The technicalities of renography have always been a source of debate in nuclear medicine, which is reflected by the fact that a consensus could simply not be reached on a small number of issues. The structure of the report ensures that these are clearly indicated. This should serve to highlight gaps in our current knowledge, thus helping to direct future research. It is envisaged that the recommendations will be revised on a 2-year cycle to ensure that they remain up to date. An "open" process will be used to encourage participation and ownership. It is hoped that promotion of these guidelines, suitably complemented by audit processes, will raise standards in the practice of gamma camera renography.

Struggle for control. General practitioners in the Swedish health care system

This paper reports on findings on the perspectives of general practitioners (GPs) in Sweden since the introduction of the Stockholm model. The research design was exploratory with the intention of discovering several perspectives shared by doctors. The subjects were asked to describe their work, how long they had been working and to describe whether they were familiar with the Stockholm model. Questions also focused on professional autonomy, the use of diagnostic related groups (DRGs), the isolation of work and the possible impact on patient care. While previous research suggests that may be losing autonomy, the experience in Sweden, in particular, as it relates to GPs, may be different. Most of the interviewed reported that the Stockholm model had increased productivity and efficiency, that economic incentives influenced their medical decisions and that medical treatment appears more patient focused than before. GPs reported an enhanced social and economic status within the medical profession since the introduction of the Stockholm model. T.is paper introduces an international perspective into existing research and scholarship on the changing status of the medical profession in Sweden and investigates the dominant (sometimes explicit and usually implicit) question that is undergoing significant change with serious implications for the practice of medicine.1 In the preface to 'The Changing Medical Profession: an International Perspective', Mckinley and Hafferty2 stated that As nations across the globe face the rising tide of health care costs and the prospect of massive changes in the organization and financing of health care, issues of the structure of physician autonomy, shifts in the status of state-professional relations and ultimately the reconceptualization of medicine and its place in society will shape the debate in medicine. (p. 1). Duran-Arenas and Kennedy3 suggested that power is central in the analysis of professional power and that the relationship between the state and the medical profession mediated by community or societal concerns may play a major role in predicting the future role of doctors (p. 37). This paper reports findings on the perspectives of general practitioners (GPs) in Sweden since die introduction of the Stockholm model. While previous research has concluded that, by and large, in die decade of cost control and retrenchment, have suffered because of loss of autonomy and increased deskilling, the experience in Sweden in particular as it relates to GPs might be different at least in relation to their economic and social status widi the other medical specialities. There is no doubt that in

Reframing women's health in nursing education: A feminist approach

To operate from a feminist paradigm is a new way of thinking for nurse educators. Feminist perspectives in nursing provide a new stage of consciousness--one that values women's voices, their way of knowing, and their life experiences, and, most important, one that challenges traditional patriarchal practices. Furthermore, nursing curricula with feminist perspectives provides a biopsychosocial approach that encourages the full recognition of variables that can influence women's health, such as socioeconomic status, racial and ethnic background, and biobehavioral factors. The debate in medicine over a specialty in women's health is not unique. The history of academia abounds with descriptions of struggles to establish new fields and disciplines. Recent specialties, such as pediatrics and gerontology, which are distinguished by age rather than specific organ or system, struggled for establishment and recognition. Historically, nursing curricula has emulated the biomedical model that is reductionistic and contradictory to nursing's holistic mission. Rather than classifying women's health into a separate entity, women's health may be introduced into present curricula by employing feminist ideals and pedagogy throughout the curriculum. This approach would provide a mechanism to explore women's health issues that were previously minimally addressed at best, or not addressed at all. More important, students would be provided with an opportunity to examine the societal effects of racism, sexism, and classism, and this education would potentially lead to a growing awareness of concerns specific to women and minorities.

Emergency department observation beds improve patient care: Society for academic emergency medicine debate

Summary Pro Side: Dr Graff What we are dealing with is not a physical unit but in reality a concept. We are not emergency room doctors — we are emergency physician specialists. We deal with emergency medicine in all its aspects; we don't deal with a room. Whether you have an observation unit or an observation policy, what is important is the concept of how to deal with a certain type of patient. The overcrowding issue may actually help us. Rather than us putting our head into a hole saying we can't deal with this type of patient — ie, we don't deal with continuing care — we should provide ongoing care for a certain type of patient, a patient who is appropriate for an observation unit. We shouldn't deal with a patient who is appropriate for admission to the hospital, who has 20 or 30 medicines, and who needs intensive services. We are going to manage patients who have a limited intensity of service that we define as manageable for our nurses, a level of service similar to that on the medicine floors. This saves the bed upstairs for patients who are train wrecks with very high service needs that would consume our staff's energies. At the same time, we are offering to society a way of dealing with the health care crisis. The latest Health Care Financing Administration statistics show that more than 12.4% of our nation's gross national product is for health care. This is up from 11.6% of the gross national product from last year despite cost-containment studies and efforts. Our specialty should have input into solutions being developed for these problems. With observation units we are part of the safety net for the population, managing many common emergencies that otherwise would have needed hospital admission. We are part of the solution trying to deal with health care policy.

Medical Critique [Krytyka Lekarska]: A Journal of Medicine and Philosophy - 1897-1907

Medico-philosophical reflections were developed in the 19th and the 20th centuries by three consecutive generations of Polish physicians, active in what was later named the Polish School of Philosophy of Medicine. The second generation of this school published its own journal, Medical Critique [Krytika Lekarska], from 1897 to 1907. Medical Critique included numerous articles on the nature of medical knowledge, the reductionism versus holism debate in biology and medicine, the importance of teleologically-oriented approaches in medicine, the influence of theories and of a priori ideas on clinical observations and on 'clinical facts', the problem of classification of diseases, the normative and ethical dimension of medicine, and the ion relationships between philosophy, history and medicine. The existence of a journal dealing specifically with theoretical reflections on medicine undoubtedly contributed to the propagation of original work in the philosophy of medicine in Poland.

1983 Society of teachers of emergency medicine debate

*Associate Residency DIrector, Department of Emergency Medlclne, Henry Ford Hospital, Detroit, Mlchlgan TAsslstant Professor, Dlvlslon of Emergency MedIcal Services, Uwersity of Connecticut and Director, Department of Emergency Medicine, St. Francls Hospital and MedIcal Center, Hartford, Connecticut *ClInical AssIstant Professor of Emergency Medlclne, Unlverslty of Illlnols, College of Medlclne at Peoria, Director of Emergency Medtcal Serwces. St. Francls Medlcal Center, Peoria, lltlnols §Professor, Dwsion of Emergency Medicine, Department of Surgery, University of Colorado Director, Department of Emergency Medicine, Denver General Hospital

Controversy in Medicine Debate: the defect in rheumatoid arthritis is inherent to the lymphocyte.

Controversy in Medicine Debate: the defect in rheumatoid arthritis is inherent to the lymphocyte.

Breast Cancer Revisited

The recently published DEBATES IN MEDICINE (230:95-109, 1974) point out some of the crucial problems that persist in the evaluation of the proper treatment of breast cancer. Attempts to define treatment on the basis of differences in survival rates of 5% to 10% in uncontrolled retrospective studies make no sense in terms of what we know about the disease. Furthermore, even the prospective randomized studies do not clearly define the elements necessary for proper evaluation of treatment. Not all cancers of the breast behave in the same manner. It is fundamental in understanding breast cancer treatment to define what (little) we know about its natural history. In terms of the average doubling time (30 days), a 2-cm lesion has been present for approximately eight years prior to diagnosis. If the volume of a spherical cancer is given by the formula, 1/6πd3 (or 4.189×r3), then an increase in size from