Implications For Medical Research Research Articles

What is “Healing”?: Reflections on Diagnostic Criteria, Nosology, and Etiology

This article examines the conceptual history and contemporary usages of the term "healing." In response to longstanding definitional ambiguity, reflections are offered on what are termed the diagnostic criteria, nosology, and etiology of healing. First, a summary is provided of how healing has been defined within medicine. Second, the dimensionality of healing is discussed. Third, healing's putative determinants are outlined. For biomedicine, healing mainly concerns repair of wounds or lesions and is unidimensional. For complementary medicine, by contrast, healing has been defined alternatively as an intervention, an outcome, and a process-or all of these at once-and is multidimensional, impacting multiple systems from the cellular to the psychosocial and beyond. Notwithstanding these usages, a review of medical texts reveals that healing is rarely defined, nor is its dimensionality or determinants described. Persistent lack of critical attention to the meaning of "healing" has implications for medical research and practice.

Whole Health/Integrative Health in the VHA: Focusing on What Matters to the Veteran Rather Than What is the Matter with Them

This article examines the conceptual history and contemporary usages of the term “healing.” In response to longstanding definitional ambiguity, reflections are offered on what are termed the diagnostic criteria, nosology, and etiology of healing. First, a summary is provided of how healing has been defined within medicine. Second, the dimensionality of healing is discussed. Third, healing’s putative determinants are outlined. For biomedicine, healing mainly concerns repair of wounds or lesions and is unidimensional. For complementary medicine, by contrast, healing has been defined alternatively as an intervention, an outcome, and a process—or all of these at once—and is multidimensional, impacting multiple systems from the cellular to the psychosocial and beyond. Notwithstanding these usages, a review of medical texts reveals that healing is rarely defined, nor is its dimensionality or determinants described. Persistent lack of critical attention to the meaning of “healing” has implications for medical research and practice.

Biobank-related research and intellectual property rights: deconstructing the obscurity

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HHS Guidance on Synthetic DNA Is the Right Step

Synthetic biology has advanced to the point where some pathogens can be manufactured from scratch. This technical leap has beneficent implications for medical research and vaccine design, but it also raises concerns that the technology could be used to produce a deadly pathogen for nefarious use. Addressing these concerns, the Department of Health and Human Services (HHS) released their Screening Framework Guidance for Providers of Synthetic Double-Stranded DNA on October 13, 2010. They took the right approach: The oversight framework for gene synthesis companies included in this guidance is adaptable to new technical developments and changing risks, it can be implemented immediately, it can be readily adopted by other countries, and it will cost little. Though there have been some calls to increase the regulatory controls on synthetic biology, these should be resisted. For now, at least, the oversight is appropriate to the risks.

Genetic structure of a unique admixed population: implications for medical research

STATEMENT: In naming population groups, we think a chief aim is to use terms that the group members use themselves, or find familiar and comfortable. The terms used in this manuscript to describe populations are as historically correct as possible and are chosen so as not to offend any population group. Two of the authors (DCP and REvdR) belong to the Coloured population, with one of the authors (REvdR) having contributed extensively to current literature on the history of the Coloured people of South Africa and served as Vice-President of the South African Institute of Race Relations. According to the 2001 South African census (http://www.statssa.gov.za/census01/HTML/CInBrief/CIB2001.pdf), "Statistics South Africa continues to classify people by population group, in order to monitor progress in moving away from the apartheid-based discrimination of the past. However, membership of a population group is now based on self-perception and self-classification, not on a legal definition. Five options were provided on the questionnaire, Black African, Coloured, Indian or Asian, White and Other. Responses in the category 'Other' were very few and were therefore imputed". We have elected to use the term Bushmen rather than San to refer to the hunter-gatherer people of Southern Africa. Although they have no collective name for themselves, this decision was based on the term Bushmen (or Bossiesman) being the more familiar to the communities themselves, while the term San is the more accepted academic classification. Understanding human genetic structure has fundamental implications for understanding the evolution and impact of human diseases. In this study, we describe the complex genetic substructure of a unique and recently admixed population arising approximately 350 years ago as a direct result of European settlement in South Africa. Analysis was performed using over 900 000 genome-wide single nucleotide polymorphisms in 20 unrelated ancestry-informative marker selected Coloured individuals and made comparisons with historically predicted founder populations. We show that there is substantial genetic contribution from at least four distinct population groups: Europeans, South Asians, Indonesians and a population genetically close to the isiXhosa sub-Saharan Bantu. This is in good accord with the historical record. We briefly examine the implications of determining the genetic diversity of this population, not only for furthering understanding of human evolution out of Africa, but also for genome-wide association studies using admixture mapping. In conclusion, we define the genetic structure of a uniquely admixed population that holds great potential to advance genetic-based medical research.

Ethical Trials to Determine the Risks and Benefits of Radiation Exposure from Coronary CT Angiography

This essay discusses the ethical implications of medical research using ionizing radiation in the diagnostic imaging range. Coronary CT angiography will be used as an example. Since coronary artery disease is the most common cause of death in the United States, any change in the work-up or management of patients with coronary artery disease has enormous clinical and economic implications. Risks of diagnostic radiation differ from those encountered in routine medical research as radiation-related cancers and heritable genetic damage can manifest in the irradiated individual or in subsequent generations. The risk to research subjects is ethically troubling because the research may not offer direct benefit to participants, although the benefits to society and future patients could be considerable. The American College of Radiology has a mandate to lead in the discussion of how to best minimize the risks of diagnostic radiation exposure in clinical research while encouraging studies likely to maximize benefits for future patients.

The Data Protection (Amendment) Act, 2003: The Data Protection Directive and its Implications for Medical Research in Ireland

Directive 95/46/EC on the Protection of Individuals with regard to the Processing of Personal Data and on the Free Movement of Such Data has been transposed into national law and is now the Data Protection (Amendment) Act, 2003. The Directive and the transposing Act provide for new obligations to those processing data. The new obligation of primary concern is the necessity to obtain consent prior to the processing of data (Article 7, Directive 95/46/EC). This has caused much concern especially in relation to 'secondary data' or 'archived data'. There exist, what seem to be in the minds of the medical research community, two competing interests: (i) that of the need to obtain consent prior to processing data and (ii) the need to protect and foster medical research. At the same time as the introduction of the Act, other prior legislation, i.e. the Freedom of Information Act, 1997-2003, has encouraged candour within the doctor-patient relationship and the High Court in Ireland, in the case of Geoghegan v. Harris, has promulgated the 'reasonable-patient test' as being the correct law in relation to the disclosure of risks to patients. The court stated that doctors have a duty to disclose all material risks to patients. The case demonstrates an example of a move toward a more open medical relationship. An example of this rationale was also recently seen in the United Kingdom in the House of Lords decision in Chester v. Afshar. Within the medical research community in Ireland, the need to respect the autonomy of patients and research participants by providing information to such parties has also been observed (Sheikh A. A., 2000 and Irish Council for Bioethics, 2005). Disquiet has been expressed in Ireland and other jurisdictions by the medical research communities in relation to the exact working and meaning of the Directive and therefore the transposing Acts (Strobl et al). This may be due to the fact that, as observed by Beyleveld "The Directive makes no specific mention of medical research and, consequently, it contains no provisions for medical research as an explicitly delineated category." (Beyleveld D., 2004) This paper examines the Irish Act and discusses whether the concerns expressed are well-founded and if the Act is open to interpretation such that it would not hamper medical research and public health work.

Pheromones cause disease: pheromone/odourant transduction

This paper compares two models of the sense of smell and demonstrates that the new model has advantages over the accepted model with implications for medical research. The accepted transduction model had an odourant or pheromone contacting an aqueous sensory lymph then movement through it to a receptor membrane beneath. If the odourant or pheromone were non-soluble, the odourant/pheromone supposedly would be bound to a soluble protein in the lymph to be carried across. Thus, an odourant/carrier protein complex physically moved through the receptor lymph/mucus to interact with a membrane bound receptor. After the membranous receptor interaction, the molecule would be deactivated and any odourant/pheromone-binding protein recycled.This new electrical chemosensory model being proposed here has the pheromone or other odourant generating an electrical event in the extra-cellular mucus. Before the pheromone arrives, proteins of the ‘carrier class’ dissolved in the receptor mucus slowly and continuously sequester ions. A sensed pheromonal chemical species sorbs to the mucus and immediately binds to the now ion-holding dissolved protein. The binding of the pheromone to the protein causes a measurable conformational change in the pheromone/odourant-binding protein, desequestering ions. Releasing the bound ions changes the potential differences across a nearby super-sensitive dendritic membrane resulting in dendrite excitation.Pheromones will be implicated in the aetiology of the infectious, psychiatric and autoimmune diseases. This is the third article in a series of twelve to systematically explore this contention (see references 1–9).

Children as carers: the impact of parental illness and disability on children's caring roles

The nature and extent of young caring in the UK continue to be a feature of a growing number of research programmes motivated by a children and carers' rights philosophy. However, the context in which young caring occurs as a result of parental ill‐health or disability can only be fully understood by examining the findings and implications of medical research into parental impairment, and the social movements that have served to re‐define the concept of ‘disability’ in society. This paper examines the arguments put forward by medical researchers, by those proposing a social model of disability and by those who have specifically investigated the conditions and experiences of young carers. It argues that children's caring roles within families where there is parental illness or disability need to be understood not only as a reflection of the nature of the medical condition itself, but as a consequence of complex family, social and economic processes. A ‘whole family’ approach is proposed, where the needs of children and parents are respected and responded to.

Compensation for harm: The implications for medical research

The rising incidence of medical litigation in the 1980's led to a relatively minor modification in January 1990 of the United Kingdom's negligence-based system of medical compensation, as a result of which employing Health Authorities now accept full vicarious liability for the negligent (but not other) actions of employed clinicians (Crown indemnity). During the same period, by contrast, bodies such as the Royal College of Physicians have strongly influenced locally established Research Ethics Committees towards favouring no-fault compensation for harm resulting from medical research. The discordance between these two approaches to compensation has caused anxiety during the last year. There has been particular concern about the possible discouragement of non-commercially sponsored research. Hitherto however, no data has been available to inform this discussion. This paper reports the findings of a questionnaire survey of all research ethics committees in the United Kingdom (64% response rate), which indicates that 61% of committees require no-fault compensation for at least some projects and that 33% of these committees have rejected projects solely or mainly due to the lack of such provision. Rejection is significantly more common in Health Districts which contain teaching hospitals. Our critical analysis of the arguments advanced in favour of no-fault provision for research subjects suggests that they do not place adequate emphasis upon respect for the autonomy of individuals. We consider that it is in general more consistent with such respect fully to inform research subjects of the available compensation arrangements, rather than for ethics committees to make no-fault compensation a general requirement before ethical approval is given.

Observation of magnetically induced polarization in a ferrofluid

Light transmitted through a magnetite colloid subjected to a pulsed magnetic field is analyzed to determine particle size. Absorption measurements of light give a measure of the magnetic dipole moment. A comparison with theoretical estimates for particle coagulation is made and implications for medical research are noted.

Diagnostic aspects of computer applications in medical research on the University of Pennsylvania.

The diagnostic implications of medical research utilizing a digital computer are discussed according to the type of mathematical analysis and/or computer technique employed. Illustrative examples include the solution of differential equations in anesthesiology, the use of Fourier analysis in ballistocardiology, and the use of multiple regression analysis in neoplastic chemotherapy.