Stop Trying Research Articles

“You are not a beautiful and unique snowflake”

“You are not a beautiful and unique snowflake”

Identity Making from Soap to Nuts

Identity Making from Soap to Nuts

Doctor Does Not Know Best: Why in the New Century Physicians Must Stop Trying to Benefit Patients

While twentieth-century medical ethics has focused on the duty of physicians to benefit their patients, the next century will see that duty challenged in three ways. First, we will increasingly recognize that it is unrealistic to expect physicians to be able to determine what will benefit their patients. Either they limit their attention to medical well-being when total well-being is the proper end of the patient or they strive for total well-being, which takes them beyond their expertise. Even within the medical sphere, they have no basis for choosing among the proper medical goals for medicine. Also, there are many plausible strategies for relating predicted benefits to harms, and physicians cannot be expert in picking among these strategies. Second, increasingly plausible ethical systems recognize that in some cases, patient benefit must be sacrificed to protect patient rights including the right to the truth, to have promises kept, to have autonomy respected, and to not be killed. Third, ethics of the next century will increasingly recognize that some patient benefits must be sacrificed to fulfill duties to others - either the duty to serve the interests of others or other duties such as keeping promises, telling the truth, and, particularly, promoting justice. Physicians in the twenty-first century will be seen as having a new, more limited duty to assist the patient in pursuing the patient's understanding of the patient's interest within the constraints of deontological ethical principles and externally imposed duties to promote justice. The result will be a duty to be loyal to the consumer of health care with the recognition that often this will mean that the physician is not permitted to pursue the physician's understanding of the patient's well-being.

Retirement and the parable of the fishermen

Using a parable about a fishing community, the paper draws morals for retirement policy‐makers. It concludes that government should phase out universal pensions, reduce taxes, avoid tax discrimination for savings, stop trying to influence market interest rates and promoting consumption, and remove barriers to trade and investment.

Principle and Process in the Ethics of Educational Research: Response to Robin Small

For readers of this journal, some background on the differences between cricket and baseball might be helpful. In cricket (as I understand it), the bowler throws the ball to a batsman. If the batsman fails to hit the ball, and it knock the wooden bails off the wicket, the batsman is out. A material effect occurs, and it is plainly visible to all participants. In baseball, the analogue is when a pitcher throws the ball to a batter, and the batter fails to hit the ball. In this instance, the umpire, positioned behind the catcher (analogous to the wicket-keeper), must make a judgement about whether the ball passes through the `strike zone', the rectangular air space from the batter's knees to chest-height, and across the width of the home base. The umpire is supposed to call a throw that passes through this space a `strike', and outside it, a `ball'. Since the throws from a pitcher sometimes exceed 100 miles per hour, and are frequently following a curved trajectory, the umpire's call is often a topic of great dispute among the competing teams' players, managers, and fans. Slow-motion video replays and computer-enhanced graphics are sometimes marshalled in the analysis (after the fact) of whether the umpire's call was `correct' or not. Certain umpires have notoriously generous strike zones, others are stingy; some give more latitude to high throws, others to low ones; and so on. There is no higher court of appeal. All of this is background to the following famous baseball story, which goes that, during a particularly tense moment in a game, a throw came zipping in that brushed the very edges of the strike zone. The batter, pitcher, and catcher turned to ask the umpire, `What was that, a ball or a strike?' The umpire, taking his time, replied, `It ain't nothin' until I call it'. It may be because of my upbringing with such sporting anecdotes that I have so little difficulty with Robin Small's central thesis, that we should accept the rock-bottom proceduralism of group deliberative processes in making judgements about research ethics, and stop trying to establish objective codes that such committees can `apply' to tell them what is right and wrong. Where judgements of ethical or unethical research conduct are concerned, `it ain't nothin' until they call it'. In this essay, I want to focus more closely on some of the details, of Professor Small's argument: first to try to clarify, as I understand it, what he means by this claim; and second to suggest that the consequences of his argument are even more far-ranging than he seems to suggest. Dr Small's argument goes through a change from the beginning to the end of his essay. At the outset he says, `I will effectively be claiming that ethics committees provide better means for making good ethical decisions than such codes. That is, my claim is that codes of ethics are not very useful, and that ethics committees can be very useful, if they work properly'. He says that it need not be entirely either/or, but that `when an ethics committee is working properly, it goes by procedures and precedents, and not by referring to any code of ethics'. Yet, at the end, he says, `What role remains for codes of ethics in this new perspective? A helpful suggestion is made by Andy Clark, who writes: This reconception reveals such summary maxims as the guides and signposts that enable collaborative moral exploration. Here I think we have a sketch of the proper relation between codes of research ethics and the work of those groups of people who have to cope with ethical issues in educational research. We need not throw away our codes, but we should keep them in perspective'. I think you see the difficulty right away. An argument that begins by opposing codes and committees (principles and procedures) as alternative moral approaches, saying that committees are more useful than codes, ends by acknowledging that indeed codes can be very useful to committees, enabling the process of collective deliberation. …

History and the Idea of Progress ed. by Arthur M. Melzer, et al

806 Book Reviews TECHNOLOGY AND CULTURE in both East and West, to suggest that some day the Soviets might enter the personal computer marketplace” (p. 73). Many small errors also plague the book, including the details of the life of the founder of the Soviet semiconductor industry (pp. 60-61), the spelling of Walter McDougall’s name (p. 125), the role of Lunacharsky in GLAVNAUKA (p. 7), and the size of the vote for Vladimir Zhirinovsky in his first run for the Russian parliament (p. 152); Zhirinovsky received not the majority of the votes but the plu­ rality. Despite these flaws, the book contains some interesting informa­ tion and, if quotations and facts are carefully checked, can be of use to researchers. Rezun should be credited for identifying a promising network ofproblems and for making considerable progress in resolv­ ing them. Unfortunately, his admirable ambitions were not accom­ panied by sufficient scholarly depth and accuracy. Loren Graham Dr. Graham is professor of the history of science at MIT and Harvard University. History and the Idea of Progress. Edited by Arthur M. Melzer, Jerry Weinberger, and M. Richard Zinman. Ithaca, N.Y.: Cornell Uni­ versity Press. 1995. Pp. viii+271; notes. $37.50 (cloth), $14.50 (paper). In 1989, Communist regimes unraveled country by country throughout Eastern Europe. Francis Fukuyama responded to the dramatic collapse of Communism with an attention-grabbing essay, “The End of History?” Now he leads off this volume, twelve essays from an extended symposium held at Michigan State University (1990-91), with a restatement of his views under the title, “The Pos­ sibility of a Universal History.” Fukuyama had made several bold claims in his earlier essay (which elicited strong reactions from several of the symposium’s contribu­ tors) . The collapse of Communism meant the end of history, in his view, because it brought the unabashed victory of economic and po­ litical liberalism. The ideological struggles that had fired the imagi­ nation of intellectuals and created conflicting political movements now have no future. Western liberal democracy stands alone with no comprehensive ideological alternative to challenge it. For intel­ lectuals the future will prove “a very sad time,” absent the daring, courage, imagination, and idealism that had fueled their efforts. Hegel anticipated this end of history, writes Fukuyama here. He based his views of universal history not on the progress of science and technology but on the human struggle for “recognition.” Hobbes and other political theorists viewed history as dominated by self-interest and a struggle for self-preservation. Hegel, says Fuku­ TECHNOLOGY AND CULTURE Book Reviews 807 yama, took a more noble and accurate position: humans are willing to risk their lives to gain recognition, and this makes them truly hu­ man. Liberal democratic values embody this sense of self-worth; Communism thwarted it, and failed. The first set ofessays to follow Fukuyama’s piece study key contrib­ utors to the philosophy of history: Hegel, Machiavelli, Kant, Nietzsche, and Spengler. Most of the later essays, the focus of this review, deal more directly with Fukuyama’s claims. Richard Rorty vigorously agrees with Fukuyama. “We leftists,” he says, must give up our romantic visions. We should stop viewing Capi­ talism (capital C) as the great enemy, stop trying to reify History (“a large blurry object”), and “stick to small experimental ways of relieving misery and overcoming injustice.” Alan Gilbert sharply dis­ agrees with Fukuyama. Radicals, Gilbert counters, hold the same val­ ues as liberals. Marx expressed a fundamental democratic value when he declared that “the freedom of each is a condition for the free development of all,” Gilbert argues. Radicals, moreover, pursue democratic values more consistently and faithfully than the pro­ fessed liberal U.S. leaders who claim to live by them. U.S. support for oppressive military dictatorships shows that power, not democracy, determines U.S. foreign policy. Connor Cruise O’Brien sides with the liberals. He views the tri­ umph of Western liberal democracy as a victory of a pragmatic and flexible Anglophone expression of the Enlightenment over a dog­ matic and arbitrary Francophone version, a version embodied by Communism. However, O’Brien disagrees (as do other symposium authors) with Fukuyama’s contention that the defeat...

The recession of 1990: An Austrian explanation

Deficit spending and money-supply expansion do not eliminate recessions. Theycause recessions. This fact will never be understood unless economists and government policymakers stop trying to micro-manage the economy, and start studying what their actions are doing to the structure of production. Heavy inflation of the money supply followed by sharp cutbacks change the rules right in the middle of the game for millions of businesses in the economy. For the last 40 years, government expansionary policies have stimulated industries to create false and untenable investments. These policies are followed by government corrective actions that destroy those same projects—waste the billions of dollars invested in them, and throw millions out of work. Business cycles are not an essential feature of market capitalism. They are the result of government interference with the market.

“I was just learning the ropes”: becoming a practitioner of safer sex

On the eve of the 21 st century, diverse communities face a future of continual management of the AIDS epidemic. Changes in sexual activity have become the primary method to curb the continued transmission of HIV. Safer sex has emerged as a collection of practices and ideas deployed to combat the spread of AIDS. Since sex workers make it their business to exchange sexual services for economic compensation, many have become extremely sophisticated in their innovations and expressions of eroticism using safer sex techniques. Based on original empirical research, this paper explores how becoming a competent practitioner of safer sex involves the alignment of particular social conditions and transformations of identity. I'm very angry about the fact that people keep talking about safe sex educators and safe sex control of the sex workers because we're not the problem. If anything, we're one small population where there is a solution going on. There are a lot of people, doctors and health educators included, who don't have a clue and could learn a lot from us. That's true. And see when you're talking to a health educator, they don't have hands-on experience. The tips they give you, they're not things you're going to go home and do, you know? I mean you want to learn it from somebody who actually knows how to have fun doing it. Yeh, I'm so tired of that myth. Excuse me, but if you doctors do know anything about safe sex, most of them learned it from us. So please, stop trying to save us. Come learn from us; let us educate you.-Michelle, 6 year veteran prostitute

"Weight cycling" and mortality: how do the epidemiologists explain the role of intentional weight loss?

In the past 5 years, four prospective, epidemiologic studies of "weight cycling" found that mortality is higher for persons with unstable body weight than for persons whose body weight is relatively stable [1-3,5]. These findings have generated considerable interest and controversy in both the scientific community and the lay press because of the belief that the weight fluctuations were caused by intentional weight loss. None of these studies, however, collected information that would indicate whether the weight changes were intentional or unintentional. This review examines the reasons given by the authors of these studies to support the inference that intentional weight loss caused the increase in mortality. The authors acknowledged that weight loss can be caused by preexisting illness, and they usually made efforts to control for the confounding effects of illness in their analyses. However, they generally concluded that the weight fluctuations resulted from unsuccessful dieting, but no data were presented on the incidence or causes of weight fluctuation in the populations from which the samples were drawn. In none of the studies did the authors recommend that obese persons stop trying to lose weight. The reader is cautioned to await further studies in which intentionality of weight loss is directly assessed before concluding that dieting to reduce weight increases the risk of mortality.

But Not Alone

Anyone wishing to help infertile couples must recognize that the most intractable problem of infertility is living indefinitely with an uncertainty that may never be resolved until that moment when you decide, finally, to let go of all hope and stop trying to become pregnant. I have come to believe what others have told me: that anything can be endured more easily than experiencing profound sadness on every painstakingly regulated day of every carefully monitored menstrual cycle without ever knowing whether it is time to grieve for the child you will never have. Trying to conceive, for me, was a source of hope but also of protracted agony, because it meant I could never leave my sadness behind me. My husband and I struggled with infertility for a blessedly brief time—2 1/2 years. Even so, I am moved to share my thoughts because I was particularly bad at learning to

In Quest of Practical Communication

The purpose of this article is to present a tongue-in-cheek look at physical education language. Upon examining the language and terminology used in physical education and research literature, the authors have developed lists of commonly used physical education terminology and explained how to use the lists to make scholarly or researchsounding sentences. The subtle message of the article is “Stop trying to impress. Speak and write to be understood.”

The Hopelessly Unconscious Patient

The great advances in medicine have brought countless benefits to mankind. Many patients today enjoy active, comfortable, productive lives after being literally brought back from the dead by our resuscitative skills. On the other hand, the same scientific advances have created a tremendous moral, medical and ethical problem for society and the physician—the problem of the hopelessly unconscious patient. Are we prolonging life in these patients or merely prolonging the act of dying? When should we, if ever, stop trying to sustain a patient's life? What is life and, perhaps of greater importance, what is death?These are some of the questions Dr. Adriani and Father Moraczewski examine. These gentlemen, of great stature in their respective fields, hold somewhat divergent views of this problem but share a common deep concern and compassion for the hopelessly unconscious patient.

It's All in the Approach

A small three-year-old Mexican girl cried loudly as she clung to her mother. Tears streamed down her cheeks, as I tried to apply the blood pressure cuff to the child's tiny arm. Another student nurse had already faced this same dilemma and had sought my help. Together we tried to tell little Maria that she had nothing to fear. Since she spoke only Spanish, our explanation in English did little good. Even if she had understood us, she could not have heard us above her crying. Maria had congenital heart disease. She had come from Mexico City for corrective surgery. Her operation was scheduled for that afternoon. It was important that her blood pressure be checked and we were determined to check it. To prove to her there was nothing to fear, we tried taking each other's blood pressure. We wrapped the cuff around her doll's arm. Nothing worked. Maria continued to cry. Her breathing became heavier, her skin clammy and cyanotic. We were about to stop trying and let the child rest when the chief of cardiology entered. He sat in the chair across the room and watched us as we tried one last time. Still we were unable to take her blood

The Family Group in Golden Hamsters: Its Formation and Break-Up

AbstractI. Behaviour of the golden hamster during normal parturition is described. 2. This is compared with behaviour of mothers who did not rear their litters because of faulty response to suckling attempts by the pups. Absence of milk at the nipples is suggested as a cause for this unwillingness to nurse. 3. Pups which are not born in the nest are often abandoned. 4. Pups born dead are often treated as food, but live pups are not eaten until after parturition is over. 5. Litters do not form into the characteristic compact unit until they have fed and been brooded. 6. Three stages in family break-up are recognised: (i) At about twentyfive days the mother begins to wean her litter, stops rebuilding the old nest, and may build a smaller one elsewhere. It is possible she would normally leave her litter at this point. (ii) During their fifth week the pups stop trying to suckle and showing contact behaviour ; they begin to sleep in small groups, and seem to try to escape from the mother's cage. At this time the mother attacks them occasionally. (iii) With sexual maturity of the females (six weeks) play-fighting stops, and marking was not seen. If a female becomes pregnant she becomes dominant in a few days, but does not dare fight the mother. 7. It is likely that the third stage is an artefact of captivity and that the litter would be left by the mother in stage (i) and would largely disperse during stage (ii) in natural conditions. 8. The interpretations of observations described are necessarily tentative, and need experimental tests before they can be accepted.

Beyond the Cold War

Before the United States can extricate itself from the untenable position in world affairs which it is cur rently maintaining, it must learn that it cannot prevent a third world war by means which would have avoided the sec ond. The Soviet Union is not a duplicate of Hitler's power- hungry fascist state, determined to obtain world domination at all costs. The Russians and Chinese would much prefer to devote their energies to their internal affairs; our policy of con taining and encircling the Communists has generated the very military power which we fear. We must learn, since we can not make a fortress of the Western world, to withdraw grace fully from our outposts. We must accept the changes taking place in the world and stop trying to force history into our own pattern. With the end of the garrison state must come a con version of that tremendous part of our economy currently spent on armaments to such useful purposes as education and slum clearance. Increased negotiation will lead to an increase of mutual trust, which in turn will lead to the international co- operation and trade which are such an inevitable outgrowth of modern technology. Under capable leadership the United States can do much to make the world a unit for the benefit of mankind, instead of, as it now is, a unit for holocaustic war.—Ed .