What is medicine?: towards a philosophical approach.

The failure of Western medicine to deal with many of the problems it is currently facing has led to an awareness of the need for a fundamental reappraisal. The way in which medical concepts derived from the nineteenth century have brought technical medical advances in this century and the alliances that medicine has made with statistics and more recently the social sciences, have prevented a questioning of medicine''s underlying assumptions. Thus, despite a number of critical initiatives from both within and outside medicine, there has been no coherent development to seriously confront the question ''what is medicine?''. It is suggested that the basis for such a development depends on the return to a philosophical questioning of our conceptual understanding of disease, a subject which has largely been ignored during the past hundred years.     

The role of computers in preventive medicine in a rural family practice.

Five family physicians in a group practice in rural Quebec have introduced a computer system to improve the delivery of preventive medicine. In addition to billing, the computer is used mainly to recall specific groups of patients for preventive measures, to prompt the physicians to carry out certain procedures at the patient's next visit, to indicate which procedures are required for the family members and to generate reminder letters. The physicians are conducting a randomized controlled trial to evaluate the impact of computer-generated reminder letters on patient compliance and disease prevention among families in their practice.     

The model of western integrative medicine: The role of Chinese medicine

The basic concept of integrative medicine(IM) is that by combining mainstream(biomedicine) with complementary and alternative medicine(CAM), synergistic therapeutic effects can be attained.When the methods of mind/body medicine(MBM) are added to this combination,as in Western countries,a new concept emerges that drastically changes the approach toward illness. It is interesting to note that the joining of traditional Chinese medicine and Western medicine in the early days of the Peoples’ Republic of China preceded the Western model of IM by almost 50 years.Several elements that make up the key components of IM as practiced today in the West were already present in the Chinese version of IM,and Chinese medicine has played and continues to play an important role in advancing IM.However,one of the major differences between the Chinese and the Western models of IM today,besides MBM and some other treatment options,is that Western integrative medicine(WIM) strictly requires its CAM methods to be supported by scientific evidence. The therapeutic methods of IM and their applications are many and varied.However,they are most frequently employed to treat chronic medical conditions,e.g.,bronchial asthma,rheumatic disease, chronic inflammatory bowel disorder and chronic pain.Other fields in which IM may be applied are internal medicine(inflammatory bowel diseases and cardiovascular diseases),musculoskeletal disorders,oncology (chemotherapy-induced side effects),obstetrics and gynecology(dysmenorrhea,endometriosis,infertility and menopausal complaints),pediatrics,geriatrics,neurology(migraine and chronic headache),and psychiatry (anxiety and depression). The concept of WIM is discussed here in detail by reviewing its scope and implications for the practice of medicine and focusing on the role of Chinese medicine in WIM.     

Human reproductive technologies and the law: a select committee report

The House of Commons Science & Technology Committee has reviewed the Human Fertilisation and Embryology Act. It considered a) the balance between legislation, regulation and reproductive freedom; b) the role of Parliament in human reproductive technologies; and c) the foundation, adequacy and appropriateness of the ethical framework for legislation. It also considered the Act itself and the workings of the Human Fertilisation and Embryology Authority. Its report is written from a very liberal perspective, but is a very thorough overview of current issues and debate in the field. There follow, slightly abridged, the conclusions and recommendations of the 200-page report.     

The impact of United States law on medicine as a profession

Sara Rosenbaum, JD

JAMA. 2003;289:1546-1556.

The evolution of US law has had an enormous influence on medicine as a profession, and much of this legal evolution can be attributed to changes in the science and practice of medicine. This changing legal framework and its intersection with medicine has many facets. Three of the most important facets concern the evolution of the no duty-to-treat principle and the role of modern health care financing and civil rights law in altering this rule, the manner in which advances in medicine led courts and legislatures to change the standards against which professional medical liability is measured, and the basic loss of highly preferential treatment under US laws aimed at preventing anticompetitive conduct by businesses. However, despite the impact on the profession of an evolving legal system, concern over the integrity of medical professionalism continues to significantly influence both laws and lawmakers, including legislatures, regulatory agencies, and the courts.