The future of social medicine

The future of social medicine is based on 150 years of history and the rapidly evolving context within which medicine functions in modern societies. There are two views of social medicine. One is based on the vision of Guerin and, particularly, Virchow 150 years ago that: ”Doctors are the natural advocates of the poor, and social problems are largely within their jurisdiction.” The New York Academy of Medicine's Institute on Social Medicine 50 years ago reflected this broad view. Medicine, however, enamored of the biomedical paradigm and the advances in knowledge through biomedical research, largely abandoned this broad perspective, even as the knowledge about the social, behavioral, and environmental determinants of health was advancing rapidly. A second view of social medicine, and one that has influenced many in the past 30 years, was defined by McKeown and Lowe: ‘Social medicine is concerned with a body of knowledge and methods of obtaining knowledge appropriate to a discipline. This discipline may be said to comprise (a) epidemiology, and (b) the study of the medical needs of society, or in the contemporary short hand medical care.” Social medicine, in my view, includes not only the definition of McKeown and Lowe, but the broader context within which medicine fits in society. The context is changing. The social contract as defined by Bismarck and Beveridge has to be redefined. Just as the New York Academy of Medicine provided the vision of social medicine 50 years ago, the Academy has given us a new vision with the publication ofMedicine and Public Health: the Power of Collaboration in 1997. Authored by Dr. Roz Lasker, director of the Academy's Division of Public Health, the book identifies the key changes required by medicine and public health to advance the goals of medicine and public health for the benefit of both individual patients and the population as a whole. The book points the way for the future of social medicine by identifying not only what needs to be done, but also how to do it.     

胰岛素类药物的进展与未来

自从Von Mering及Minkowski于1889年用胰腺切除术使狗患类似人的糖尿病后,一些国家的医务工作者争先致力于从胰腺中制备出治疗糖尿病的物质。1911年至1921年由于Banting、Best、Collic利Macleod的共同努力,从动物胰腺中成功制备出这种物质一胰岛素。1922年首次将胰岛素应用于14岁病儿获得良效,从此开创了糖尿病治疗的新时代。70多年来胰岛素的应用取得了很大进展,本文简述近年来胰岛素类药物治疗糖尿病的一些新进展。1 胰岛素制剂的类型1.1 常规胰岛素(普遍重结晶胰岛素)是从猪或牛胰腺中提取并用重结晶方式生产的胰岛素制剂,该制剂自胰岛素开始应用至今已70余年历史,是应用最早最普遍的胰岛素,我国生产的     

Overview of the clinical application of regenerative medicine products in Japan

OBJECTIVE: To identify barriers to the clinical application of regenerative medicine products (RMPs) in Japan. METHODS: Current Japanese regulatory systems and guidelines were compared with those of the United States (US) and the European Union (EU). A questionnaire was administered to representatives from 23 Japanese companies and 10 research institutes, and an in-person semi-structured interview was conducted with representatives from 10 companies that develop RMP. RESULTS: We found that Japan, the US and the EU have similar pre-clinical safety guideline frameworks relating to RMP. However, differences exist between these countries with respect to their review and approval systems and the implementation of guidelines, and these represent major barriers to the clinical application of RMP in Japan. Most companies studied are facing regulatory hurdles such as stringent review processes and regulatory guidelines that do not provide detailed practical examples of the pre-clinical quality and safety data required. CONCLUSIONS: These results suggest that effective regulatory infrastructure including regulatory systems, guidelines, and communication channels between product developers and regulatory bodies are essential for the prompt clinical application of RMP in Japan.     

Evidence and the future of medicine

For the foreseeable future, the rapid influx of information from sequencing the human genome will raise to a still higher level the complexity of scientific and ethical issues confronting the practice of medicine. Sustained attention to the nature and quality of medical evidence and the extent of medical uncertainty is thus important for all concerned--health care providers, policy makers, the media, and the general public. The situation poses a special challenge for educators. This article presents the author's Ethics of Evidence, an approach for dealing with the uncertainties of medicine in the full context of contemporary culture. Meant to be of service to all of society, the Ethics of Evidence can be symbolized by a lighthouse--a beacon to warn of danger and to show the way. It is illustrated here by the example of hypertension, a medical condition afflicting tens of millions of Americans.     

Community medicine: future imperfect?

The development of community medicine is seen in historical perspective and found to be a redirection of preceding trends rather than the development of new concepts. The current problems of the specialty are reviewed and found to be due to erroneous perceptions of its role by many doctors, to the specialty's present preoccupation with its academic purity, and to the failure to provide within the National Health Service the resources that were vital to the functions it was asked to perform. It is argued that the essential skill of community physicians is epidemiology, which must be applied within the management process of the National Health Service to enable it to adapt itself to the needs of changing disease patterns. It must also be applied to the prevention of disease and this will necessarily involve the community physician in much wider social problems than the provision of medical care services. This second responsibility may well prove to be the more crucial in the longer term.