Will our health system fall apart? The need for a new paradigm

It is a truism that medicine is in a crisis but the truism is right. This paper sets out the symptoms of the crisis. The effectiveness of modern medicine has been questioned by many. Doctors use too many tests and do not always understand the results. This is the practice of 'decerebrate medicine'. The alleged triumphs of modern medicine have made only a modest impact on mortality rates and death from iatrogenic causes is real. Modern medicine is allied to the industrial society with its hierarchies and division of work. This leads to tensions between doctors and between doctors and their patients. Administrators fear the progressive rise in health costs and ask whether more really means better. Economists demand evaluation of medical procedures and there is a growing demand for real preventive medicine. Health is a problem for the whole of society. This paper then sets out the epistemological aspects of the crisis in medicine. It suggests that a new paradigm must be constructed in the light of the scientific revolution. The concept of medicine based on analytical science with its reductionism and disjunctivism is not enough to cover the complexity of man. The new paradigm needs to embrace all the sciences, both of nature and of man. A view is given of how this process of comprehending an exceedingly complex problem should be tackled and the role to be played by information sciences.     

Traditional healing systems and the ethos of science

This paper addresses the challenge posed to traditional Chinese medicine by the ethos of science and explores three related assumptions. First, the ethos of traditional Chinese medicine is incompatible with the ethos of science. Second, the challenge of science to traditional Chinese medicine is represented by the requirement to comply with internationally recognized standards of medical research and practice applied to biomedicine, adopted and implemented by the State. The State requires that the safety and effectiveness of traditional Chinese medicine procedures and medications be ascertained following the methodology chartered by the ethos of science. Third, traditional Chinese medicine practitioners present a third ethos, the "ethos of pragmatic healing" based on the pragmatic acculturation of clinical practice, as an alternative to the ethos of science. This third ethos is an inadequate response to the challenge because it increases the divergence between health care policy requirements of scientific scrutiny and the fostering of traditional Chinese medicine as an icon of Chinese culture. The study is based on data from personal interviews with representative samples of three ethnic populations in Singapore; secondary data from other studies; relevant official data; and documents from biomedical and traditional Chinese medicine organizations. The methods include inductive analysis, multiple correlation and regression, and factor analysis among others. The analysis indicates that the pressure to comply with official health regulations and the inability to succeed under the ethos of science lead traditional Chinese medicine practitioners to respond with an ethos of pragmatic healing that eschews conceptual analysis, ignores the paradigmatic divide with biomedicine, and focuses on "using what works". This third ethos can only be a temporary response to the pressure to upgrade the practice of traditional Chinese medicine and it does not correspond to pragmatic acculturation commonly found in the population. The ethos of pragmatic healing leaves the challenge of science unresolved and it is likely to increase the level of conflict between the realm of biomedicine (including health care policy requirements of scientific scrutiny) and the ethos of traditional Chinese medicine.     

Images of scientific medicine

This paper draws on empirical evidence from recent survey and qualitative research to develop an analysis of lay perceptions of modern medicine and medical practice. It builds on previous exploratory work and examines lay evaluation of a range of medical procedures which include medicines and drugs; elective surgery; reproductive technology and life saving technology. Overall, there was an ambivalence to modern medicine and the criteria used to evaluate modern medicine included whether it was: life saving or life threatening, quality of life enhancing or diminishing, natural or unnatural, restored independence or created dependence, and whether it was good value for money or not. The theoretical implications of these findings for understanding the structure and nature of lay perceptions are discussed.     

Close to the bench as well as at the bedside: involving service users in all phases of translational research

Aim The paper aims to develop a model of translational research in which service user and other stakeholder involvement are central to each phase. Background ‘Translational’ is the current medical buzzword: translational research has been termed ‘bench to bedside’ research and promises to fast‐track biomedical advances in the service of patient benefit. Models usually conceive of translational research as a ‘pipeline’ that is divided into phases: the early phase is characterized as the province of basic scientists and laboratory‐based clinical researchers; the later phases focus on the implementation, dissemination and diffusion of health applications. If service user involvement is mentioned, it is usually restricted to these later phases. Methods The paper critically reviews existing literature on translational research and medicine. The authors develop a theoretical argument that addresses why a reconceptualization of translational research is required on scientific, ethical and pragmatic grounds. Results The authors reconceptualize the model of translational research as an interlocking loop rather than as a pipeline, one in which service user and other stakeholder involvement feed into each of its elements. The authors demonstrate that for the ‘interlocking loop’ model of translational research to be materialized in practice will require changes in how health research is structured and organized. Conclusion The authors demonstrate the scientific, ethical and pragmatic benefits of involving service users in every phase of translational research. The authors’ reconceptualized model of translational research contributes to theoretical and policy debates regarding both translational research and service user involvement.     

Rhetoric versus reality: The role of research in deconstructing concepts of caring

Our aim was to employ a critical analytic lens to explicate the role of nursing research in supporting the notion of caring realities. To do this, we used case exemplars to illustrate the infusion of such discourses. The first exemplar examines the fundamental concept of caring: using Florence Nightingale's Notes on Nursing, the case study surfaces caring as originally grounded in ritualized practice and subsequently describes its transmutation, via competing discourses, to a more holistic concept. It is argued that in the many and varied attempts to define the dynamic concept of care, caring has now become paradoxically, a more fragmented concept despite attempts to render it more holistic and inclusive. In the second exemplar, one of the authors draws on her personal experience of the gap between theory and practice, so pronounced that it pushed the author to revisit the concept of evidence‐based practice and nursing education. In our third and final exemplar, we refer to the absence of knowledge and practice generated through natural enquiry and curiosity, an absence which has led to production of corporate led rhetoric. Drawing together the central arguments of the three exemplars, we reflect on the influential role of nursing research in enabling the deconstruction of taken for granted assumptions such as caring, evidence‐based practice and empowerment; assumptions which have been generated by discourses riddled with confusion and alienation from the reality of practice and the natural spirit of professional enquiry.     

Integrating ancient and modern medicine in Chinese hospitals. The interaction among technology, traditional Chinese medicine, and health care.

Modern industrial society and its industrial processes can sometimes discourage the practice of traditional medicine. The existence and use of traditional Chinese medicine for several thousands of years indicates that it has sound elements. As has been true with features of other ancient, highly developed civilizations, the discipline of traditional Chinese medicine offers a valuable resource in the treatment and prevention of disease. Its scientific aspects and valuable experiences must continue to be developed according to Western scientific methodology. China has initiated a program to utilize modern industrialized technology in the integration of the traditional Chinese and modern Western medical systems. The policy and process aimed at integrating traditional Chinese medicine with Western medicine are presented in this paper. These measures have resulted in considerable utilization and development of the traditional Chinese medicine system, and have had a major impact on the development of public health care, as well as medical technology and science. The positive interactions between these fields of study and existing problems are discussed, and some comments on future expectations are presented.     

现代中医药学的经济价值研究

中医药在我国已有数千年的历史,是中华民族宝贵的医药文化,为中华民族的繁衍生息做出了巨大贡献。作为我国独特的文化遗产,近年来中医药以其独特的生存方式备受瞩目,成为传统医药文化与现代经济相结合的产物。在现代医学迅速发展的大背帚下,人们逐渐认识到中医药对人体的养生保健和临床治疗作用,且同化学药物相比较,安全性更为可靠,但中医药学对于现代医疗科技的吸收与运用相对滞后,在一定程度上阻碍了自身的发展。本文从现代中医药经济及其遥作模式和发展潜力出发,进一步研究了中医学和中药学的现代经济价值。     

攀登医学生命树 观看人生

以关于人身心的全方位的医学科研管理学为理论基础，在认同自然抗病力假说的前提下，对笔者提出的以神为根、以人为本、以物为枝叶的医学生命树哲学猜想的特定概念，特别是关于神的概念，做出了自我认知的诠释。通过分析、综合，归纳、演绎，推理、判断，从中医、中西医结合的原则与现代生物一心理一社会医学模式相整合，又通过四川汶川大地震的突发自然暴力事件中所显示出医学与生命的关系，力求印证这个哲学猜想的理论价值和现实意义。     

The Second International Scientific Symposium on Tea & Human Health, September 14th, 1998

It is fascinating to reflect that tea, the world's most widely consumed beverage next to water, began in Chinese antiquity not as a beverage but as a medicine. Several millennia later, modern scientific research is confirming that such ancient intuition has relevance to contemporary health concerns including cancer, heart disease, and antibiotic-resistant bacteria. The timeliness of this message as the 20th century concludes could not be better. The importance of a balanced diet has been recognized and studied throughout this century. The concept that we are what we eat has become a part of popular culture. If tea's health message, which future scientific research will continue to articulate, is creatively presented and embraces the romantic image that tea affords the industry, there is every reason to expect a rebirth and reinvigoration of this ancient beverage as a new millennium commences.     

Medicine and technology. Remarks on the notion of responsibility in the technology-assisted health care

The introduction of the modern diagnostic and therapeutic procedures to the medical practice provided a new challenge for the medicine. The art of medicine, with its default purpose of acting for the benefit of health, is therefore required to derive from technological progress effectively and rationally. As a result, the medical ethics has been engaged with the rules of economy and management of deficit medical procedures as well as their rational and fair distribution. The above suggests, that medics, given these recourses, should approach each patient with a consideration to their therapeutic rights. However, the physicians cannot just concentrate on the good of one particular patient, but must take into account joint responsibility for the good of a potential patient. This makes medical ethical dilemmas similar to the ethical issues of business. The notion of responsibility is the key for discriminating these two kinds of ethics.     

Complementary and alternative medicine in Brazil: one concept, different meanings

This article discusses the various meanings ascribed to the concept of Complementary and Alternative Medicine (CAM) in Brazil, where research on this theme has a limited tradition in terms of influences from anthropology, sociology of knowledge and epistemology, and sociology of CAM and clinical medicine. By means of the concepts identified in the literature, we elaborated a table with types of meanings. The terms Alternative Medicine and Complementary Medicine were found in more than one of the types in the table. Alternative Medicine identifies a model of medical practice influenced by the social, political, and economic context and by the logic of scientific production based on opposing pairs. Beginning in the 1980s, the important volume of reflections on official medical practice and the search for other forms of knowledge production led to the creation of the concept of Complementary Medicine. Its meaning is that of a new epistemological form of knowledge production between the official and alternative poles, a set of therapeutic practices, and confusion with the nomenclature for ancillary medical diagnostic tests, referred to in Portuguese as "complementary exams".     

生命个体动力学说再探——极性和对称

11的中西医理论汇通。方法提出一种新的学说-生命个体动力学说,试从中医角度理解物理,从物理角度理解中医。结果从现代物理学角度,可对中医学有许多新的理解,从中医学角度,能明确许多物理概念的实质,形成了一种古今理论汇通,并合理的解释了极性和对称的产生原理。结论在物理学角度,按照力学和能量运行规律,探讨生命体形态的一种特征-极性和对称,是生命个体动力学说的一个重要内容之一。按阴阳学说的观点,能明确许多物理概念的实质,明确产生极性和对称的根本原因,在这个角度产生的生命个体动力学说,可解释中西医两种性质完全不同的理论,形成真正意义上的中西医理论汇通。     

The tyranny of diagnosis: specific entities and individual experience

The articulation and acceptance of specific disease entities constitute one of the most important intellectual and cultural events of the past two centuries. This notion is central to how we organize health care delivery, think about ourselves, debate and formulate social policy, and define and manage deviance. Diagnosis is indispensable to linking specific disease concepts with doctor and patient and the social and economic institutions shaping such clinical interactions. Disease is a social entity, not an array of ideal types. The history of medicine is partly the story of how disease entities have become social entities, accumulating the flesh of diagnostic and therapeutic practice, social expectation, and bureaucratic reification. Despite criticism of reductionist medicine in the West and less focus on disease entities and mechanisms, our social response still depends on this concept of sickness. But this concept can no longer remain invisible if we are to understand contemporary medicine as both a social and a technological system.     

科研管理视角的人体疾病与医学

文章试图以“以人为本”的科学观为指导，结合自身从事医学科研管理工作实践，从人体疾病与医学最基本的概念出发，力求在理论与实践结合上谈几点体验，以期抛砖引玉，对新一代医学科研管理者，在创立有中国特色的医学科研管理新学科进程中，在本学科已走过的奠基一发扬一潜进的基础上复兴，乘国家“十一五”科学发展规划的东风，为医学科研管理的体制、机制创新做出新的业绩。     

“佛山推手”在防治亚健康领域的应用研究

通过从太极推手创编出来的"佛山推手"的编制及应用推广研究,说明"佛山推手"是以"治未病"核心理念指导的一项有浓厚地方特色的中医维护和促进健康的保健养生运动,通过科研学术和群众普及活动开展,在防治亚健康领域的应用研究方面取得了一定成效。     

脾胃病的中医治疗研究进展

在中医理论中,脾胃病主要是指脾胃消化功能受到严重影响的一种疾病。人体的气血是由脾胃消化食物转化而来,所以脾胃对人体健康具有非常重要的影响。随着中医治疗脾胃病的研究进展取得了非常大的突破,从基础理论实践逐步转变为临床实践阶段,有大量的研究文献提出了相应的观点。为了能够明确中医治疗脾胃病的研究发展方向,必须将中医辨证治疗理论与现代医学治疗相结合,促进脾胃病治疗的整体水平同步提升。本文综合近两年的主要文献资料对脾胃病的中医治疗研究进展进行详细论述,为脾胃病的中医治疗研究提供重要参考依据。     

精益管理模式在中医院科研课题管理系统中的应用探索

近年来,精益管理已经被应用于我国医疗等行业中,在提高医院工作效率,降低医院运营成本等方面取得了良好成效。洛阳正骨医院作为百年老字号三级甲等医院,诊疗水平居国内领先地位,但是由于中医院规模和传统思维的局限性,科研课题管理理念相对保守,直接影响了医院在学术领域的影响力。因此,立足实际,结合科研发展新形势,引入科研课题精益管理新模式,更好服务于科研工作者,使整个科研课题管理系统高效运转,最终提高医院的科研学术地位及综合影响力是该院今后可持续发展的一个工作重点。     

中医药防治病毒性肝炎转化医学模式初探

目的 以转化医学模式申报、管理、应用中医药防治病毒性肝炎科研项目,实现基础科研和临床应用的双向联通.方法 以承担国家“十一五”重大科技专项课题为契机,组建转化医学研究团队,统筹管理科研项目分配和申报,共享科研仪器设备和医学生物标本及生物信息库,通过科学的运行机制实现中医药防治病毒性肝炎科研成果向临床应用进行转化.结果 近2年,实施转化医学模式的医院在研国家级项目达4项,天津市局级项目4项;2年来培养中西医结合人才3人,选派4人攻读医学硕士、博士研究生,3人取得硕士学位.结论 以转化医学模式,组织管理中医药防治病毒性肝炎科学研究,能够打破传统医学研究的分隔,重建中医药防治病毒性肝炎医学研究体系,实现实验室与临床的双向转化,不失为从人才培养到学科建设等各方面的中医药转化医学模式的有益探索.     

2005-2012年新疆医科大学科技文献发表情况分析

目的 分析新疆医科大学2005-2012年科研论文发表情况,为某校在科研管理和学科建设上提供重要的科学依据.方法 运用文献计量学的方法,对收录于CNKI《中国期刊全文数据库》2005-2012年新疆医科大学科技文献,从年度分布、文献刊载期刊、作者情况、学科分类、研究层次等方面进行统计分析.结果 2005-2012年新疆医科大学共发表中文论文18 004篇,其中中文核心期刊4 205篇.2012年发表论文数量是2005年的2.19倍,中文核心文献量是3.94倍,年平均增长速度1.12％.18 004篇论文刊载在1 190种期刊上,期刊平均发文量15篇.新疆刊物所占比例较大（70％）.2005-2012年作者人数为7 270人,人均发文2.48篇.合作度为3.55.合著率92.86％.学科分布居前6位的是：肿瘤学、外科学、临床医学、中医学、心血管系统疾病、医学教育与医学边缘学科.研究层次,工程技术（自科）基础与应用基础研究（自科）这两项研究层次占据了发表文献的90％.结论 对揭示某校文献的发表规律,探讨科研的发展趋势,客观地评价科研工作的成就,促进科研工作的不断发展,具有重要的指导意义.     

Cultural factors associated with the seclusion disease in Alto Xingu (Central Brazil)

This article presents an anthropological approach to the symbolic aspects of the disease, considering traditional representations about the puberty seclusion syndrome which affects adolescent indians from the Upper Xingu region (Central Brazil), in a comparative perspective with the clinical-epidemiological approach. The traditional nosological category and its etiological implications in indigenous medicine and culture are contrasted with the western medical category - a peripheral neuropathy, possibly of toxic origin - identified in some cases of the syndrome. An epidemiological analysis of the data collected from the traditional point of view shows relations with events of cultural origin, associated with social and political contexts and with the nature of cross-cultural relations. Moreover, this culture-bound syndrome presents some methological issues for western medicine, particularly for biomedical and social-epidemiological approaches. Finally, the authors make explicit some cultural assumptions characteristic of modern western society, underlying the procedures used by the scientific disciplines involved.