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Perspectives in Biology and Medicine

Nancy M King
The origins and aspirations of institutional review boards (IRBs), the American oversight system for research with human subjects, are well known, and their failures have been documented and disputed for decades. Contention about IRBs is often ideological and unsatisfying, but their shortcomings are real. A new wave of attention to the promise and problems of this oversight system has coincided with the years-long effort to update the federal "Common Rule." Three very different recent books-Rebecca Dresser's Silent Partners, Robert Klitzman's Ethics Police, and Carl Schneider's The Censor's Hand-draw from a wealth of experiential, empirical, and rhetorical resources to triangulate this long-standing set of concerns and tensions at individual, institutional, and system levels...
2018: Perspectives in Biology and Medicine
Christopher Nowlin
Mary Shelley's Frankenstein is 200 years old and remains relevant to 21st-century scientific experimentation. Molecular biologists today have become especially bold in their attempts to cure diseases while remaining mindful of the real dangers of their research. Scientists presumably share an abiding concern about producing uncontrollable mutations in people, animals, and the wider environment, yet a sense of urgency appears to inform the current scientific willingness to take risks, especially in the realm of embryology and germ-line modification...
2018: Perspectives in Biology and Medicine
Charlotte Blease
In the relatively nascent field of placebo studies, empirical studies have burgeoned. Yet debate about how to define the terms placebo and "placebo effect" has not abated. A number of prominent scholars (drawn from medical practice, as well as philosophy, psychology, and anthropology) continue to propose and defend different conceptual models for these terms, and the perception that conceptual debate persists is often given as one justification for new definitions. Paradoxically-in spite of this lively debate-this article finds considerable underlying agreement about definitional matters within placebo studies...
2018: Perspectives in Biology and Medicine
Andrew Turner
This article examines three common strategies for dealing with the problems generated by the terms placebo and "placebo effect." These strategies are to redefine, to reconceptualize, and to eliminate our placebo language. The promise of these strategies is that a new language for talking about placebo phenomena may deliver clinical, ethical, and methodological advances. However, the nature and impact of these advances is rarely explored in detail. This article surveys some of the promised benefits of new terms such as "meaning response" and "contextual healing...
2018: Perspectives in Biology and Medicine
Nathalie Peiris, Maxie Blasini, Thelma Wright, Luana Colloca
The placebo effect is a complex phenomenon that can be described from neurobiological, psychosocial, and epistemological perspectives. Different leaders in the field have proposed multiple theories and models that attempt to describe both the nature and the mechanisms of action underlying placebo effects. This article focuses on the most relevant psychological models that have been suggested for characterizing the different mechanisms underlying the placebo effect. We outline how the dynamic psychoneurobiological aspects of the placebo phenomenon can be a potential reliable and useful tool in daily clinical practice for illness and symptom management within a wide variety of specialties and health-care practices...
2018: Perspectives in Biology and Medicine
Marco Annoni, Charlotte Blease
In this article we propose a critical reassessment of Daniel Moerman's "meaning response." First, we reconstruct and criticize Moerman's original proposal of introducing the "meaning response" as a way of clarifying some terminological and conceptual issues in the placebo debate. Next we evaluate the criticisms that Moerman's proposal is epistemically moot since other existing and more empirically grounded models already account for all the phenomena that fall under the concept of the "meaning response...
2018: Perspectives in Biology and Medicine
Phil Hutchinson, Daniel E Moerman
In 2002, Dan Moerman outlined three candidate explanations for the "placebo response": the "conditioned stimulus-response," Irving Kirsch's "response-expectancy" explanation, and the "meaning response." The meaning response, Moerman argued, was the only one of the three candidate explanations that could cover all the data, gained from decades of RCTs and centuries of historical record. Moerman went so far as to propose replacing the term "placebo effect/response" with the term "meaning response," because people are not responding to placebos, since there is nothing to respond to; people are responding to meanings...
2018: Perspectives in Biology and Medicine
Howard Brody
The placebo effect can be defined as a bodily change due to the symbolic effects of a treatment or treatment situation. It is further explained by the meaning model: a positive placebo response is most likely to occur when the meaning of the illness is altered for the patient in a positive direction. Moerman's suggestion that "placebo effect" be replaced by "meaning response" is based in part on dissatisfaction with the characterization of placebo, which is avoided when one focuses instead more comprehensively on placebo effect...
2018: Perspectives in Biology and Medicine
Charlotte Blease, Marco Annoni, Phil Hutchinson
No abstract text is available yet for this article.
2018: Perspectives in Biology and Medicine
Franklin G Miller
What is known as the "placebo effect" has received increasing attention in recent years in scientific investigation and the news media. The concept of the placebo effect, however, is subject to confusion and misleading implications, especially when applied broadly. This essay argues that it is desirable to confine the concept, as applied to biomedicine, to the therapeutic effects of deliberate placebo interventions. The author examines in detail the conceptual problems in characterizing the therapeutic benefits that flow from communication in the clinician-patient relationship as placebo effects...
2018: Perspectives in Biology and Medicine
Ted J Kaptchuk
Open-label placebos (OLP)-placebo pills honestly prescribed-have challenged the notion that placebos require either deception or concealment to evoke salubrious benefits. This essay describes how the author arrived at the counter-intuitive OLP hypothesis, discusses evidence for OLP effectiveness, and examines mechanistic explanations for OLP. Current dominant theories such as expectation and conditioning are found to be insufficient or inaccurate. The author proposes that emerging concepts of prediction and error processing (PEP), Bayesian brain, and embodied cognition are more appropriate models for understanding OLP...
2018: Perspectives in Biology and Medicine
Karim Bschir
Stuart Firestein's book Failure: Why Science Is So Successful (2015) presents an image of science that includes failure in its diverse forms as an essential feature of scientific practice. Firestein makes it clear that failure is a frequently underappreciated component in popular as well as professional accounts of scientific knowledge production. This review essay provides an analysis of Firestein's considerations from a philosophical perspective and assesses its quality and originality as a contribution to the age-old philosophical question of what science is and how it works...
2018: Perspectives in Biology and Medicine
Marilyn McEntyre
Poetry by patients that depicts and reflects on hospital experience invites readers to recognize how many procedures deemed acceptable, and even prescribed, by health-care professionals leave patients feeling violated. Such situations are often inherently ambiguous, but some of these accounts urge readers to reconsider what we have normalized and how our collective threshold of tolerance for intrusive, even violent measures may need to be recalibrated.
2018: Perspectives in Biology and Medicine
Abraham Fuks
The clinical environment of the hospital ward and clinic is where medical students become physicians by engaging with patients under the tutelage of clinician teachers. These formative experiences guide the students' regard and respect for patients, shape their nascent medical identities, and influence their confidence in their chosen profession. This essay is grounded in an exegesis of narratives proffered by senior medical students during a selective course on the language of medicine. These stories reveal the affinity of students for their patients and their sensitivity to inappropriate behaviors by physicians and other caregivers...
2018: Perspectives in Biology and Medicine
Marta Spranzi
The prevention of abuse is a crucial issue in medical ethics. At the very least, the hospital setting should respect basic human rights, including dignity and life. In this respect, the normative reference to the concept of humanity plays a crucial role. However, the public as well as health-care professionals need to be aware of a more subtle and invisible form of abuse, "ordinary abuse." It can be defined as the undue suspension of the implicit rules of ordinary interactions, whose importance has been stressed by Erving Goffman and Harold Garfinkel...
2018: Perspectives in Biology and Medicine
Holly M Dunsworth
Humans give birth to big-brained babies through a bony birth canal that metamorphosed during the evolution of bipedalism; they have a tighter fit at birth between baby and bony birth canal than do our closest relatives the chimpanzees; and they are incapable of grasping onto caregivers as early as infant chimpanzees develop the skill. Since the mid-20th century, these observations and more have been linked together into the "obstetrical dilemma" (OD): human babies are helpless because they are born early to escape before they outgrow the mother's pelvis, the expansion of which is prevented by natural selection for bipedalism...
2018: Perspectives in Biology and Medicine
Raphael Cohen-Almagor
In 2014, Belgium became the first country in the world to legislate euthanasia for children. The decision evoked questions and criticisms in Belgium and in the world at large: should children have the right to ask to die? Are children able to make reasoned and independent choices on such an important matter? Does maturity matter? Are children as autonomous as adults? Is it a logical move to grant terminally ill children who are in intolerable pain this right? What happens if there is a conflict of wishes between the child and parents? This article argues that these questions should be addressed while legislators are fully aware of the relevant medical data regarding child development...
2018: Perspectives in Biology and Medicine
Bob Simpson
This article is concerned with the practice of bioethics outside of the Euro-American and Anglophone settings in which it was first formulated. In theoretical terms, the article considers the frictions that arise when global-scale projects such as bioethics are introduced into diverse social and cultural settings. Methodologically, the article is constructed around the biography of an Indian medical educator trained in bioethics and working to promote the subdiscipline in the Indian context. The article describes the situated practice of bioethics and highlights the incommensurability of some of its key terms and concepts when practiced outside of the global North...
2018: Perspectives in Biology and Medicine
Stewart Justman
When Congress amended the Food, Drug, and Cosmetic Act in 1962 to ensure the efficacy of drugs before they reach the market, it imposed a standard of evidence distinctly weaker than the reasonable one of preponderance. The difference is material. Some drugs now on the market may or may not have a preponderance of trial evidence of efficacy. An obstacle to a finding of efficacy is the well-known nemesis of drug makers with a definite interest in favorable trials: the placebo effect. Trials where the placebo effect runs high are vulnerable to negative findings, and trials with such findings all too often find their way to burial sites like regulatory archives...
2018: Perspectives in Biology and Medicine
Michael J Joyner
The discovery in the late 1970s that the vascular endothelium plays a major role in regulating the caliber of blood vessels caused a minor paradigm shift in thinking about the cardiovascular system. That the gas nitric oxide (NO) was central to this discovery was unexpected and set the stage for a broader series of insights related to gaseous signaling molecules in biological systems. Over the last 25 years, the author's lab has attempted to understand what NO does in alive, awake, exercising humans. This article recounts six lessons learned along the way, about luck, reductionism, and the translation of biomedical discoveries to therapy, as well as about philosophical questions related to big versus small science and curiosity-driven versus goal-directed approaches...
2018: Perspectives in Biology and Medicine
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