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Biomedical subjects

K F Schaffner

Publications and source records attributed to K F Schaffner.

At least 19 recordsLinked to original sources
PubMed2001

Preventing severe mental illnesses--new prospects and ethical challenges.

We review some exciting recent developments in studies of psychoses in general and schizophrenia in particular that offer hope such illnesses can be identified and treated early. Early treatment promises better outcomes for both the affected individuals and their families, and perhaps even the prospect of true prevention. But testing such interventions in vulnerable patients can raise ethical difficulties that if not adequately addressed may harm patients and hamper the development of these interventions. We believe there are appropriate ways of dealing with the ethical problems in the early intervention field, though we also suggest that additional work on both scientific and ethical fronts will need to be done to make these ways real. As a start toward that end, we have summarized a number of the debates in the field and from the following articles, and have distilled five 'points to consider' that interested parties will need to take into account.

Clinical Trials as Topic↗
PubMed2000

Medical informatics and the concept of disease.

This paper attempts to address the general question whether information technologies, as applied in the area of medicine and health care, have or are likely to change fundamental concepts regarding disease and health. After a short excursion into the domain of medical informatics I provide a brief overview of some of the current theories of what a disease is from a more philosophical perspective, i.e. the "value free" and "value laden" view of disease. Next, I consider at some length, whether health care informatics is currently modifying fundamental concepts of disease. To this question I will answer largely in the negative, and I will provide the sketch of some arguments from current research programs in medical informatics why I think this is the case. This argumentation is supported by a detailed account of how the disease profile for beriberi heart disease, used in one of the major medical informatics diagnostic programs, QMR (and its ancestor INTERNIST-1), was developed, and why at least this program essentially follows received views of traditional medicine. The one main exception to the conformity of this program to "received" views of a disease occurs when the program's designers need to fine-tune a disease definition. This fine-tuning is to comport with the expert's perspective on the disease, including his or her epistemic values, as well as the program's other resources for diagnosing components of a disease.

Beriberi↗
PubMed1999

Coming home to Hume: a sociobiological foundation for a concept of 'health' and morality.

Assessing the normative status of concepts of health and disease involves one in questions regarding the relationship between fact and value. Some have argued that Christopher Boorse's conception of health and disease lacks such a valuational element because it cannot account for types of harms which, while disvalued, do not have evolutionarily dysfunctional consequences. I take Boorse's account and incorporate some Humean-like sociobiological assumptions in order to respond to this challenge. The possession of moral sentiments, I argue, offers an evolutionary advantage (thus falling within Boorse's definition of normal functional abilities). However, this does not amount to emotivism: on the contrary, these sentiments can be the basis of a value system. This value structure introduces the concept of sympathizing with a fellow being's suffering as the basis of a normative dimension to disease. For example, it holds the disvalue of disease to lie in the fact that disease involves suffering and functional limitations. The naturalistic Humean type of account presented here thus jumps the normative-descriptive divide. When Boorse's account is extended to include social sentiments and behaviors, a conception of health emerges which is broader than Boorse's or Kass's, but narrower than the WHO's.

Bioethics↗
PubMed1993

Clinical trials and causation: Bayesian perspectives.

In addition to the safety, it is essential to establish the causal efficacy of extant and new treatments, and well-designed clinical trials are thought by most to be the 'gold standard' to accomplish this. Contrary to most statisticians' and regulators' views, however, I will argue that the concept of causation involved in clinical trials is not all that clear. I discuss the manipulability approach to causation, interpreted counterfactually, which seems to fit causation as it is found in such sciences as physiology, but it has unclear relations to a concept of causation proposed by a number of epidemiologists. I characterize 'epidemiological causation' as probabilistic and formulated at a population level, and dependent on certain general criteria for causation as well as study-design considerations. I then attempt to clarify the connections between these concepts of causation and Cartwright's views on complexity and causality, a 'Bayesian' framework proposed by Rubin and further elaborated by Holland, and Glymour and his colleagues' recent directed graphical causal modelling approach.

Bayes Theorem↗
PubMed1992

Theory change in immunology. Part I: Extended theories and scientific progress.

This two-part article examines the competition between the clonal selection theory and the instructive theory of the immune response from 1957-1967. In Part I the concept of a temporally 'extended theory' is introduced, which requires attention to the hitherto largely ignored issue of theory individuation. Factors which influence the acceptability of such an extended theory at different temporal points are also embedded in a Bayesian framework, which is shown to provide a rational account of belief change in science. In Part II these factors, as elaborated in the Bayesian framework, are applied to the case of the success of the clonal selection theory and the failure of the instructive theory.

Allergy and Immunology↗
PubMed1992

Theory change in immunology. Part II: The clonal selection theory.

This two-part article examines the competition between the clonal selection theory and the instructive theory of the immune response from 1957-1967. In Part I the concept of a temporally 'extended theory' is introduced, which requires attention to the hitherto largely ignored issue of theory individuation. Factors which influence the acceptability of such an extended theory at different temporal points are also embedded in a Bayesian framework, which is shown to provide a rational account of belief change in science. In Part II these factors, as elaborated in the Bayesian framework, are applied to the case of the success of the clonal selection theory and the failure of the instructive theory.

Allergy and Immunology↗
PubMed1992

Molecular genetics, reductionism, and disease concepts in psychiatry.

The study of mental illness by the methods of molecular genetics is still in its infancy, but the use of genetic markers in psychiatry may potentially lead to a Virchowian revolution in the conception of mental illness. Genetic markers may define novel clusters of patients having diverse clinical presentations but sharing a common genetic and mechanistic basis. Such clusters may differ radically from the conventional classification schemes of psychiatric illness. However, the reduction of even relatively simple Mendelian phenomena to molecular genetics has been shown to be a surprisingly complex and problematic enterprise. Mental illnesses exist at many levels of including social, environmental, and developmental interactions. Reductionistic shifts in the classification of such a disease entity will have to address the interlevel dynamics that take place within the structure of theories of mental illness. The question of how molecular analysis of psychiatric disease will impact on the structure of existing theories and classification systems is the central topic of this paper.

Bipolar Disorder↗
PubMed1988

Philosophical, ethical, and legal aspects of resuscitation medicine. II. Recognizing the tragic choice: food, water, and the right to assisted suicide.

This paper reviews the ethical foundations of decisions to suspend life-sustaining nutrition and hydration for seriously ill and permanently comatose patients, and also examines three legal cases in this area (Barber, Bouvia, and Brophy). The cause of such patients' deaths is examined, and the current consensus that it is the underlying illness which is the identifiable cause is criticized. I argue that the responsible cause in such cases is typically the physician's decision to suspend food and/or water, made with the deliberate concurrence of the patients, families and/or courts. I also argue that with proper safeguards this is both a reasonable policy and one that should be interpreted as a general surrogate for rational, medically assisted suicide.

Enteral Nutrition↗
PubMed1988

Biclonal IgM gammopathy in chronic lymphocytic leukemia.

The association of chronic lymphocytic leukemia (CLL) with serum paraproteinemia (ie, monoclonal immunoglobulin production and secretion) is well known. We, however, could find only three previous reports of CLL where multiple serum paraproteins were encountered. We describe a case of biclonal gammopathy in CLL, involving IgM/kappa and IgM/lambda, with each paraprotein reaching serum levels of approximately 10 g/L (1 g/dL). Using immunohistochemical techniques, we identified two morphologically similar lymphocyte populations, which could be stained for either mu and kappa or mu and lambda. The peripheral blood contained a majority of mu/kappa-containing cells (kappa/lambda = 17.5:1), while the bone marrow only contained a modest excess of cells staining for mu/kappa (kappa/lambda = 2.4:1). The clinical significance and prognosis of biclonal IgM gammopathies is uncertain, since so few cases have been reported. Our patient has now been followed up for more than four years.

Aged↗
PubMed1986

Exemplar reasoning about biological models and diseases: a relation between the philosophy of medicine and philosophy of science.

This paper discusses the structure of medical science with a special focus on the role of generalizations and universals in medicine, and philosophy of medicine's relation with the philosophy of science. I argue that a usually overlooked aspect of Kuhnian paradigms, namely, their characteristic of being "exemplars", is of considerable significance in the biomedical sciences. This significance rests on certain important differences from the physical sciences in the nature of theories in the basic and the clinical medical sciences. I describe those differences and maintain that they are these differentiating features that require the use of more comparative and analogical reasoning in medicine. I suggest that Kitcher's recent introduction of the notion of a 'practice' may have similar implications if it is construed to contain more analogical elements than he appears to recognize in his initial formulation. Finally I argue that though Gorovitz and MacIntyre's characterization of medicine as a "science of particulars" bears some similarities with my thesis, I maintain that such a position without careful qualification can lead to ignoring both the nature of generalizations in these sciences and their role as positive analogies tying together a family of overlapping models.

Humans↗
PubMed1985

Ethical and legal issues related to the use of computer programs in clinical medicine.

As computer programs are used with increasing frequency in the clinical setting, ethicists, lawyers, computer scientists, clinicians, and patients must confront a group of problems: In what situations is it appropriate to use a medical computer program? Who should use these programs and how should they be used? What is the legal status of a computer program that provides medical advice? Can a proper balance be achieved between confidentiality of patient information and shared access to records by health care personnel? How can regulatory agencies, physicians, and patients determine if a program is safe for human use? Will programs be able to communicate with users well enough to prevent clinically harmful misunderstandings? Because few if any definitive answers are yet available, these questions remain the subject of much discussion.

Computers↗
PubMed1985

Ethics of clinical trials in family medicine.

In this paper several issues are examined that arise from conducting randomized clinical trials in a family practice setting. The distinctive research tradition in family practice involves a patient's primary care physician performing an experimental investigation that usually, though not invariably, is focused on common health problems. Representative clinical trials are presented as examples that illustrate two ethical difficulties evoked by such research: a potential violation of the primary care physician's therapeutic imperative to provide the best possible treatment for his or her patient, and the likelihood that the type of physician-patient relationship fostered in family practice significantly diminishes the capacity of the patient to give true informed consent. In an attempt to resolve these ethical difficulties, a model of moral reasoning is presented that is based on easily understood ethical principles and is applicable to actual clinical decision making. Using that model, a tentative set of rules or guidelines is offered for implementing clinical trials in family medicine.

Clinical Trials as Topic↗
PubMed1985

Ethical problems of recording physician-patient interactions in family practice settings.

Recordings of actual physician-patient interactions are an important tool for family medicine education and research. Their use, however, poses two sets of ethical problems: one dealing with privacy and confidentiality, and another related to limitations upon informed consent in the context of ordinary medical care. Experience with audiotaping and videotaping led to engaging in a "principle-based" method of ethical reasoning in which problems generated by difficult cases were examined in light of both current rules or guidelines and four fundamental ethical principles. Through this approach specific policies were developed for voluntary, informed consent and for protection of privacy, while recognizing that each case must be judged in the light of the physician's obligation to do the best for each patient.

Confidentiality↗