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[Note on the epistemology of clinical pharmacology: comparison with the approach of Karl Popper].

Is clinical pharmacology a science or only an application of science? Karl Popper suggested a method to identify science and to sort it out from other logical activities such as metaphysics, whereby the falsification criterion he proposed can apply to the theory in such a way that the theory could be refuted. The clinical pharmacologist's approach requires the build-up of a therapeutic model on the basis of two other models: the physiopathologic and the pharmacological. The three-model construct is a theory. Is it scientific in the Popperian sense? From the therapeutic model, one can predict the efficacy of a drug, and the corresponding statement is tested by a clinical trial. Whatever the original statement, it is modified into a refutable one because of the use of the statistical approach in clinical trials. Furthermore, the predicate represents a hypothesis of the model validity, which will then be confronted with 'reality' through clinical experiment. As the therapeutic model is refutable, clinical pharmacology is a science in the Popperian sense.

Drug Therapy↗

[X-rays between art and science in The Magic Mountain].

When x-ray, in the early 1900s, was hailed as the new instrument of objective verification and indisputable proof, it signaled the reign of the visual over the other senses of empirical verification, such as sound and touch. The extent of visual evidence was believed to be all- encompassing: x-rays were supposedly a sort of super photography that could prove the existence of immaterial substances, the materiality of things heretofore unseen. Thomas Mann's The Magic Mountain (1924) elaborates on three invisible aspects of the body: the verification of disease (tuberculosis), the visualization of intimate feelings such as love, and the ultimate proof of the spirtual self after death. In all three areas - medical, psychological and metaphysical - the x-ray was thought to be a magical instrument that could render the body (and soul) transparent. The Magic Mountain does not simply reflect these beliefs, but problematizes cultural conceptions inspired by medical-scientific axiomas.

Germany↗

[Not Available].

In the opinion of the natural sciences and medicine of the Romantic Era, Paracelsus represents a central step from the Middle Ages to modern times. Their interpretations of this perceived kindred spirit "not free from criticism" focus on metaphysical orientations, holistic approach to cosmology and anthropology, biochemical perspective, ethical dominance, immenent union of etiology, pathophenomenology and therapy.

Chemistry↗

[The "doctrine of signatures" and graphical technologies at the dawn of modernity].

The "Doctrine of signatures" occupies an important position in the scientific and medical thinking from the 16th century onwards. In a universe conceived as a vast system of correspondences, in particular between our world and God's will, the signatures are the visible marks of the purpose of divine creation. In therapeutic practices they indicate the virtues of plants by their resemblance to specific organs they are supposed to be able to cure. This Doctrine, like the medical practices it served, is often relegated to a pre-modern knowledge. Shifting the perspective from its doctrinal content to its practical applications in medical treatises, this article suggests that the graphical and scriptural treatment of signatures by Oswald Crollius (ca 1560-1609), Giovanni Battista Della Porta (1534-1615) and Wolfgang Ambrosius Fabricius (1653) allowed the invention of an instrument which, by formalising and systematising the correspondences between plants and organs, made possible a practical use in which metaphysical and religious justifications were not explicitly involved any more, precisely these justifications which resulted in confining this doctrine outside of modernity.

Europe↗

The value of life according to "law as a way to survive".

Law as a Way to Survive is a comprehensive evolution-theory orientated philosophy of law and state that is tested in this article on its pertinence and explanatory power for the following issues: animal rights, abortion, euthanasia and assisted suicide. These subjects are suitable as tests precisely because they are not those for which LWS or rival theories, with which it will be compared, and for which it was primarily developed for. It will be concluded that LWS is very superior in pertinence and explanatory power both because it is much less metaphysical and much more complex than its rivals.

Abortion, Induced↗

Neuroethics: a guide for the perplexed.

Like filings to a magnet, issues of all shapes, sizes, and degrees of importance are sticking to the idea of neuroethics. Martha Farah, an early thinker in this new field, proposes that, numerous as they are, the problems actually fall into just three categories. She finds that neuroethics has made a quick start sizing up many practical--and some unique--questions swirling up from brain science, but, she writes, watch for challenges that reach beyond these to the metaphysical. Neuroscience may one day explain in terms of neural tissue virtually all aspects of human cognition and emotion--realms traditionally deemed apart from physical law. Thus, we should also expect neuroethics to grapple with our fundamental distinction between persons and mere "things." If mental processes prove to result from purely physical events, this opens to question our notions of consciousness, spirituality, free will, and moral responsibility.

Behavior↗

[Psychopathological characteristics of overevaluation tendencies and their significance for prognosis of the course of schizophrenia with its onset in adolescence].

As a result of a clinico-psychopathological study of 72 patients with schizophrenia which occurred at an adolescent and juvenile age and ran its course with psychopathlike disorders, 59 cases of metaphysical intoxication and 13 with pathological fantasies were revealed. It has been established that these disorders have two common interrelated structural elements, namely the overvalued structure and the bent component, which allows one to attribute these elements to a group of disorders designated by the term overvalued bents. The predominance of one or other component is dependent on the disease course. The domination of the overvalued element in the structure of overvalued bents correlated with a sluggish, slow-progressive course, whereas the domination of the bents element with a shift-like one.

Adolescent↗

Genes, causation and intentionality.

I want to exhibit the deeper metaphysical reasons why some common ways of describing the causal role of genes in development and evolution are problematic. Specifically, I show why using the concept of information in an intentional sense in genetics is inappropriate, even given a naturalistic account of intentionality. Furthermore, I argue that descriptions that use notions such as programming, directing or orchestrating are problematic not for empirical reasons, but because they are not strictly causal. They are intentional. By contrast, other notions that are part of the received view in genetics and evolutionary theory are defensible if understood correctly, in particular the idea that genes are the main replicators in evolution. The paper concludes that dropping all intentional or intentionally laden concepts does not force us to accept the so-called causal parity thesis, at least not in its stronger form.

Animals↗

[Prayer, an intermediary world].

Prayer, considered under its theological aspect as a love relation between the orant and God becomes, under a psychopathological point of view, deviated as it is from its original aim, a space of potential cure for narcissistic wounds. In this sense, prayer is a kind of intermediary world between normality and madness, which according to the religious ideas of the individual and the importance of his mental disorders, tends towards one or the other of these extremes, and makes his defences operative. It happens therefore that Faith, as materialized in prayer, can be a mean to save oneself of mental morbidity. Prayer is an intricate phenomenon which originates in the multiple dimensions of the human being, where religion, psychology, morals, pathology and metaphysics confront each other.

Christianity↗

[Theory of mass madness. Epilogue of the Research Program on Psychiatric Epidemiology of the National Council of Scientific and Technical Research].

This "Metaphysics of Madness" appears as a "sinister mirror of madness", and the madman as a victim of the violence of his conflicts. This has come to reinforce the "tragic" anthropology which was already latent in the ancient pests, in the battles, in the mass suicides. An effort was made to determine the space where madness operates in our cultural context by means of an internationally guaranteed survey of symptoms. The analysis of madness lays out hermeneutics of multiple levels through which the most profound and conflictive structures of our culture become visible. Even if madness is principally entered upon as a psychiatric category, it presents a similar incidence as a category of cultural anthropology, it being necessary to add besides its importance as a literary category, the deciphering of the psychotic discourse as a linguistic category, the necessity of a sociological contextualization and its foundation on philosophic and even theological categories. Madness as a category of the spirit is the daring effort of understanding its liberation "in this deceit of destiny which fools it as to a liberty it has not conquered". After a consideration of texts of two decisive figures related to the philosophic history of madness--Kant and Hegel--the important position of Ludwig Binswanger and his conception of the Ideenflucht (flight of ideas) in the history of psychiatry is brought out. Finally, the theory of the madness of the masses (Massenwahntheorie) stated by Broch--a double madness, of fragmentation, on the one hand, and of aberration and paranoia of power, on the other--shows a universally valid analysis in which the particular, recurrent tragic model of our culture inscribes itself. This model is to be identified with Massenwahntheorie VII, i.e., as a prolongation of the prodigious work carried out by Broch.

Anthropology, Cultural↗

Bilateral total corneal and conjunctival choristomas associated with epidermal nevus.

A 4-year-old boy had been noted from birth to have bilateral masses obscuring the entire outer portion of the eyes. Systemic findings included mild growth retardation, multiple cortical lesions of the distal metaphyseal ends of the lower extremities, and diffuse skin pigmentation of the right side of the body. The epibulbar lesions were excised; on the right side, there was a thin cornea that necessitated corneal transplantation. The diagnosis of composite epibulbar choristomas associated with linear epidermal nevus was established by pathologic examination. This case report as well as a literature review establish the association of epibulbar choristomas with cutaneous linear nevi of the epidermal and sebaceous types.

Biopsy↗

Frontometaphyseal Dysplasia. Evidence for dominant inheritance.

A 10-year-old boy with mixed bilateral hearing loss and unusual facies was found to have frontometaphyseal dysplasia. He has prominent supraorbital ridges, height-span disproportion, dental abnormalities, thick clavicles, pectus excavatum, winged scapulae, joint contractures, and generalized muscular underdevelopment. Roentgenograms show supraorbital hyperostosis, antegonial notching of the mandible, flared ilia, contraction of the midpelvis, flattened vertebrae, deformities of the ribs posteriorly, flared metaphyses of the long tubular bones, and greatly widened and elongated metacarpals, metatarsals, and phalanges. His mother has prominent supraorbital ridges, distinct scoliosis, contractures of the fifth fingers, and conductive hearing loss. She also has many of the roentgenographic features of frontometaphyseal dysplasia. Frontometaphyseal dysplasia in a mother and son strongly suggests a dominant mode of inheritance.

Adult↗

Dyssegmental dwarfism. A lethal anisospondylic camptomicromelic dwarfism.

Dyssegment dwarfism is a lethal anisospondylic camptomicromelic form of growth retardation that appears to have autosomal recessive inheritance. It is characterized by short neck, cleft palate, narrow chest, severe shortening of long bones and trunk, reduced joint mobility, inguinal hernia, and probably hirsutism and hydroureter/hydronephrosis. Some cases are seen with occipital exencephalocele. The long bones are short and bent with metaphyseal flaring. The vertebral bodies are of different size and many consist of separate ossified masses. The iliac bones are small with hypoplasia of the horizontal and inferior margina. Maturation of cartilage cells at the epiphyseal plates is grossly disturbed and there are puddle-like spaces among the resting cartilage cells.

Abnormalities, Multiple↗

Parathyroid autotransplantation in renal osteodystrophy.

Severe renal osteodystrophy with metaphyseal fractures developed in two children with hypoplastic-dysplastic kidneys and chronic renal failure despite therapy with vitamin D, CaCO3, phosphate-binding agents, and protein restriction. Serum immunoreactive parathyroid hormone (iPTH) levels were elevated to 709 and 1,537 pg/mL (N = 255 +/- 92 pg/mL). Total parathyroidectomy and then autotransplantation of a small portion of parathyroids into the left brachioradialis muscle resulted in complete healing of renal osteodystrophy with the same dose of vitamin D. Serum iPTH and histological studies have demonstrated functioning parathyroid autotransplants, 19 and 20 months postoperatively in these two patients. Advantage of such a procedure over 3 3/4 parathyroidectomy is that this transplanted parathyroid tissue is easily accessible for partial removal in case of recurrence of uncontrollable hyperparathyroidism. We believe that total parathyroidectomy and autotransplantation can be successfully performed even in small children.

Child, Preschool↗

Calcitriol deficiency in idiopathic juvenile osteoporosis.

Low plasma calcitriol (1,25-dihydroxycholecalciferol) and normal serum calcifediol (25-hydroxycholecalciferol) levels were noted during the evaluation of an 11-year-old girl with diffuse osteoporosis and pathologic fractures. The onset of osteoporosis prior to puberty and the characteristic metaphyseal location of the fractures supported the diagnosis of idiopathic juvenile osteoporosis (IJO). Treatment with calcitriol, 1.0 microgram daily, was associated with bone mineral accretion and a diminished incidence of fractures. Plasma calcitriol levels returned to normal when the disease resolved following puberty. This experience suggests a relationship between calcitriol deficiency and the pathogenesis of IJO.

Bone and Bones↗

Skeletal lesions following meningococcemia and disseminated intravascular coagulation. A recognizable skeletal dystrophy.

Partial destruction of the right humeral and right femoral head were discovered in a 30-month-old girl, two years after her recovery from meningococcal septicemia and disseminated intravascular coagulation (DIC). Additional findings were symmetrical epiphyseal-metaphyseal lesions of the lower femora and upper and lower tibiae. The combined skeletal lesions seem to be characteristic sequelae of infantile meningococcemia complicated by DIC. Since this condition is no longer uniformly fatal, the characteristic skeletal dystrophy will be encountered more frequently and should be recognized by radiologists, pediatricians, and orthopedists. The features shared by our patient and the seven previously published cases are presented.

Bone Diseases↗

Fractures in young children. Distinguishing child abuse from unintentional injuries.

OBJECTIVE: To determine features of fractures in young children that would be helpful in distinguishing child abuse from unintentional injuries. DESIGN: Case series. SETTING: Pediatric Services of Yale-New Haven (Conn) Hospital (a tertiary care center). PATIENTS: Consecutive children who were less than 3 years of age and who were examined for a fracture from January 1979 through December 1983 were identified from the daily logs of the emergency department or the hospital's child abuse registry. OUTCOME MEASURE: Each case was rated, by means of predefined criteria and a consensus of two clinicians and two pediatric radiologists, on a seven-point scale from "definite child abuse" to "definite unintentional injury." A middle rating of "unknown" was used if there was not enough information to reach a consensus. RESULTS: Of the 253 fractures in 215 children that were identified, we categorized 24.2% as abuse, 8.4% as unknown, and 67.4% as unintentional injuries. Fractures that were considered likely due to abuse were (1) fractures in children whose caretakers reported either a change in the child's behavior, but no accidental event, or a minor fall, but the injury was more severe than expected; (2) fractures of the radius/ulna, tibia/fibula, or femur in children less than 1 year of age; or (3) midshaft or metaphyseal fractures of the humerus. Linear fractures of the parietal bone were the most common skull fractures, whether due to abuse or unintentional injuries. CONCLUSION: In young children with fractures, child abuse is common. By comparing fractures due to abuse and those due to unintentional injuries, we obtained empiric evidence to help clinicians and radiologists correctly examine children with such serious injuries.

Accidental Falls↗

Kniest dysplasia: radiologic, histopathological, and scanning electronmicroscopic findings.

We describe severe neonatal Kniest dysplasia. Radiological findings in a severe case include short bowed tubular bones with exaggerated metaphyseal flare, moderate platyspondyly with vertical clefts of the vertebral bodies, and characteristically shaped iliac bones. Pathologic findings included a disorganized physeal growth plate, soft crumbly cartilage with a "Swiss-cheese" appearance, and diastase resistant intracytoplasmic inclusions in the resting chondrocytes. Transmission electronmicroscopy showed dilated cisternae of rough endoplasmic reticulum with finely granular material of accumulated protein. Scanning electronmicroscopy documented striking fragmentation and disintegration of collagen fibrils resulting in a web-like pattern and large open cyst-like spaces, and deficiency and disorganization of the collagen fibrils.

Adult↗