The General Data Protection Regulation (GDPR) was introduced in 2018 to harmonize data privacy and security laws across the European Union (EU). It applies to any organization collecting personal data in the EU. To date, service-level consent has been used as a proportionate approach for clinical trials, which implement low-risk, routine, service-wide interventions for which individual consent is considered inappropriate. In the context of public health research, GDPR now requires that individuals have the option to choose whether their data may (...) be used for research, which presents a challenge when consent has been given by the clinical service and not by individual service users. We report here on development of a pragmatic opt-out solution to this consent paradox in the context of a partner notification intervention trial in sexual health clinics in the UK. Our approach supports the individual’s right to withhold their data from trial analysis while routinely offering the same care to all patients. (shrink)

Book reviewed in this article: Thinking Clearly About Death. By Jay F. Rosenberg.

The Nature of Suffering underscores the change that is taking place in medicine from a basic concern with disease to a greater focus on the sick person. Cassell centers his discussion on the problem of suffering because, he says, its recognition and relief are a test of the adequacy of any system of medicine. He describes what suffering is and its relationship to the sick person: bodies do not suffer, people do. An exclusive concern with scientific knowledge of the (...) body and disease, therefore, impedes an understanding of suffering and diminishes the care of the suffering patient. The growing criticism that medicine is not sufficiently humanistic does not go deep enough to provide a basis for a new understanding of medicine. New concepts in medicine must have their basis in its history and in the development of ideas about disease and treatment. Cassell uses many stories about patients to demonstrate that, despite the current dominance of science and technology, there can be no diagnosis, search for the cause of the patient's disease, prognostication, or treatment without consideration of the individual sick person. Recent trends in medicine and society, Cassell believes, show that it is time for the sick person to be not merely an important concern for physicians but the central focus of medicine. He addresses the exciting problems involved in such a shift. In this new medicine, doctors would have to know the person as well as they know the disease. What are persons, however, and how are doctors to comprehend them? The kinds of knowledge involved are varied, including values and aesthetics as well as science. In the process of knowing the experience of patient and doctor move to center stage. He believes that the exploration of the person will engage medicine in the 21st century just as understanding the body has occupied the last hundred years. (shrink)

Like the broom in “The Sorcerer's Apprentice,” technologies take on a life of their own. To bring them under control, doctors must learn to tolerate ambiguity, resist the lure of the immediate, cease fearing uncertainty, and rechannel their response to wonder.

The goals of medicine -- A story about a patient with aortic stenosis -- What are facts in medicine? -- Clarify the chain of events that led to the present state : the case as a narrative -- The case of Myra Manner -- Examine your presuppositions and preconceptions -- Separate and examine the values at issue -- A question of judgment -- The patient, the doctor, and the relationship -- Observation, prognosis, and prognosticating -- Thinking in medicine -- Accepting (...) the challenge. (shrink)

Healers: Extraordinary Clinicians at Work, by David Schenck and Larry R. Churchill, and What Patients Teach: The Everyday Ethics of Health Care, by Churchill, Joseph B. Fanning, and Schenck are both important and thought‐inspiring books. For the first, Schenck and Churchill recruited fifty practitioners, mostly physicians but some clinicians who practice alternative therapies, “identified by their peers as excellent healers,” and interviewed them to find out what they did to establish a good relationship with their patients. The results of their (...) interviews and how they wrote their book makes this the best and most concrete understanding of a necessary step to healing that I have read. What Patients Teach examines the patients’ perspective about forming relationships with their clinicians. The patients’ clinicians were asked to nominate patients to be interviewed to help answer the question. This volume, while important, is less extraordinary than the first because we hear less what the patients want to say and more what the authors want to tell us. That aside, taken together, these two books are a major advance in the literature of healing. (shrink)

Although written primarily for medical research, the Belmont principles have permeated clinical medicine as well. In fact, they are part of a broad cultural shift that has dramatically reworked the relationship between doctor and patient. In the early 1950s, medicine was about making the patient better and maintaining optimism when the patient could not get better. By the 1990s, medicine was about the treatment of specific physiological systems, as directed by the patient, but as limited by the society's concern for (...) justice. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.3 (2003) 225-226 [Access article in PDF] Travelers in the Land of Sickness Eric J. Cassell THE PROBLEM OF knowing another person and the world in which that person lives, particularly someone with major mental illness, is addressed in this interesting and rich essay. The number of different metaphors and concepts Potter employs to describe the task of crossing into and then understanding the (...) thoughts, emotions, symptoms, constraints, context, and perspectives of another testifies to the difficulties involved.Yet, as I read the essay, it was not clear what the clinician world traveler, moral tourist, empathizer (and other categories) is supposed to do on the journey to another person. Why do we reach out to the sick person? What is it that we want to know or do that makes this trip necessary? Potter is primarily concerned with mental illness—the examples she cites are patients with schizophrenia—while my experience has in the main been with persons with physical illness, but for the moment, the differences are less important than the central lesson. The illness that the patient presents—the experience of the symptoms, the impairments, disability, and disruptions of the emotional and social existence that happen because of the disease result from an amalgam of the disease process with the specific nature of the sick person. There is no disease in pure form; there is no disease in abstract for clinicians. There is only this sick person. She correctly quotes me, because of all this, as pointing out the importance of integrating knowledge of this particular patient with the abstract knowledge of disease to understand the illness as it is expressed in this person. All to form a basis for the treatment of the patient and especially to help relieve suffering because suffering is always personal, particular, and individual. (It is important in thinking about this topic to remember that most serious diseases, psychiatric and otherwise, are chronic and take place over significant lived time. The acute schizophrenic symptoms or the acute infectious diseases, as dramatic as they are, distract attention from the importance of the place of the sick person.)In physical disease, our long (and continuing) history of separating human beings from nature and the body, and the importance medicine places on objectivity and the objective, have made the inevitable personalization of the disease and symptoms virtually invisible. After ages of explaining psychiatric diseases as the alienation of the person, and a long psychoanalytic period of finding their origins in the person, in the last 30 years these diseases have become increasingly objectified. The place of the person has been diminished as psychiatry has entered the DSM, neurotransmitter, and effective psychotropic drug era. For both physical and mental disease, however, and whatever the current ideology, the nature of person is crucial in determining the onset, diagnosis, course, treatment, and outcome of each illness. It is in order to have an impact on these crucial aspects of sickness that clinicians must come to know their patients to the degree possible. [End Page 225]But there is something more. Nancy Potter quotes a woman with schizophrenia as saying, "All that was my former self has crumbled and fallen together and a creature has emerged of whom I know nothing. She is a stranger to me... She is not real—she is not I... She is I—and because I still have myself on my hands, even if I am a maniac, I must deal with me somehow." (Potter, 2003, p. 215)Must she deal with this crazy self alone? Is that not what her doctors and caregivers are for? But how can they take care of her, protect her, keep what is left intact, and sustain her until she is (hopefully) better without knowing who she is? She makes clear in those few phrases that inside her there is a person with a past, a family, a world, a culture, a role(s) in life, relationships, a body, dreams for the future, things she does, and all the other things that make up a person. It is in... (shrink)

In a controversial paper, David Seedhouse argues that medical ethics is not and cannot be a distinct discipline with it own field of study. He derives this claim from a characterization of ethics, which he states but does not defend. He claims further that the project of medical ethics as it exists and of moral philosophy do not overlap. I show that Seedhouse's views on ethics have wide implications which he does not declare, and in the light of this argue (...) that Seedhouse owes us a defence of his characterization of ethics. Further, I show that his characterization of ethics, which he uses to attack medical ethics, is a committed position within moral philosophy. As a consequence of this, it does not allow the relation between moral philosophy and medical ethics to be discussed without prejudice to its outcome. Finally, I explore the relation between Seedhouse's position and naturalism, and its implications for medical epistemology. I argue that this shows us that Seedhouse's position, if it can be defended, is likely to lead to a fruitful and important line of inquiry which reconnects philosophy and medical ethics. (shrink)

A fundamental fact about human minds is that they are never truly alone: all minds are steeped in situated interaction. That social interaction matters is recognized by any experimentalist who seeks to exclude its influence by studying individuals in isolation. On this view, interaction complicates cognition. Here, we explore the more radical stance that interaction co-constitutes cognition: that we benefit from looking beyond single minds toward cognition as a process involving interacting minds. All around the cognitive sciences, there are approaches (...) that put interaction center stage. Their diverse and pluralistic origins may obscure the fact that collectively, they harbor insights and methods that can respecify foundational assumptions and fuel novel interdisciplinary work. What might the cognitive sciences gain from stronger interactional foundations? This represents, we believe, one of the key questions for the future. Writing as a transdisciplinary collective assembled from across the classic cognitive science hexagon and beyond, we highlight the opportunity for a figure-ground reversal that puts interaction at the heart of cognition. The interactive stance is a way of seeing that deserves to be a key part of the conceptual toolkit of cognitive scientists. (shrink)

Basado enteramente en pruebas internas, este estudio se propone mostrar que el manuscrito único del Dīwān de Ibn Quzmān, publicado en edición facsímil por David de Gunzburg en 1896, es una copia dictada. Se indica también que el copista, a quien con frecuencia se ha culpado de introducir en el texto popular andaluz correcciones o clasicismos, no estaba bien equipado para desempeñar tal papel. Si bien era un calígrafo de primera categoría, se aducen pruebas de que su conocimiento del árabe (...) no estaba a la altura de la calidad de su caligrafía. El estudio muestra que él fue el responsable de una amplia gama de problemas textuales que ha dejado perplejos a sucesivos editores del Dīwān. En marcado contraste, se muestra que Ibn Quzmān poseía un dominio magistral de la lengua árabe y de las tradiciones-árabes clásicas. Al parecer también había adquirido un alto grado de 'aculturación' en la lengua romance. Además de ofrecer las pruebas en que se basan estos asertos, el estudio constituye un ejemplo ilustrativo de cómo estas pruebas pueden ayudar a una mejor lectura e interpretación del Dīwān de Ibn Quzmān. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:American Journal of Philology 123.3 (2002) 529-534 [Access article in PDF] Colin Adams and Ray Laurence, eds. Travel and Geography in the Roman Empire. London and New York: Routledge, 2001. x + 202 pp. 48 black-and-white figures. Cloth, $75. Five of the six contributions to this varied and valuable collection of essays originated as papers delivered at the 1999 Roman Archaeology Conference in Durham, England. The sixth and longest (...) piece, by Benet Salway, was then added, together with an introduction by one co-editor (Adams) and an afterword by the [End Page 529] other (Laurence). Notes follow each contribution, with a consolidated bibliography and index at the end. Although in black and white only, the range of photos, figures, and maps is appropriately extensive.The volume stems from due recognition that geographical knowledge and travel in the Roman world are topics at last attracting the serious attention they deserve. Between them, the contributions amply demonstrate how even some of the aspects most fundamental to our understanding stir deep controversy and how incomplete the exploitation of much of the diverse source material has been to date. Happily, the emergence of exciting new discoveries is prompting fresh examination of testimony long known and neglected.Useful, though limited in scope, is Anne Kolb's "Transport and Communication in the Roman State: The cursus publicus" (95-105), which mainly confines itself to identifying those categories of imperial officials and other individuals entitled to use the service (more properly referred to as vehiculatio during the Principate). By contrast, the support Kolb offers for the doubtful claim that transport of freight—other than baggage accompanying officials—was a "relatively unimportant" aspect of the service, even in the Late Empire (102), remains inadequate. Throughout, changes to the service over such a long span seem underappreciated (not least, for example, Nerva's removal of the burden from Italy).Adams modestly characterizes his contribution "'There and Back Again': Getting around in Roman Egypt" (138-66) as descriptive rather than analytical. His aim is to demonstrate the scope and value of the testimony preserved on papyri, and he does this engagingly, with unfailing regard for the impact of Egypt's unique geography and topography on travel there. Even though its publication dates back to 1952, few readers are likely to be familiar with the extensive archive preserving an itinerary and accounts for Theophanes' return journey from Antinoopolis to Antioch around 320 (160-62). Even fewer will be aware of the record of travelers and animals accommodated overnight, and rations issued to them, kept by the two large, busy mansiones in the Oxyrhynchite nome during the mid-fourth century and only published in 1994 (142-44). Vivid illustration of the multiple hazards awaiting travelers by road from causes both natural and human (154-56) can serve as a sobering counterbalance to the ideal conditions evoked by Aelius Aristides and quoted earlier by Adams (as eulogy) in the Introduction (1-2). One manifestation of "recreational" travel, which seems strangely absent from the discussion, on page 157 in particular, is pilgrimage (note, in general, Der Neue Pauly, s.v. Pilgerschaft 1).Jon Coulston's "Transport and Travel on the Column of Trajan" (106-37) is another predominantly descriptive contribution but one well geared to substantiate its conclusion: "The conflict is not simply between Romans and Dacians, Trajan and Decebalus. It is also a contest between Romans and barbarians, disciplina and perturbatio, labor and inertia, imperial virtues and enemy perfidy, civilisation and untamed nature, urbanisation and wilderness" (129-30). Description, moreover, is justified here when no other piece of Roman propaganda art, [End Page 530] before or after, depicts armies on the move—tents (for which soldiers were charged! [Tacitus Annals 1.17.4]), carts, pack animals, equipment, provisions, along roads, over bridges—with such amazing fullness and detail. We possess no more forceful illustration of the huge "train" that had to accompany every legion (118-19; the comparison made with Ottoman armies on campaign in the sixteenth and seventeenth centuries is instructive). Coulston's acute observation, lucid presentation, and reluctance to overinterpret... (shrink)

Filosofische ponering van de subjectiviteit van elke interpretatie.

Tsc question of the date of Ctesibius has been much obscured of late years by those German scholars1 who assert that Ctesibius the pneumatic and hydraulic engineer mentioned by Vitruvius IX. 8. 2 is distinct and separate from Κτησίβιος Κτησίβιος μηΧανικός who is mentioned by Athenaeus Mechanicus , Philo of Byzantium , and Hedylus ap. Athenaeum Naucratitam Deipn. XI., p. 497, d-e = Anthologia Graeca ed. Cougny, Paris , 1890, Vol. III., p. 298, n. 67.

A simple model of an exciton-phonon system is studied in connection with quantum chaos.