Western pharmaceuticals are flooding the Third World. Injections, capsules and tablets are available in city markets and village shops, from 'traditional' practitioners and street vendors, as well as from more orthodox sources like hospitals. Although many are aware of this 'pharmaceutical invasion', little has been written about how local people perceive and use these products. This book is a first attempt to remedy that situation. It presents studies of the ways Western medicines are circulated and understood in the cities and rural areas of Africa, Asia and Latin America. We feel that such a collection is long overdue for two reasons. The first is a practical one: people dealing with health problems in developing countries need information about local situations and they need examples of methods they can use to examine the particular contexts in which they are working. We hope that this book will be useful for pharmacists, doctors, nurses, health planners, policy makers and concerned citizens, who are interested in the realities of drug use. Why do people want various kinds of medicine? How do they evaluate and choose them and how do they obtain them? The second reason for these studies of medicines is to fill a need in medical anthropology as a field of study. Here we address our colleagues in anthropol ogy, medical sociology and related disciplines."

As our modem society is so obviously influenced by technology, there is a growing awareness of its importance for education. The interest for including technology as a part of general education curricula is increasing. In many countries technology is an element in the curriculum either as a topic, a project, part of a Science-Technology-Society (STS) programme, part of science education, or as a separate subject. In order to clarify what technology is, there is a need for international discussions in which philosophers, engineers, scientists and educational ists are involved. One of the few conferences with such a broad representation was the second Jerusalem International Science and Technology Education Conference (JISTEC) that was held in Jerusalem, January 8-11, 1996, a conference that can truly be seen as a milestone in the international history of technology education. More than 1,000 technology educators from more than 80 countries of the world and ministers of education from 28 coun tries came together to discuss current issues in technology education during JlSTEC. To cite from Dr. Michael Dyrenfurth's personal overview of the conference in the Journal of Industrial Teacher Education (vol. 33, no. 2, Winter 1996, pp. 83-85): 'Simply put, this conference represented the most stellar international collection of technology education advocates the world has ever seen in one place'. Or in the words of Dr."

On May 13-15, 1982, some 50 scientists and scholars - physicians, philos ophers and social scientists - convened at Hasselby Castle in Stockholm for the first Nordic Symposium on the Philosophy of Medicine. The topics for the symposium included (1) the concepts of health and disease, (2) classification in medicine, and (3) causality and causal explanations in medicine. The majority of the participants were Scandinavian but the symposium was also able to welcome four distinguished guests from other parts of the world, Professors Stuart F. Spicker and H. Tristram Engelhardt, Jr., U.S.A., Dr Anne M. Fagot, France, and Dr Werner Morbach, West Germany. The latter represented Professor Kazem Sadegh-zadeh, who unfortunately was prevented from attending. One of the main purposes of this symposium was to bring together people in Scandinavia who at present work within the field of Philosophy of Medi cine. This group is still relatively small but is growing rapidly, and the scholarly activity has recently been notable. This fact is clearly demonstrated by the presentation of 'Philosophy of Medicine in Scandinavia' in the Appendix of this volume."

In the last few years there has been a great revival of interest in culture-bound psychiatric syndromes. A spate of new papers has been published on well known and less familiar syndromes, and there have been a number of attempts to put some order into the field of inquiry. In a review of the literature on culture-bound syndromes up to 1969 Yap made certain suggestions for organizing thinking about them which for the most part have not received general acceptance (see Carr, this volume, p. 199). Through the seventies new descriptive and conceptual work was scarce, but in the last few years books and papers discussing the field were authored or edited by Tseng and McDermott (1981), AI-Issa (1982), Friedman and Faguet (1982) and Murphy (1982). In 1983 Favazza summarized his understanding of the state of current thinking for the fourth edition of the Comprehensive Textbook of Psychiatry, and a symposium on culture-bound syndromes was organized by Kenny for the Eighth International Congress of Anthropology and Ethnology. The strong est impression to emerge from all this recent work is that there is no substantive consensus, and that the very concept, "culture-bound syndrome" could well use some serious reconsideration. As the role of culture-specific beliefs and prac tices in all affliction has come to be increasingly recognized it has become less and less clear what sets the culture-bound syndromes apart."

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From the tone of the report by the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Re search, one might conclude that the whole-brain-oriented definition of death is now firmly established as an enduring element of public policy. In that report, Defining Death: Medical, Legal and Ethical Issues in the Determination of Death, the President's Commission forwarded a uni form determination of death act, which laid heavy accent on the signifi cance of the brain stem in determining whether an individual is alive or dead: An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards ( 1], p. 2). The plausibility of these criteria is undermined as soon as one confronts the question of the level of treatment that ought to be provided to human bodies that have permanently lost consciousness but whose brain stems are still functioning."

Comparative Veterinary Anatomy: A Clinical Approach describes the comprehensive, clinical application of anatomy for veterinarians, veterinary students, allied health professionals and undergraduate students majoring in biology and zoology. The book covers the applied anatomy of dogs, cats, horses, cows and other farm animals, with a short section on avian/exotics, with a focus on specific clinical anatomical topics. The work improves the understanding of basic veterinary anatomy by making it relevant in the context of common clinical problems. This book will serve as a single-source reference on the application of important anatomical structures in a clinical setting. Students, practitioners and specialists will find this information easy-to-use and well-illustrated, thus presenting an accurate representation of essential anatomical structures that relates to real-life clinical situations in veterinary medicine.

This volume developed from and around a series of six lectures sponsored by Rice University and the University of Texas Medical Branch at Galveston in the Fall of 1976. Though these lectures on the concepts of mental health, mental illness and personal responsibility, and the social treatment of the mentally ill were given to general audiences in Houston and Galveston, they were revised and expanded to produce six extensive formal essays by Dan Brock, Jules Coleman, Joseph Margolis, Michael Moore, Jerome Neu, and Rolf Sartorius. The five remaining contributions by Daniel Creson, Corinna Delkeskamp, Edmund Erde, James Speer, and Stephen Wear were in various ways engendered by the debates occasioned by the original six lectures. In fact, the majority of the last five contributions emerged from informal dis. cussions occasioned by the original lecture series. The result is an interlocking set of essays that address the law and public policy insofar as they bear on the treatment of the mentally ill, special atten. tion being given to the defmition of mental illness, generally and in the law, to the issues of the bearing of mental incompetence in cases of criminal and civil liability, and to the issue of involuntary commitment for the purpose of treatment or for institutional care. There is as well a critical defense of Thomas Szasz's radical proposal that mental illnesses are best understood as problems in living, not as diseases."

A major focus of the philosophy of medicine and, in general, of the philosophy of science has been the interplay of facts and values. Nowhere is an evaluation of this interplay more important than in the ethics of diagnosis. Traditionally, diagnosis has been understood as an epistemological activity which is concerned with facts and excludes the intrusion of values. The essays in this volume challenge this assumption. Questions of knowledge in diagnosis are intimately related to the concerns with intervention that characterize the applied science of medicine. Broad social and individual goals, as well as diverse ethical frameworks, are shown to condition both the processes and results of diagnosis. This has significant implications for bioethics, implications that have not previously been developed. With this volume, the ethics of diagnosis' is established as an important branch of bioethics.

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Over a period of a year, the symposium on clinical judgment has taken shape as a volume devoted to the analysis of how knowledge claims are framed in medicine and how choices of treatment are made. We hope it will afford the reader, whether layman, physician or philosopher, a useful perspective on the process of knowing what occurs in medicine; and that the results of the dis cussions at the Fifth Symposium on Philosophy and Medicine will lead to a better understanding of how philosophy and medicine can usefully challenge each other. As the interchange between physicians, philosophers, nurses and psychologists recorded in the major papers, the commentaries and the round table discussion shows, these issues are truly interdisciplinary. In particular, they have shown that members of the health care professions have much to learn about themselves from philosophers as well as much of interest to engage philosophers. By making the structure of medical reasoning more apparent to its users, philosophers can show health care practitioners how better to master clinical judgment and how better to focus it towards the goods and values medicine wishes to pursue. Becoming clearer about the process of knowing can in short teach us how to know better and how to learn more efficiently. The result can be more than (though it surely would be enough ) a powerful intellectual insight into a major cultural endeavor, medicine."

"The fixed person for fixed duties, who in older societies was such a godsend, in the future ill be a public danger." Twenty years ago, a single legal metaphor accurately captured the role that American society accorded to physicians. The physician was "c- tain of the ship." Physicians were in charge of the clinic, the Operating room, and the health care team, responsible - and held accountabl- for all that happened within the scope of their supervision. This grant of responsibility carried with it a corresponding grant of authority; like the ship's captain, the physician was answerable to no one regarding the practice of his art. However compelling the metaphor, few would disagree that the mandate accorded to the medical profession by society is changing. As a result of pressures from a number of diverse directions - including technological advances, the development of new health professionals, changes in health care financing and delivery, the recent emphasis on consumer choice and patients' rights - what our society expects phy- cians to do and to be is different now. The purpose of this volume is to examine and evaluate the conceptual foundations and the moral imp- cations of that difference. Each of the twelve essays of this volume assesses the current and future validity of the "captain of the ship" metaphor from a different perspective. The essays are grouped into four sections. In Section I, Russell Maulitz explores the physician's role historically.

This volume, which has developed from the Fourteenth Trans Disciplinary Symposium on Philosophy and Medicine, September 5-8, 1982, at Tel Aviv University, Israel, contains the contributions of a group of distinguished scholars who together examine the ethical issues raised by the advance of biomedical science and technology. We are, of course, still at the beginning of a revolution in our understanding of human biology; scientific medicine and clinical research are scarcely one hundred years old. Both the sciences and the technology of medicine until ten or fifteen years ago had the feeling of the 19th century about them; we sense that they belonged to an older time; that era is ending. The next twenty-five to fifty years of investigative work belong to neurobiology, genetics, and reproductive biology. The technologies of information processing and imaging will make diagnosis and treatment almost incomprehensible by my generation of physicians. Our science and technology will become so powerful that we shall require all of the art and wisdom we can muster to be sure that they remain dedicated, as Francis Bacon hoped four centuries ago, "to the uses of life." It is well that, as philosophers and physicians, we grapple with the issues now when they are relatively simple, and while the pace of change is relatively slow. We require a strategy for the future; that strategy must be worked out by scientists, philosophers, physicians, lawyers, theologians, and, I should like to add, artists and poets."

Explores the social world where abortion politics and mainstream medicine collide. The author interviewed physicians of obstetrics and gynecology around the United States to find out why physicians rarely integrate abortion into their medical practice. While abortion stigma, violence, and political contention provide some explanation, her findings demonstrate that willing physicians are further encumbered by a variety of barriers within their practice environments. Structural barriers to the mainstream practice of abortion effectively institutionalize the buck-passing of abortion patients to abortion clinics. As the author notes, ""Public-health-minded HMOs and physician practices could significantly change the world of abortion care if they stopped outsourcing it."" Drawing from forty in-depth interviews, the book presents a challenge to a commonly held assumption that physicians decide whether or not to provide abortion based on personal ideology. Physician narratives demonstrate how their choices around learning, doing, and even having abortions themselves disrupt the pro-choice/pro-life moral and political binary.|Willing and Unable explores the social world where abortion politics and mainstream medicine collide. The author interviewed physicians of obstetrics and gynecology around the United States to find out why physicians rarely integrate abortion into their medical practice. While abortion stigma, violence, and political contention provide some explanation, her findings demonstrate that willing physicians are further encumbered by a variety of barriers within their practice environments. Structural barriers to the mainstream practice of abortion effectively institutionalize the buck-passing of abortion patients to abortion clinics. As the author notes, ""Public-health-minded HMOs and physician practices could significantly change the world of abortion care if they stopped outsourcing it."" Drawing from forty in-depth interviews, the book presents a challenge to a commonly held assumption that physicians decide whether or not to provide abortion based on personal ideology. Physician narratives demonstrate how their choices around learning, doing, and even having abortions themselves disrupt the pro-choice/pro-life moral and political binary.

This book examines the factors influencing women's choices of obstetrical care in a Bariba community in the People's Republic of Benin, West Africa. When selecting a research topic, I decided to investigate health care among the Bariba for several reasons. First, I had served as a Peace Corps Volunteer in northern Benin (then Dahomey) and had established a network of contacts in the region. In addition, I had worked for a year as assistant manager of a pharmacy in a northern town and had become interested in the pattern of utilization of health care services by urban residents. This three-year residence proved an invaluable asset in preparing and conducting research in the northern region. In particular, I was able to establish relationships with several indigenous midwives whose families I already knew both from prior research experience and mutual friend ships. These relationships enabled me to obtain detailed information regarding obstetrical practice and thus form the foundation of this book. The fieldwork upon which the book is directly based was conducted between June 1976 and December 1977 and sponsored by the F ord-Rockefeller Popula tion Policy Program, the Social Science Research Council, the National Science Foundation, and the FUlbright-Hays Doctoral Dissertation Research Program. The Ford-Rockefeller Population Policy Program funded the project as a collab oration between myself and Professor Eusebe Alihonou, Professor Agrege (Gynecologie-Obstetrique) at the National University of Benin."

Human existence is marked by pain, limitation, disability, disease, suffering, and death. These facts of life and of death give ample grounds for characterizing much of the human condition as unfortunate. A core philosophical question is whether the circumstances are in addition unfair or unjust in the sense of justifying claims on the resources, time, and abilities of others. The temptation to use the languages of rights and of justice is und- standable. Faced with pain, disability, and death, it seems natural to complain that "someone should do something," "this is unfair," or "it just isn't fight that people should suffer this way." Yet it is one thing to complain about the unfairness of another's actions, and another thing to complain about the unfairness of biological or physical processes. If no one is to blame for one's illness, disability, or death, in what sense are one's unfortunate circumstances unfair or unjust? How can claims against others for aid and support arise if no one has caused the unfortunate state of affairs? To justify the languages of fights to health care or justice in health care requires showing why particular unfortunate circumstances are also unfair, in the sense of demanding the labors of others. It requires understanding as well the limits of property claims. After all, claims regarding justice in health care or about fights to health care limit the property fights of those whose resources will be used to provide care.

The growth of knowledge and its effects on the practice of medicine have been issues of philosophical and ethical interest for several decades and will remain so for many years to come. The outline of the present volume was conceived nearly three years ago. In 1987, a conference on this theme was held in Maastricht, the Netherlands, on the occasion of the founding of the European Society for Philosophy of Medicine and Health Care (ESPMH). Most of the chapters of this book are derived from papers presented at that meeting, and for the purpose of editing the book Stuart Spicker, Ph. D. , joined two founding members of ESPMH, Henk ten Have and Gerrit Kimsma. The three of them successfully brought together a number of interesting contribu tions to the theme, and ESPMH is grateful and proud to have initiated the production of this volume. The Society intends that annual meetings be held in different European countries on a rotating basis and to publish volumes related to these meetings whenever feasible. In 1988, the second conference was held in Aarhus, Denmark on "Values in Medical Decision Making and Resource Allocation in Health Care". In 1989, a meeting was held in Czestochowa, Poland, on "European Traditions in Philosophy of Medicine. From Brentano to Bieganski". It is hoped that these conferences and the books to be derived from them, will initiate a new European tradition, lasting well into the 21 st century! P. J.

Explores the social world where abortion politics and mainstream medicine collide. The author interviewed physicians of obstetrics and gynecology around the United States to find out why physicians rarely integrate abortion into their medical practice. While abortion stigma, violence, and political contention provide some explanation, her findings demonstrate that willing physicians are further encumbered by a variety of barriers within their practice environments. Structural barriers to the mainstream practice of abortion effectively institutionalize the buck-passing of abortion patients to abortion clinics. As the author notes, ""Public-health-minded HMOs and physician practices could significantly change the world of abortion care if they stopped outsourcing it."" Drawing from forty in-depth interviews, the book presents a challenge to a commonly held assumption that physicians decide whether or not to provide abortion based on personal ideology. Physician narratives demonstrate how their choices around learning, doing, and even having abortions themselves disrupt the pro-choice/pro-life moral and political binary.|Willing and Unable explores the social world where abortion politics and mainstream medicine collide. The author interviewed physicians of obstetrics and gynecology around the United States to find out why physicians rarely integrate abortion into their medical practice. While abortion stigma, violence, and political contention provide some explanation, her findings demonstrate that willing physicians are further encumbered by a variety of barriers within their practice environments. Structural barriers to the mainstream practice of abortion effectively institutionalize the buck-passing of abortion patients to abortion clinics. As the author notes, ""Public-health-minded HMOs and physician practices could significantly change the world of abortion care if they stopped outsourcing it."" Drawing from forty in-depth interviews, the book presents a challenge to a commonly held assumption that physicians decide whether or not to provide abortion based on personal ideology. Physician narratives demonstrate how their choices around learning, doing, and even having abortions themselves disrupt the pro-choice/pro-life moral and political binary.