The Pragmatic Turn in Clinical Research

How does knowledge obtained in clinical trials apply to the actual treatment of patients? This question has recently acquired a new significance amidst complaints about the limited ability of trial results to improve clinical practice. Pragmatic clinical trials have been advocated to address this problem. In this article, I trace the emergence of the pragmatic turn in clinical research, starting from the first mention of ‘pragmatic trial’ in 1967, and analyse the changes to how pragmatism has been conceived. I argue that contemporary version of pragmatism risks missing the mark by focusing exclusively on establishing similarity between the trial and the clinic for the purpose of greater generalizability. This focus eclipses the move for carefully aligning medical experimentation with conditions, needs and concerns in the clinic aimed at greater usefulness.

Introduction

“Can military medicine be ethical?” is one question that may puzzle readers whose knowledge of medical ethics since 9/11 is colored by the prisons of Abu Ghraib and Guantanamo Bay. To address these and other challenges, Military Medical Ethics in Contemporary Armed Conflict explores controversial topics that include preferential care for compatriot warfighters, force feeding detainees, weaponizing medicine to wage war, medical experimentation, and neural enhancement for warfighters. Less controversial but no less compelling concerns direct our attention to postwar justice: the duty to rebuild war-torn nations and the obligation to care for war-torn veterans.

Animals in Moral Limbo: How Literary Pigs May Help Lab-Generated Ones

When considering that artistic and literary artifacts reflect the cultural views and mores of a particular time period, there is a significant misalignment between stories depicting increased moral status of pigs (e.g., vis-à-vis human-porcine relationships) and ongoing practices of pig consumption, commodification, and medical experimentation. In fact, there has been increased industrial farm meat production and biotechnological experimentation. Xenotransplantation trials, for example, are being heralded “the answer” to organ shortages needed for human transplantation, while significant ethical concerns persist. In this paper, I posit that literary reflections add a valuable dimension to animal ethics deliberations, providing a meta-narrative against which to assess normative practices. Beginning with synopses of three books: E.B. White’s Charlotte’s Web (1952), Robert Newton Peck’s A Day No Pigs Would Die (1972), and Paul Griffin’s Saving Marty (2017), I illustrate a shifting moral status view of human–pig relationships. Next, I discuss personhood attributions through biological, philosophical, and legal frameworks; review benefits and risks of xenotransplantation; reflect on the moral status of non-human animals; and offer concluding thoughts.

Cinema, MD

Cinema, MD argues that within cinema there is a history of medicine—one version in the many different histories of medicine. How did filmmakers write a history of medicine? This book discusses how cinema depicts medicine, in all its glory and all its failures, and what can we learn from it. It offers an account of all the major films with medical themes. The book asks a number of critical questions, such as why scriptwriters and directors chose the subjects, the plots, the cast, and the images that they did. Films have covered a wide range of medical topics, depicting not only physicians, nurses, and other health-care personnel working in hospitals, clinics, and asylums but also epidemics, diseases and disabilities, mental illness, and addictions. Films have portrayed medical feats such as vaccinations and organ transplantations. Filmmakers also have tackled subjects such as death and dying, medical experimentation, and rare diseases, as well as documenting criticism of the medical status quo.

The Rules of Medical Experimentation on People in the Light of the Polish Law and Administrative Solutions

In the history of mankind there are known cases of conducting experiments with a goal against people. After all, there has been eugenic research, or research leading to the creation of biological weapons. Such experiments are usually hidden from the public and governed by the internal and classified regulations of particular states. That is why it is important for the domestic legal orders world-wide to establish not only research methods and ways of conducting experiments (from the point of view of medical art and effectiveness of research) but also – and perhaps even more importantly – legal principles and rules limiting the conduct of medical experiments, and to establish rules of conduct with the effect of saving and prolonging the life and health of the patient. This article will analyse the Polish legal regulations and Polish doctrine in the field as a case study, describing an example of the national measures implemented to provide control of the research and medical experiment procedures.

Medical racism

The article analyses key examples of unethical medical experimentation on humans. The first part deals with racism, its ideology, and connectedness with concepts of medical racism. Concepts of the race that first emerged during the colonial expansion were defined by following their origins and function and not the philosophical thought. The second part builds upon the autonomy of patients. It includes the right to informed consent, protection of privacy, right of confidence, and persons with limited autonomy, all from a historical perspective on medical racism. In this section, the selected cases of medical racism show that the development of legal regulations and ethical norms importantly influenced the medical practice and the protection of subjects. The historical evidence also witnesses that even if the formal protection existed, there were deviations from it. The deviations were closely related to socio-political regulation and the rapid development of medicine that was a step before ethical norms. Additionally, war crimes against humanity were connected with personal ideological orientations of doctors whose racist, discriminatory beliefs were far beyond medical ethics and the purpose of medical practice. In the end, the article deals with the questions whether the results from unethical and unscientific experiments should be used and in what way medical racism endangers vulnerable groups today.