Medical science Archives - Page 4 of 8

Flexner versus Osler

Michel AccadApril 26, 2016December 13, 2016Healthcare policy, Medical science, Philosophymedical education5 Comments

In the introduction to a talk I gave at the Mises Institute this year, I noted how, in the early part of the twentieth century, a convergence of interests between social progressivists and ideological empiricists led to the publication of the Flexner report and the subsequent enactment of licensing laws.

That historical context is further treated in an outstanding article by Alfred Tauber, who was professor of medicine and philosophy at Boston University School of Medicine.

In “The two faces of medical education: Flexner and Osler revisited,” Tauber contrasts the radically different views these two men held about the ethos of medicine and the proper approach to medical education. It is ironic that the victorious position would be the one pushed by Flexner who, as Murray Rothbard put it, was “an unemployed former owner of a prep school in Kentucky…sporting neither a medical degree nor any other advanced degree.”Continue reading “Flexner versus Osler”

From reacting machine to acting person – part 2

Michel AccadApril 22, 2016September 10, 2021Medical science, Philosophy2 Comments

[This is part 2 of my paper presentation at AERC 2016 at the Mises Institute. Find part 1 here and the audio here.]

I would therefore like to entertain an interpretation of health rooted in the view that human beings are persons acting purposely, persons who select means to achieve chosen ends, which is the framework of praxeology.

Under a praxeological framework, I would distinguish external means such as land, labor, and capital, which are generally the concern of economic theory, from internal means, such as the physical and mental conditions of the person that allow him or her to pursue chosen ends.

Health, then, may be defined as the state that is present when a person’s physical and mental conditions allow the pursuit of his or her chosen ends. Disease, then, is the absence of health.Continue reading “From reacting machine to acting person – part 2”

From reacting machine to acting person – part 1

Michel AccadApril 22, 2016September 10, 2021Medical science, Philosophy2 Comments

[This is the transcript of a paper I presented at the Austrian Economics Research Conference at the Mises Institute. I have included the slides below and you can hear the audio here. The title of the paper is “From reacting machine to acting person: a praxeological interpretation of the patient, his health, and his medical care.” For more info on praxeology, see my previous article here. I have split the presentation into two parts. This is a very condensed talk, covering a lot of ground, but I will elaborate on various points I make in the paper in the ‘progress notes’ section of this website over the next few days and weeks. Thank you for reading and for any feedback you might have.]

The elephant in the room in healthcare is that there is no precise definition of health. I believe that this ambiguity plays a major role in our perennial healthcare crises, and I am hopeful that Austrian insights can be helpful.

Here is the outline of my talk.

I will first identify the two dominant modes of thinking about health in modern Western societies. I will show that those conceptual modes are counterproductive to fostering health, both economically and medically. I will then propose a praxeological interpretation of health, and sketch the possible benefits and ramifications of that interpretation.

The dominant mode of thinking about health in Western societies owes its origins to René Descartes who, at the beginning of the scientific revolution, proposed the machine concept of the organism. Descartes’ proposal was a radical departure from pre-existing notions which were rooted in the idea that organisms have essences and natures. Instead, he proposed that every material body is an assemblage of tiny particles moving mechanically according to physical laws. In the case of plants and animals, God directs the laws and the motions. In the case of humans, the mechanical bodies are under the control of a separate human soul acting like a “ghost in the machine.”Continue reading “From reacting machine to acting person – part 1”

An introduction to praxeology and Austrian school economics

Michel AccadApril 13, 2016December 13, 2016Healthcare economics, Medical science, Philosophy4 Comments

A couple of weeks ago, I presented a paper about health and medical care at the 2016 Austrian Economics Research Conference, which was held at the Mises Institute. I will be sharing the content of the talk in the next few posts, but given that I use some terms and concepts borrowed from that school of thought (e.g., “praxeology”), I thought that I would first take the opportunity to give a brief introduction to Austrian economics for those unfamiliar with it.

Brief history

Austrian school economics refers to a school of economic thought whose adherents generally share similar views on methodology. The originators of that school were mid-to-late nineteenth century Austrian scholars whose economic ideas were in opposition to the ones dominant in Germany at that time. The term “Austrian school,” given in disparagement by members of the German Historical School, stuck. The German school has disappeared, but the Austrian school remains vibrant today.Continue reading “An introduction to praxeology and Austrian school economics”

A guide to top medical journals

Michel AccadApril 6, 2016December 13, 2016Medical science7 Comments

Charles Ornstein is an award-winning healthcare journalist who recently wrote an article in the Boston Globe about an ongoing controversy regarding a top medical publication. Yet Ornstein still wonders about the current status of medical journals:

Which medical journal do you believe is best adapting to the realities of medical research today? @jflier @VinayPrasad82

— Charles Ornstein (@charlesornstein) April 5, 2016

To help answer Mr. Ornstein’s query, I have asked the editors of top medical journals to submit responses to a simple questionnaire. Here are their answers.Continue reading “A guide to top medical journals”

The machine metaphor in medicine

Michel AccadMarch 25, 2016August 31, 2020Medical science, Philosophydisease definition, health definitionLeave a comment

In the first part of a paper I will present at the Austrian Economics Research Conference next week, I talk about the healthcare system’s elephant in the room: how an activity that occupies 18 percent of GDP is doing so without any precise definition of health.

The lack of definition does not mean that there aren’t any prevailing notions about health. In fact, there is one particular concept that is clearly dominant, however implicit or covert it may be: it’s the notion of health that emerges if one adopts the “machine metaphor” for the body, a metaphor that is as pervasive as could be, given that it seems to have no viable counterpart (see, for example, here).Continue reading “The machine metaphor in medicine”

The medical fortunetellers

Michel AccadMarch 18, 2016September 10, 2021Medical sciencestatistics in medicine2 Comments

[I’m preparing my paper for the AERC 2016 and have less time for original content, so I thought I would bring to your attention this editorial I wrote a few years ago. I hope you enjoy it. Figure 1 in this article is my most important contribution to empirical science to date!]

There was a time when the foretelling of future events was an undertaking of prophets, palm-readers, and weathermen. In recent years, however, the medical profession seems to have embraced this activity with a great deal of enthusiasm. A prime example is the use of the term “predicts” in the titles of journal articles dealing with human subjects. According to a search of the MEDLINE® database, “predicts” appeared a total of only 13 times before 1980.¹ Since then, however, the occurrence of the term in citation titles has increased dramatically. Expressed as a percentage of the annual number of MEDLINE publications, the trend follows a curve that could be described as hyperbolic (Fig. 1).

Fig. 1. Percentage of MEDLINE® publications on human subjects with the term “predicts” in the title.

[Read the rest here]

The devolution of evidence-based medicine

Michel AccadMarch 11, 2016November 24, 2018Medical scienceevidence-based medicine, medical decision-making11 Comments

Anish Koka recently wrote a great piece entitled “In Defense of Small Data” that was published on The Health Care Blog.

While many doctors remain enamored with the promise of Big Data or hold their breath in anticipation of the next mega clinical trial, Koka skillfully puts the vagaries of medical progress in their right perspective. More often than not, Koka notes, big changes come from astute observations by little guys with small data sets.

In times past, alert clinicians would make advances using their powers of observation, their five senses (as well as the common one) and, most importantly, their clinical judgment. They would produce a case series describing their experience so others could try to replicate the findings and judge for themselves.

Today, this is no longer the case. We live in the era of “evidence-based medicine,” or EBM, which began about fifty years ago. Reflecting on the scientific standards that the medical field has progressively imposed on itself over the last few decades, I can make out that demands for better scientific methodology have ratcheted up four levels:Continue reading “The devolution of evidence-based medicine”

Why I don’t believe in science

Michel AccadFebruary 12, 2016April 19, 2018Medical science, Philosophyevidence-based medicine, medical decision-making10 Comments

A few days ago, cardiologist and master blogger John Mandrola wrote a piece that caught my attention. More precisely, it was the title of his blog post that grabbed me: “To Believe in Science Is To Believe in Data Sharing.”

Mandrola wrote about a proposal drafted by the International Committee of Medical Journal Editors (ICMJE) that would require authors of clinical research manuscripts to share patient-level data as a condition for publication. The data would be made available to other researchers who could then perform their own analyses, publish their own papers, etc.

The ICMJE proposal is obviously controversial, raising thorny questions about whether “data” are the kinds of things that can be subject to ownership and, if so, whether there are sufficient ethical or utilitarian grounds to demand that data be “forked over,” so to speak, for others to review and analyze.

Now all of that is of great interest, but I’d like to focus attention on the idea that conditions Mandrola’s endorsement of data sharing. And the question I have is this: Should we believe in science?Continue reading “Why I don’t believe in science”

The physician as entrepreneur

Michel AccadDecember 4, 2015December 13, 2016Healthcare economics, Medical practice, Medical sciencedoctor-patient relationship, medical decision-makingLeave a comment

Frank Knight, risk and uncertainty

In this article, I wish to introduce the reader to the theory of entrepreneurship advanced by Frank Knight (1885-1972), and show that the common, everyday work of the physician could be considered a form of entrepreneurial activity in the Knightian sense.

Knight was an influential American economist. He is best known for his book Risk, Uncertainty, and Profit in which he proposed to distinguish risk and uncertainty as follows:Continue reading “The physician as entrepreneur”