American Doctors at the Nuremberg Medical Trial.

Three Hippocratic physicians played critical roles in the prosecution of 23 Nazi doctors charged with murder and torture for conducting lethal medical experiments on concentration camp prisoners. Two of the physicians, Leopold Alexander and Andrew C. Ivy, were Americans, and the other, Werner Leibbrandt, was German. At the 70th anniversary of the Doctors' Trial it is fitting to recall the three's influences and contributions to the formulation of strict research ethics rules, known as the Nuremberg Code. Their contributions help us better understand why they insisted on strict research rules and yet ultimately were unable to apply these rules to their own research. Exploring their contributions at Nuremberg may help us appreciate the continuing difficulty physician-researchers have with accepting public regulation of research.

The Physician's Duty to Treat During Pandemics.

Physicians assume a primary ethical duty to place the welfare of their patients above their own interests. Thus, for example, physicians must not exploit the patient-physician relationship for personal financial gain through the practice of self-referral. But how far does the duty to patient welfare extend? Must physicians assume a serious risk to their own health to ensure that patients receive needed care? In the past, physicians were expected to provide care during pandemics without regard to the risk to their own health. In recent decades, however, the duty to treat during pandemics has suffered from erosion even while the risks to physicians from meeting the duty has gone down. After exploring the historical evolution of the duty to treat and the reasons for the duty, I conclude that restoring a strong duty to treat would protect patient welfare without subjecting physicians to undue health risks.

Translating Learned Surgery1.

This essay explores the increasingly visible or strong relationship between educated surgeons and artisans that can be documented in vernacular translations of Latin surgery texts in the sixteenth century. We often consider the vernacular as a tool for broad dissemination, but vernacular translation was used by educated surgeons for more calculated, professional reasons. In vernacular texts, they began to articulate their role and responsibilities in urban settings (rather than military settings). This essay focuses on the Latin and Italian surgery texts of Giovanni Andrea della Croce, a Venetian, educated surgeon, who began to frame (in text and image) his work according to aspects of artisanal traditions.

The Great Pox and the Surgeon's Role in the Sixteenth Century.

The sixteenth century saw a shift in perceptions of the scope of surgery. The medieval focus on elevating the status of surgery had been accompanied by a certain distancing of surgery from manual operations, but the medical humanism of the sixteenth century embraced manual skills as an important part of medicine, most noticeably in the case of anatomy. In the first part of this paper I use accounts of the treatment of ulcers as a way of exploring these changes in perceptions. Ulcers were a well-known surgical ailment in medieval medicine, but in the sixteenth century they were also associated with the Great Pox. This made their treatment an important test case for establishing the scope of surgery and ultimately led Gabriele Falloppio to claim that ulcers from the Pox were not a part of surgery at all. In the second half of the paper, I look at sixteenth-century descriptions of surgery found in works on surgery and anatomy and note how important the idea of the efficacy of surgical treatment was in them. I conclude by suggesting that the concern with efficacy was itself another aspect of the arrival of the Pox.

Bringing the pregnancy test home from the hospital.

This paper explores the settlement process of one of the most common home diagnostic tools currently in use, the home pregnancy test. The controversial new device appeared to threaten the jurisdiction of both doctors and Food and Drug Administration regulations, while it aligned with the women's health movement's goals. But this study finds a more nuanced narrative: one of boundaries and positions that at once were blurry, later shifted, and were ultimately aligned without compromising the credibility of doctors or the legal system. To understand this process, the roles of court decisions and regulations are explained by stages of juris-technical accordance. In this case, rather than restricting technological innovation, legal innovation provided pathways for widespread acceptance of the home pregnancy test by various groups. As more tools move from expert users to layperson users, this paper demonstrates the utility of examining existing juris-technical assemblages as we consider the future of self-monitoring and self-diagnosis.

Reinventing the political role of health professionals in conflict prevention & reconciliation: the Sudanese model.

Given the persistent recurrence of armed conflict, influential actors owe it to the affected communities to take action. The legitimacy of health professionals to mitigate the effects of conflict relates to their ability to save lives and address the physical and mental consequences of armed conflict during which thousands of lives may be lost. Medical professionals have unique and potentially far-reaching skills. These become crucial during wartime and disasters in terms of providing medical services and humanitarian aid. However, they are insufficiently used in one area: involvement in politics as a tool to foster peace. Despite this, Sudanese individuals from medical backgrounds have participated actively in conflict resolution and peace-building processes. In fact, their political actions throughout the last six decades have aimed to prevent conflict at four different levels, which are described by Yusuf et al. in their article on the political involvement of health professionals in prevention. Their stand against President Nimeiri's Sharia laws was primordial prevention of religious conflict at the national level. Their leading role in the second Sudanese Intifada uprising was a key factor in saving the country from civil war, and another example of primary prevention. Sudanese physicians were also involved in secondary prevention by being influentially involved in almost all national peace agreements. Avoiding disputes at the tertiary level represents the weakest link in their repeated efforts. This paper outlines the different roles Sudanese medical personnel have taken in peacemaking. It also critically evaluates them in order to consider new methods of political involvement that suit future challenges.

[Three aspects of the medical ethos]. / Trois aspects de l'éthos médical.

For many years, a major focus of interest has been the patient, in the context of a constantly changing society and increasingly complex medical practices. We propose to shift this focus on the physician, who is entangled in a similar, but less evident way. In these three articles, we explore, in succession, the lived experience of the contemporary physician, the ethos which brings together the medical community, and the education of the future physician, using research projects currently under way within the Service of Liaison Psychiatry at Lausanne University Hospital. Here, we describe three aspects of the medical ethos shaping medicine and the physicians: pragmatism, scientific rationality, and the individualistic embodiment of clinical practice.

[The problems of struggle with alcoholism in works of Pirogov congresses].

The article demonstrates that the Pirogov Society considered prevalence of alcoholism in Russia as an important social problem. The Pirogov congresses discussed such issues as impact of alcohol on human organism, principles of organization of struggle with alcoholism and its treatment and the role of physicians in the struggle with alcoholism as well.

The origins of American health libertarianism.

This Article examines Americans' enduring demand for freedom of therapeutic choice as a popular constitutional movement originating in the United States' early years. In exploring extrajudicial advocacy for therapeutic choice between the American Revolution and the Civil War, this piece illustrates how multiple concepts of freedom in addition to bodily freedom bolstered the concept of a constitutional right to medical liberty. There is a deep current of belief in the United States that people have a right to choose their preferred treatments without government interference. Modern American history has given rise to movements for access to abortion, life-ending drugs, unapproved cancer treatments, and medical marijuana. Recently, cries of "Death Panels" have routinely been directed against health care reform proposals that citizens believe would limit the products and procedures covered by government health insurance. Some of the most prominent contemporary struggles for health freedom have been waged in court. But other important recent battles for freedom of therapeutic choice have taken place in other forums, from legislative hearings to Food and Drug Administration advisory committee meetings to public demonstrations. This attitude of therapeutic libertarianism is not new. Drawing mainly on primary historical sources, this Article examines arguments in favor of freedom of therapeutic choice voiced in antebellum America in the context of battles against state licensing regimes. After considering some anti-licensing arguments made before independence, it discusses the views and statements of Benjamin Rush, an influential founding father who was also the most prominent American physician of the early national period. The Article then analyzes the Jacksonian-era battle against medical licensing laws waged by the practitioners and supporters of a school of botanical medicine known as Thomsonianism. This triumphant struggle was waged in explicitly constitutional terms, even though it occurred entirely outside of the courts. The Thomsonian campaign thus offers one of the most striking examples of a successful popular constitutional movement in American history. This article shows that, at its origin, the American commitment to freedom of therapeutic choice was based on notions of not only bodily freedom, but also economic freedom, freedom of conscience, and freedom of injury. Finally, this Article considers ways in which this early history helps illuminate the nature of current struggles for freedom of therapeutic choice.