[The Rockefeller Foundation and its efforts toward a reorientation of German medicine and public health in the 1950s]. / Die Rockefeller Foundation und ihr Engagement bei einer Neuorientierung von Medizin und Public Health in Deutschland in den 1950er Jahren.

The Rockefeller Foundation invested substantial funds into promoting the development of public health as a discipline and a re-orientation of medical training in West Germany to support the democratization of German society. Not limiting itself to the simple provision of literature, the Foundation pursued a two-pronged strategy. Firstly, the Foundation organized a program for German university physicians and public health officers to visit various universities and teaching hospitals in the USA and Canada. A second aim was to establish training institutes for postgraduate physicians. However, rather than simply imposing the US model, the Foundation intended to adapt it to the German context, in the form of a postgraduate course for physicians that integrated practical experience with a university setting. My research to date shows that the Foundation's activities did not meet with much enthusiasm from German medical professionals. Intellectual, cultural, cognitive and political differences impaired constructive collaboration between the Foundation's staff and local practitioners and academics.

Estratégias terapêuticas no tratamento da dor crônica: uma genealogia da clínica da dor / Therapeutic strategies in the treatment of chronic pain: a genealogy of the pain clinic

O objetivo desse trabalho é analisar a singularidade das estratégias terapêuticas introduzidas pelo modelo das Clínicas da Dor, através de um estudo genealógico desse projetoterapêutico e sua contextualização no âmbito da racionalidade científica moderna. Mais especificamente, pretende-se analisar as transformações na racionalidade médica que permitiram, sucessivamente, a apreensão da dor pelo discurso médico, a concepção da dorcomo uma doença e a construção e a consolidação do modelo terapêutico das Clínicas da Dor. Para tal, inicialmente, analisamos o modelo terapêutico desenvolvido pelo médico anestesista John Bonica, idealizador do modelo das Clínicas da Dor, destacando as ferramentas conceituais que possibilitaram a compreensão da dor crônica como doença e como fenômenobiopsicossocial. Num segundo momento, realizamos uma descrição e análise dos principais eventos que permitiram a consolidação da medicina da dor como uma prática específica e multidisciplinar, dando destaque à inserção deste modelo no contexto do Sistema Único de Saúde Brasileiro. Finalmente, a partir de uma experiência clínico-institucional buscamos refletir sobre os limites e possibilidades da aplicação prática deste modelo, lançando luz sobre os impasses da clínica e tensões oriundas da problematização do dualismo mente e corpo e das práticas terapêuticas interdisciplinares.

["Medical Deputies": clinics and politics in the dispute for public resources in Buenos Aires (1906-1917)]. / Los <>: clínica y política en la disputa por los recursos públicos en Buenos Aires (1906-1917).

In June 1906, the conservative deputy and doctor Eliseo Cantón submitted in the Argentinian Parliament the project of a <>, which would take up four blocks, would be located in front of the Faculty of Medicine of the University of Buenos Aires and would be made up by 20 institutes with a capacity for 80 beds each. The dispute over this huge project, which lasted until 1917, placed in the middle of the scene, a group of "medical deputies" who used the political platform as a space to define the main aspects of the hospital system. The controversy went beyond the Parliament reaching the public sphere. The lavishness of the project on the eve of the Centenary public festivities or the opulence of a Buenos Aires which inspired to be like Paris were related, in a symbolic view, to the progress of local medicine and its aspirations to be included in the international medical arena. The analysed case helps understand how an essentially political controversy - which led to economical, ethical and cognitive discussions - intervened in the process of building up a socio-professional space of the hospital medical practice.

[A combination of clinical medicine and social welfare activities of the Ophthalmic Rehabilitation Clinic at Juntendo University].

I intend to analyze in this paper tha activities of the Ophthalmic Rehabilitation Clinic at Juntendo University in order to clarify how social welfare is incorporated with medical care in rehabilitation. The patients who feel little hope of recovery often suffer a great sense of emptiness until they finally manage to rehabilitate themselves in society. The clinic was founded for them in 1964 inside the Department of Ophthalmology, Juntendo University. The Department has been providing consultation with the visually handicapped. The program consists of counseling, educational guidance, daily training, etc. It is quite remarkable that the rehabilitation program, in addition to the medical examination, has been introduced to the outpatients who have visual handicaps.

The choice: Lewellys F. Barker and the full-time plan.

In 1914, Lewellys F. Barker, William Osler's successor as Professor of Medicine and physician-in-chief at Johns Hopkins University School of Medicine, resigned to enter private practice rather than accept the terms of a full-time plan, whereby professors in clinical departments would be salaried like other professors in the university. Barker had been an early proponent of the full-time plan. His decision reflected not only a personal desire for a larger income but also contradictions inherent in the Flexnerian ideal of clinical medicine as a research-oriented university discipline devoid of financial incentives to see patients. In private practice, Barker maintained a high profile as a teacher, writer, supporter of the Johns Hopkins medical institutions, and public figure. The issues raised by his difficult decision remain relevant and have not been satisfactorily resolved.

Race, medicine, and health care in the United States: a historical survey.

Racism in medicine, a problem with roots over 2,500 years old, is a historical continuum that continuously affects African-American health and the way they receive healthcare. Racism is, at least in part, responsible for the fact African Americans, since arriving as slaves, have had the worst health care, the worst health status, and the worst health outcome of any racial or ethnic group in the U.S. Many famous doctors, philosophers, and scientists of each historical era were involved in creating and perpetuating racial inferiority mythology and stereotypes. Such theories were routinely taught in U.S. medical schools in the 18th, 19th, and first half of the 20th centuries. The conceptualization of race moved from the biological to the sociological sphere with the march of science. The atmosphere created by racial inferiority theories and stereotypes, 246 years of black chattel slavery, along with biased educational processes, almost inevitably led to medical and scientific abuse, unethical experimentation, and overutilization of African-Americans as subjects for teaching and training purposes.

Complacent and conflicting scientific expertise in British and American drug regulation: clinical risk assessment of triazolam.

This paper presents a case study in the production and interpretation of regulatory science, focusing on the conflicting British and American clinical risk assessments of triazolam (Halcion) - the most controversial sleeping pill in the world. The regulation of triazolam is shown to be more permissive in the USA than in the UK. Six principal socio-political factors are put forward to explain this; differential regulatory trust; regulators' socio-technical data selections; medico-scientific disciplinary influences; organizational and professional interests; conflicts of interest of expert advisers; and the growth of the neo-liberal regulatory state. The risk assessments of both the British and American regulatory agencies are shown to be complacent relative to technical standards which the agencies themselves later accepted. It is suggested that, when the interests of pharmaceutical manufacturers and patients diverge, regulatory assessments are crucially affected by whether regulators are predisposed to award the benefit of the scientific doubts to the manufacturers or patients, and by the balance of such predispositions both within and between regulatory institutions of scientific expertise. The triazolam case indicates that the amount of trust placed in the pharmaceutical industry by the British American regulatory systems may hamper detection of flaws in manufacturers' medical data in a timely manner and, as a consequence, compromise patients' interests. Some policy implications for drug regulation are sketched.