Demarcating scientific medicine.

Scientific medicine and homeopathy are interesting case studies for the ongoing project of demarcating science from pseudoscience. Much of the demarcation literature formulates abstract criteria for demarcating science from pseudoscience generally. In service of a more localist approach to the demarcation problem, I reconstruct a specific demarcating difference, the like comparison criterion, invoked by nineteenth century adherents to an early model of scientific medicine. If it is to remain relevant today, I argue that the like comparison criterion must be updated in our current era of epidemiological, evidence-based medicine to recognize the importance of assessing study bias and mechanistic implausibility in contemporary medical science.

[Scientific medicine and care relationship: From the therapeutic alliance to the therapeutic effect of the alliance]. / Médecine scientifique et relation de soin : de l'alliance thérapeutique à l'effet thérapeutique de l'alliance.

The new paradigm of precision medicine in oncology questions today the respective place of evidence-based medicine and doctor-patient relationship. Based on the results of a randomized study comparing the efficacy of a homeopathic molecule in the prevention of nausea and vomiting induced by chemotherapy in non-metastatic breast cancer, this article extends and develops the discussion of maintaining an unresolved tension between medical art and medical science, between care and cure. This tension sets a base for the authors of the therapeutic alliance in medicine, defined as a dialectic constantly adjourned between the alliance of the doctor with the patient and his therapy, and the therapeutic effect of this alliance. Because if a policy or a public opinion were to promote an exclusively rational medicine deprived of the field of relation to care, or on the contrary a medicine based only on clinical sense and intuition, then respectively the ethics of care and the progress of therapy would be threatened. It is advisable to be aware of erring from the truth, amplified today by social networks, as much due to a tide of scientific positivism, as an excess of the "good caring soul". Taking into account the therapeutic alliance makes it possible to no longer oppose scientific medicine and care relationship.

Por que a Homeopatia incomoda? / Why Homeopathy bothers?

Escolhemos o título acima porque, como praticantes de uma atitude médico-filosófica que vê o ser humano como uma unidade e integrado ao todo, jamais conseguimos nos furtar ao diagnóstico sistêmico. É hábito do homeopata o diagnóstico em sua totalidade, das partes integradas ao todo, buscando o porquê em tudo, até em um simples artigo de um simples jornal de uma simples cidade que integra o nosso pequeno planeta, diga ele respeito ou não à homeopatia. Inicialmente a homeopatia começou incomodando as religiões, pois quando Hahnemann experimentou substâncias em humanos, observou o aparecimento de sintomas físicos e psíquicos, estes últimos eram tidos até então como instâncias da alma e portanto propriedade dos religiosos. Além de destruir o tácito acordo entre medicina e religião, onde médicos cuidavam dos males do corpo e os religiosos dos males da alma, resgatou também a unidade que é o ser. Foi a primeira prova testemunhal na medicina ocidental da comprovação dessa unidade. (AU)

A Not-So-Gentle Refutation of the Defence of Homeopathy.

In a recent paper, Levy, Gadd, Kerridge, and Komesaroff attempt to defend the ethicality of homeopathy by attacking the utilitarian ethical framework as a basis for medical ethics and by introducing a distinction between evidence-based medicine and modern science. This paper demonstrates that their argumentation is not only insufficient to achieve that goal but also incorrect. Utilitarianism is not required to show that homeopathic practice is unethical; indeed, any normative basis of medical ethics will make it unethical, as a defence of homeopathic practice requires the rejection of modern natural sciences, which are an integral part of medical ethics systems. This paper also points out that evidence-based medicine lies at the very core of modern science. Particular arguments made by Levy et al. within the principlist medical ethics normative system are also shown to be wrong.

[Scientific conflicts. Conflict over water]. / Vom Umgang mit wissenschaftlichen Konflikten Bewegung an der Wasserfront.

Scientific progress results from conflicts about the existence of new phenomena. Two theorems are formulated: Whatever is predicted by a sufficiently famous theorist will be discovered independently of whether it exists or not. Thus the criterion for existence of a phenomenon is not its discovery but rather its reproducibility! Whatever is "discovered" by a sufficiently famous experimentalist will be explained independently of its existence. Thus the criterion for understanding a phenomenon is not an explanation but rather the unanimous acceptance of one single explanation. It is argued that the optimal intention of scientists is to be critical but not rigid and at the same time open but not credulous. Since the intentions "open" and "critical" are in opposition, the historical path of science often oscillates between the two extremes "credulous" and "rigid". This is demonstrated by historical examples and applied to the special case of water.

THE SCIENCE OF SCIENCE (NAUKOZNAWSTWO) IN POLAND: THE CHANGING THEORETICAL PERSPECTIVES AND POLITICAL CONTEXTS--A HISTORICAL SKETCH FROM THE 1910S TO 1993.

The article sketches the history of naukoznawstwo (literally meaning the science connoisseurship or the science of science or science studies) in Poland from the 1910s to the end of the Cold War (1991), and the recovery of full political independence in 1993. It outlines the changing research perspectives of this interdisciplinary field of knowledge in Poland against a background of changing political conditions caused by the reconfigurations of the political order. The first part of the article concerns the period from the 1910s, when Poland was occupied by Russia, Prussia, and Austria, through the regaining of independence by Poland in 1918, the reconstruction of the state in 1918-1939; the second part--World War II; the third part--the period from the initial period of Soviet dominance (1944-1954) in Poland and simultaneously the beginnings of the Cold War (1947-1954), the period 1955-1956 (when the Polish state was liberated from Sovietization), through the different political crises in October 1956, March 1968, December 1970, and June 1976, to the emergence of the Independent Self-governing Trade Union Solidarity in September 1980, the end of the Cold War (1991), and the recovery of full political independence in 1993. The article outlines the fundamental achievements of prominent Polish scholars (among others K. Twardowski, M. Ossowska, S. Ossowski, T. Kotarbinski, K. Ajdukiewicz, S. Michalski, F. Znaniecki, B. Suchodolski, L. Fleck, M. Choynowski, Z. Modzelewski, S. Amsterdamski), politicians (among others B. Bierut, E. Krasowska), politicians and scholars (H. Jablonski, S. Kulczynski), as well as committees (among others the Academic Section of the Józef Mianowski Fund, The Science of Science Committee of the Polish Academy of Sciences), schools of thought (among others the Lvov-Warsaw School of Philosophy), and academic units (among others the Science of Science Seminar in Kraków, the Department for the History of Science and Technology of the Polish Academy of Sciences, and The Department of Praxeology and Science of Science at the Institute for the Philosophy and Sociology of the Polish Academy of Sciences).

A gentle ethical defence of homeopathy.

Recent discourses about the legitimacy of homeopathy have focused on its scientific plausibility, mechanism of action, and evidence base. These, frequently, conclude not only that homeopathy is scientifically baseless, but that it is "unethical." They have also diminished patients' perspectives, values, and preferences. We contend that these critics confuse epistemic questions with questions of ethics, misconstrue the moral status of homeopaths, and have an impoverished idea of ethics-one that fails to account either for the moral worth of care and of relationships or for the perspectives, values, and preferences of patients. Utilitarian critics, in particular, endeavour to present an objective evaluation-a type of moral calculus-quantifying the utilities and disutilities of homeopathy as a justification for the exclusion of homeopathy from research and health care. But these critiques are built upon a narrow formulation of evidence and care and a diminished episteme that excludes the values and preferences of researchers, homeopaths, and patients engaged in the practice of homeopathy. We suggest that homeopathy is ethical as it fulfils the needs and expectations of many patients; may be practiced safely and prudentially; values care and the virtues of the therapeutic relationship; and provides important benefits for patients.

Dentistry and alternative therapy.

Many dentists have embraced the "holistic" dentistry movement. What is presented here is a critical examination of the logical and scientific fallacies inherent in this movement. Specific topics covered include amalgam "toxicity," applied kinesiology, nutrition quackery, acupuncture, homeopathy and the muddle that is commonly known as TMD.

[Division and specialization of the Western European physiology].

The 19th century has been thought to be the turning point that the experimental method began to take strong root as the core to solve many physiological subjects, and the discipline of physiology got firmly fixed as the specialized one in the western Europe. Authors found the following characteristics in the process of the division and specialization of the 19th century western physiology. 1) It was the process of its separation from the discipline of anatomy that was necessary in the development of physiology as the independent, specialized division. Newly grown ideas, that there were working functions specialized study, were the important background and basis of the development of physiology as the specialized discipline. 2) It was not until the force and influence of the metaphysical concept on the living things (vitalism) grew weak that physiology could become the specialized discipline. The new materialistic concept about living things made it possible for the researchers of that time to apply the physico-chemical method in the study of physiological problems. 3) Institutionalization of the physiological research and education accelerated its development and specialization. The followings appeared in the mid-19th century: specialized professorship, division as the separated subject in the undergraduated medical school curriculum, laboratory settings for the purpose of physiological study, establishment of independent academic societies and publication of their own journals. Two main factors, namely, both the settlement of the new physiological thought and method of the very scientific nature and the institutionalization within the academic and medical societies, exerted influences on each other in the ground of the 19th century western Europe. Through that process, the discipline of physiology took root deep as the independent specialized division in the societies of science and medicine.

Clinical trials of integrative medicine: testing whether magic works?

Over the past two decades complementary and alternative medicine treatments relying on dubious science have been embraced by medical academia. Despite low to nonexistent prior probability that testing these treatments in randomized clinical trials (RCTs) will be successful, RCTs of these modalities have proliferated, consistent with the principles of evidence-based medicine, which underemphasize prior plausibility rooted in science. We examine this phenomenon and argue that what is needed is science-based medicine rather than evidence-based medicine.

[Scientability - a concept for the handling of homeopathic remedies by EbM]. / Scientabilität - ein Konzept zum Umgang der EbM mit homöopathischen Arzneimitteln.

Evidence-based medicine (EbM) has proved to be very useful in healthcare; thanks to its methodology the reliability of our knowledge of the benefits and harms of interventions can be assessed. This at least applies to interventions which are based on a plausible concept for their mechanism of action and which have already achieved positive effects in experiments and simple studies. However, for interventions whose concepts contradict scientific findings EbM has proved to be unsuitable; it has not been able to prevent that they are still regarded as effective amongst wide parts of the population and medical experts. Particularly homeopathy has managed to even present itself as scientifically justified by using EbM. With the aim of highlighting the speculative character of homeopathy and other procedures and of preventing EbM from getting damaged, the concept of scientability is introduced in this article. This concept only approves of clinical studies if the intervention that is to be tested does not contradict definite scientific findings.

A complex systems science perspective for whole systems of complementary and alternative medicine research.

Whole systems complementary and alternative medicine (WS-CAM) approaches share a basic worldview that embraces interconnectedness; emergent, non-linear outcomes to treatment that include both local and global changes in the human condition; a contextual view of human beings that are inseparable from and responsive to their environments; and interventions that are complex, synergistic, and interdependent. These fundamental beliefs and principles run counter to the assumptions of reductionism and conventional biomedical research methods that presuppose unidimensional simple causes and thus dismantle and individually test various interventions that comprise only single aspects of the WSCAM system. This paper will demonstrate the superior fit and practical advantages of using complex adaptive systems (CAS) and related modeling approaches to develop the scientific basis for WS-CAM. Furthermore, the details of these CAS models will be used to provide working hypotheses to explain clinical phenomena such as (a) persistence of changes for weeks to months between treatments and/or after cessation of treatment, (b) nonlocal and whole systems changes resulting from therapy, (c) Hering's law, and (d) healing crises. Finally, complex systems science will be used to offer an alternative perspective on cause, beyond the simple reductionism of mainstream mechanistic ontology and more parsimonious than the historical vitalism of WS-CAM. Rather, complex systems science provides a scientifically rigorous, yet essentially holistic ontological perspective with which to conceptualize and empirically explore the development of disease and illness experiences, as well as experiences of healing and wellness.

[To the study of conventual health in the beginning of 19th century: the pharmacies]. / Para o estudo da saúde conventual no início do século XIX: as boticas.

The institution "Junta do Exame do Estado Actual e Melhoramento Temporal das Ordens Regulares" (Examination Council for the Actual State and Temporal Improvement of the Religious Orders) was created in November of 1789. Among other things, each Religious House should inform that institution about its heritage either the movables and the landed estates. The inventorying included all the goods belonging to wards and drugstores. In this paper, we aim to study those places using records obtained from a variety of Religious Houses with no regional or Religious Order preferences. We will try to give answers to questions related to that spaces such as 'Which objects could be found inside the Houses?'; 'Were they properly equipped?'; and 'Were there big differences between them in what concerns Religious Orders and Houses locations?'.

Homeopathy and its ethical use in dentistry.

Media coverage of homeopathy over the past few years has tended to concentrate on the very negative position taken by sceptics, while the possible benefits of homeopathy are ignored. This has resulted in coverage that has been rather one-sided, inaccurate and at times hysterical. A perfect example is Dr David Shaw's opinion piece 'Unethical aspects of homeopathic dentistry' (Br Dent J 2010; 209: 493-496) which falls far short of providing a basis for balanced intellectual discussion. The authors are therefore grateful to the BDJ for the opportunity to outline the case for integrating homeopathy in dental practice.