Learning to stand tall: Idiopathic scoliosis, behavioral electronics, and technologically-assisted patient participation in treatment, c. 1969-1992.

Drawing on the archives of American learning psychologist Neal E. Miller, this article investigates the role of instrumentation in the expansion and diversification of the behavior therapy domain from the late 1960s to the early 1990s. Through the case of Miller's research on the use of biofeedback to treat idiopathic scoliosis, it argues that the post-World War II adoption of electronic technology by behavioral psychologists contributed to extending their subject matter to include physiological processes and somatic conditions. It also enabled a technologically-instrumented move outside the laboratory through the development of portable ambulatory treatment devices. Using the example of the Posture-Training Device that Miller and his collaborators invented for the behavioral treatment of idiopathic scoliosis, this paper considers how electromechanical psychological instrumentation illustrated a larger and ambiguous strategic shift in behavior therapy from an orientation toward external control to one of self-control.

The empowered patient on a historical-rhetorical model: 19th-century patent-medicine ads and the 21st-century health subject.

The contemporary health subject, often described as a new, empowered patient, is not simply a character in a story of progress toward knowledge and power, away from credulity and passivity. Before the 20th century, and the assertion of a medical system that became frankly paternalistic, laypeople adjudicated on many matters of illness and its treatments. That is, 18th- and 19th-century health subjects were empowered too, and studying them, especially as consumers of health products, helps us develop a more nuanced account of our current medico-commercial selves. Comparing historical advertisements for "patent medicines" and contemporary direct-to-consumer ads for prescription pharmaceuticals, this essay contributes to such an account. It identifies strategies that drug marketers have deployed over centuries to persuade consumers to buy their products, and it tracks a rhetoric of interpellation in advertisements that not only address but also constitute health subjects. The goal of the analysis is to increase alertness to our own susceptibilities to pharmaceutical ads and adjacent rhetorics of health and illness.

Women's involvement in clinical trials: historical perspective and future implications

The importance of considering the differences between the male and female sex in clinical decision-making is crucial. However, it has been acknowledged in recent decades that clinical trials have not always adequately enrolled women or analyzed sex-specific differences in the data. As these deficiencies have hindered the progress of understanding women’s response to medications, agencies in the United States have worked towards the inclusion of women in clinical trials and appropriate analysis of sex-specific data from clinical trials. This review outlines the history and progress of women’s inclusion in clinical trials for prescription drugs and presents considerations for researchers, clinicians, and academicians on this issue (AU)

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'No "Sane" Person Would Have Any Idea': Patients' Involvement in Late Nineteenth-century British Asylum Psychiatry.

In his 1895 textbook, Mental Physiology, Bethlem Royal Hospital physician Theo Hyslop acknowledged the assistance of three fellow hospital residents. One was a junior colleague. The other two were both patients: Walter Abraham Haigh and Henry Francis Harding. Haigh was also thanked in former superintendent George Savage's book Insanity and Allied Neuroses (1884). In neither instance were the patients identified as such. This begs the question: what role did Haigh and Harding play in asylum theory and practice? And how did these two men interpret their experiences, both within and outside the asylum? By focusing on Haigh and Harding's unusual status, this paper argues that the notion of nineteenth-century 'asylum patient' needs to be investigated by paying close attention to specific national and institutional circumstances. Exploring Haigh and Harding's active engagement with their physicians provides insight into this lesser-known aspect of psychiatry's history. Their experience suggests that, in some instances, representations of madness at that period were the product of a two-way process of negotiation between alienist and patient. Patients, in other words, were not always mere victims of 'psychiatric power'; they participated in the construction and circulation of medical notions by serving as active intermediaries between medical and lay perceptions of madness.

Constructing Patient Stories: 'Dynamic' Case Notes and Clinical Encounters at Glasgow's Gartnavel Mental Hospital, 1921-32.

This article contextualises the production of patient records at Glasgow's Gartnavel Mental Hospital between 1921 and 1932. Following his appointment as asylum superintendent in 1921, psychiatrist David Kennedy Henderson sought to introduce a so-called dynamic approach to mental health care. He did so, primarily, by encouraging patients to reveal their inner lives through their own language and own understanding of their illness. To this effect, Henderson implemented several techniques devised to gather as much information as possible about patients. He notably established routine 'staff meetings' in which a psychiatrist directed questions towards a patient while a stenographer recorded word-for-word the conversation that passed between the two parties. As a result, the records compiled at Gartnavel under Henderson's guidance offer a unique window into the various strategies deployed by patients, but also allow physicians and hospital staff to negotiate their place amidst these clinical encounters. In this paper, I analyse the production of patient narratives in these materials. The article begins with Henderson's articulation of his 'dynamic' psychotherapeutic method, before proceeding to an in-depth hermeneutic investigation into samples of Gartnavel's case notes and staff meeting transcripts. In the process, patient-psychiatrist relationships are revealed to be mutually dependent and interrelated subjects of historical enquiry rather than as distinct entities. This study highlights the multi-vocal nature of the construction of stories 'from below' and interrogates their subsequent appropriation by historians.

[Health technology assessment agencies in the xxi century]. / Las agencias de evaluación de tecnología médica en el siglo xxi.

The origins of the health technology assessment (HTA) agencies date back to the 70s in the United States; in the European context, the current Agency for Quality and Health Assessment of Catalonia was among the pioneers in 1991. Epidemiological, social, technological and economic changes of recent years have led to the incorporation, by the agencies, of new functions, activities and projects that can offer better services (information and knowledge) to the various players in the healthcare system (patients, professionals, providers, insurers and policy-makers) in order to increase healthcare quality and preserve the sustainability of the health system.

[Caesarean section: History, epidemiology, and ethics to diminish its incidence]. / Operación cesárea. Una visión histórica, epidemiológica y ética para disminuir su incidencia.

Cesarean section has become the most performed surgery and it has been enhanced with the use of antibiotics and improvement in surgical techniques. The aim of this systematic review is to describe and clarify some historical and ethical characteristics of this surgery, pointing out some aspects about its epidemiological behavior, becoming a topic that should be treated globally, giving priority to the prevention and identification of factors that may increase the incidence rates. Today, this "epidemic" reported rates higher than fifty percent, so it is considered a worldwide public health problem. Consequently, in Mexico strategies aimed at its reduction have been implemented. However, sociocultural, economic, medicolegal and biomedical factors are aspects that may difficult this goal. As we decrease the percentage of cesarean section in nulliparous patients, we diminish the number of iterative cesarean and its associated complications. This aim must be achieved through the adherence to the guidelines which promote interest in monitoring and delivery care in health institutions of our country.

La operación cesárea es la cirugía mayor más frecuentemente practicada, y ha sido perfeccionada con el uso de antibióticos y mejores técnicas quirúrgicas. El objetivo de esta revisión sistemática es describir y precisar diversas características históricas y éticas con relación a esta intervención quirúrgica, señalando algunos aspectos inherentes a su comportamiento epidemiológico, siendo este último una problemática de actualidad y de suma importancia que debe tratarse de forma integral, dando prioridad a la prevención e identificación de los factores que hacen posible el aumento en las tasas de incidencia. Hoy en día, esta "epidemia" reporta tasas que superan el cincuenta por ciento, por lo que se ha considerado un problema de salud pública a nivel mundial. Consecuentemente, en México se han implementado estrategias tendentes a su disminución, no obstante, los factores socioculturales, económicos, médico-legales y biomédicos son aspectos que dificultan dicho objetivo. En la proporción en que se disminuya el porcentaje de cesárea en pacientes primigestas, disminuirá secundariamente el número de cesáreas iterativas y sus complicaciones asociadas, meta que debe alcanzarse mediante el apego a las guías que promueven el interés por la vigilancia y atención del parto en las instituciones de salud de nuestro país.

Uniting postcolonial, discourse, and linguistic theory to explore participation of African Americans in cancer research as an effect of social and historical race relationships.

This article uses a historical framework of postcolonialism; discourse analytic concepts (significance, identity, and relationships); and 5 social and cultural linguistic principles of emergence, positionality, indexicality, relationality, and partialness as a theoretical and methodological triangulation approach to data analysis of focus group discussion. Exemplars of focus group data from a study exploring African American participation in research demonstrate the application of this combined framework as a useful tool for analysis. This approach allows for examination of identity and interaction and generates a more rigorous and complete understanding of how individuals use language to construct identity as participants or nonparticipants in research.

[The patient throughout history since Hippokrates]. / Potilaan historia Hippokrateesta alkaen.

Throughout history, the patient's dependency on the social group in which he or she happens to be born, has remained unchanged. The period in the 19th to the 20th century, during which the authority of physicians over patients grew markedly, seems to have passed. As in the classical period, a wealthy western patient is again able to choose the most suitable one from the healthcare service providers. Since the 18th century medicine and religion have diverged from each other in the life of a western patient. The decisive position of the medical industry towards the end of the 20th century is a new phenomenon in the history of patient.