`
Tradition is forgetfulness of origins…Edmund Husserl
"For Merleau-Ponty, the fact that geometry propagates itself from generation to generation in an anonymous sense as a set of human operations that began at no particular time in the past and which will be developed further in the present in order to arrive at a more developed science in the future is precisely what tradition is. “Tradition is forgetfulness of origins as empirical origins in order to be an eternal origin”. So tradition, according to Merleau-Ponty, essentially involves forgetfulness of empirical origins with the formation of a sense that can be transmitted over time and involving no conception of an origin...
Husserl’s account, as we have laid it out, however does not seem to necessitate such a reading. It is certainly not clear whether Husserl means to say that tradition essentially involves forgetfulness. Husserl does suggest that in order to uncover the structure of traditionality one does not have to concern oneself with empirical facts involving the names of the first geometers and the dates of their achievement. Traditions can develop in the absence of any factual knowledge of the founders of the tradition and the time of its founding. But this certainly does not imply that traditions necessarily require a forgetfulness of the empirical origins of that tradition. Husserls account does not seem to support the stronger claim made by Merleau-Ponty, in this regard…
"If the whole material medica, as now used, could be sunk to the bottom of the sea, it would be all the better for mankind — and all the worse for the fishes."
In my first 20 years in medicine [1963-1983], I can’t recall any physicians I knew or worked with having a financial relationship with a pharmaceutical company. The first time was a Grand Rounds that was what I would now call an Infomercial – shortly before I left the University [1983-ish]. Checking back in 25 years later, it seems like everyone had multiple such connections. I have no sense of how that happened. It was the same with industry sponsored clinical trials in mainstream academic journals – from never to every. Of course there were doctors who worked for industry, but they weren’t the same ones that populated academic departments. I never recall thinking about it, but I think I assumed it was a "tradition" of medicine. I’ve looked around for some account of how all of that changed, and haven’t found a thing.
Similarly, I’ve tried to find some history of where "Conflict of Interest is not a problem if it is acknowledged" specifically came from. While I agree that if a financial COI is present, acknowledged is better than secret. But "not a problem"? Not hardly! Whether a guest·author, an employee·author, or a ghost·writer, the problem is the same. None of those categories are synonyms for the meaning of the word "author" that includes "originator" or "creator" – that implies an independent opinion. I might even be willing to go along with "Conflict of Interest is not always a problem if it is acknowledged and there is no money or other direct or indirect benefit involved."
In medical education, one doesn’t start out feeling like you’re a doctor. You’re an outsider looking in. The identity part arrives much later, if it does, indeed, arrive at all. It’s not easy to describe what I mean by that. I know I’m not talking about Evidence-Based Medicine, or the Biological Medical Model of Disease as, for example, the anti-biologists or anti-psychiatrist might explain. It has to do with an ethical tradition that is learned largely through example, by apprenticeship. While it may seem a paradox, the loudest criticisms of physicians come when that ethical tradition is absent – criticisms I find myself agreeing with most of the time. And there is simply no room in that ethical tradition for "Conflict of Interest is not a problem if it is acknowledged" no matter what argument follows.
Rather than further lament the lost idealism of a former time when the integrity of academic physicians could be assumed, where there was an ethical tradition that more or less assured us that our literature could be trusted, it’s time to accept the fact that it has eroded to a point where it’s time to rethink the system. We can no longer look at the name, academic rank, or institutional affiliation of the author of an article [or the publishing journal] and use that as evidence for the opinion it expresses. The obvious solution is a regulatory system that has enough ongoing oversight to insure that it’s not being gamed. We think our Petition fits the bill in the area of industry funded clinical trials [which is why I can’t seem to stop talking about it]. We back up primum non nocere with oversight and laws. Time to put similar teeth into the tradition of academic medical integrity…
“Rather than further lament the lost idealism of a former time when the integrity of academic physicians could be assumed, where there was an ethical tradition that more or less assured us that our literature could be trusted,..”
I did not hit my internship that much after you Mickey.
Are you referring to the literature (in those days) on aminophylline drips for COPD exacerbations, antibiotics and sputum gram stains for bronchitis, or Swan-Ganz catheters for everybody in the CCU?
It has always been necessary to critically evaluate the medical literature. Those are three quick examples from my internship year of standard practices that turned out to be completely worthless.
In general, it makes much more sense to treat depression with antidepressants that you have personally used and know that they work rather than applying any of the above methods.
The “system” is only as good as the physicians in it. There is nothing more corrosive than limiting those physicians by both government and managed care constraints. The only current ethic is the false concept of “cost-effectiveness”.It is proof that byzantine government structures are in place to be gamed because that is what politicians do since it is one of the few things that they understand.
“The ‘system’ is only as good as the physicians in it. There is nothing more corrosive than limiting those physicians by both government and managed care constraints. The only current ethic is the false concept of ‘cost-effectiveness.’ Fortunately for me, I never participated in managed care systems so I missed that particular piece of the epoch. But I did have to learn about things like Akathisia and withdrawal reactions by first causing them.
And I do recall misinformation from my internist days, but there were experts actively talking about the problems too. In psychiatry [from Prozac on], I don’t recall that happening. But I think most of us would agree that the ethic in medicine has been in a steady state of decline from the days of yore, even our yore. And from where I sit, the erosiom came from the “top down”…
Sammelweiss was a god to my father.
Thanks Mickey for bringing him up
And thanks De Dawson for another trip down memory lane.
I do remember the residents doing and working with those things as if they were gifts from God
How to know the difference?
I remember one resident almost killings an elderly patient with a PFRdissge of Halsil and nurses keeping silent because that was the way
He had to learn about dosages for the elderly.
Sometimes experience is not the fairest way to lessen at least not how that care was played out back then.
I wish I would have remembered Sammelweiss when my daughter had a titanium implant that went bad due to p acne infection
My father had always said that particular hospital had a too high infection rate but again I had forgotten his words and he was not around by then to consult with
The doc whom zI liked had the rep wash out the implant with its loose screws and rusted edges where the bacteria had eaten through this so called stellar metal according to academic research
He gave us the implant afterward and asked what we would do since it was per my young daughter ‘s request
I quipped take it to show and tell.
There was a shocked silence in the recovery room but too bad the two wasn’t there to hear it
Why are reps innocent in any negative ramifications for all of this?
They are the wolves in sheep clothing who are wining and dining the docs
The docs assume they know what they are talking about but my guess is they never have a chance to talk in depth with any of them to understand their limitations
And they are limited to the worst of salepersonitis.
Insurance folks would be with my best guess similar
Kind of the folks that should be in Dante’s Modern Circles of the Inferno
1bom,
The petition is up to 219 signatures in a little over 2 weeks. Is that few? Is that many? I wonder that might communicate about the proposal. I’m being purposefully vague because I really don’t know what that says about the proposal.