The technologies of time measurement: implications at the bedside and the bench.

This essay explores how chronologically linked indices of health and illness, such as variation in body temperature, achieved clinical and scientific significance. It shows why time has been a potent concept through which key associations among the data of medicine are ordered and revealed, and it examines the graphical and case reporting methods of organizing evidence that made such associations possible.

Linking excellence in teaching to departments' budgets.

It is time for the research and clinical practice communities, which dominate medical schools, to realize that the enhanced support of teaching is essential not only for students and society but also because these communities' successes hinge on how well their investigators and clinicians were taught. The need to learn more about the evaluation of teaching should not be a barrier to the productive use of current knowledge about it, which is sufficient for schools to improve the standing and effectiveness of teaching. A greater focus on teaching is even more urgent now because the disbursement of medical school funding is changing, and fewer funds are being allowed for the use of education. Also, other pressures, such as greater demands on faculty time for research and patient care activities and the tendency for research and clinical care to evolve into autonomously governed activities, are distracting faculty from teaching. To establish a superior ethos for education, the author proposes a new approach to faculty compensation and advancement, in which half of the available resources would be distributed according to departmental merit, which would link compensation to the performance of the faculty group composing a department. Performance in both research and teaching in all venues of medical work would be weighed equally. The dean's office would be responsible for making departmental merit awards, using advice and information from faculty, students, and administrative staff, and all decisions would be reviewed with each department chair.(ABSTRACT TRUNCATED AT 250 WORDS)

The ethics of learning and teaching medicine.

During the second half of the twentieth century, medicine turned its attention to the ethics of practice. A large and important literature has developed that clarifies the problems generated in the treatment of illness. The same focused attention now should be given to ethical issues and relationships connected with teaching and learning in medicine and to elaborating an ethics of education. Pedagogic relationships anticipate professional relationships. The associations that medical students form with teachers, patients, school, and each other, and the values that shape them have a great influence in determining the sort of physicians students will be. This article examines ethical principles and their application to the relationships and pedagogic problems encountered in studying and teaching medicine. It shows how the introduction of ethics into these areas can not only help students and teachers but also enhance the standing of teaching itself.

Criteria for standard versus experimental therapy.

This paper demarcates the boundaries between experimental and standard therapy and the influence of this division on policy, payment, and practice. It proposes a new category, crossover therapy, to deal with the many therapies that fall in between. It establishes four criteria to separate these categories: (1) the populations and conditions for which use is helpful; (2) the expected outcomes of care; (3) the skill, personnel, and site requirements and the economic, ethical, and legal understandings essential for use; and (4) the level of knowledge needed to certify that prospective users can apply it well. The paper then explores the use of experimental therapy in desperate situations and of standard therapies in new areas and gives policy recommendations to facilitate these actions.

Creating a course on ethics in the biological sciences.

The authors examine the social and scientific context within which a course on the ethical dimensions of the biological sciences was created in the mid-1980s to instruct students at The University of Texas-Houston Health Science Center's Graduate School of Biomedical Sciences. They discuss how the basic purposes of such a course--to help students resolve ethical issues encountered in the scientific work, examine the values underlying science, and explore its relation and obligations to society--may be accomplished, and describe the salience to scientific work of two ethical values significant for science, truthfulness and benefit to others, to demonstrate the application of ethics to science. The present version of the course is described. Particular issues arising in the construction of a course on ethics and science are described, such as gaining faculty support, selecting instructors, constructing a syllabus of topics, using cases in instruction, creating examinations dealing with students from other cultures who may have difficulty with applying and using American values, and evaluating the educational effort.

Overlooking ethics in the search for objectivity and misconduct in science.

The author investigates the relationship between the reliability of scientific data and the ethics of the scientist, demonstrates how attention given to misconduct in the biological sciences adversely affects the broader significance of ethics in this field, and extracts from the applications of ethics in medicine perspectives relevant to the biological sciences. As twentieth-century biological scientists applied increasingly powerful methods to diminish bias and to improve the objectivity of their work, including the replication of experimental findings to verify them, they came to believe that these methods would protect their studies from error and misleading conclusions. This assumption has been shown to be unwarranted because it cannot protect scientists from self-conscious or biased selection in reporting evidence. The canons of scientific objectivity must be grounded in something more fundamental--the canon of ethics. In the end, a commitment to the ethical standard of truthfulness, through an understanding of its meaning to science, is essential to enhance objectivity and diminish bias. Unfortunately, the ethos of concern for scientific misconduct continues to dominate the research-ethics movement. This focus is damaging because it turns the attention to seeking and finding wrong-doers and determining punishment rather than discussing generic issues of doing the right thing, preventing harms, seeking benefits, and understanding the right-making and wrong-making characteristics of actions. The focus on scientific misconduct makes ethical issues appear synonymous with legal issues and the search for ethical understanding synonymous with carrying out an investigation.(ABSTRACT TRUNCATED AT 250 WORDS)

Studying science in the context of ethics.

The authors describe their experiences in developing and introducing a course on responsible conduct at the Graduate School of Biological Sciences at the University of Texas Health Science Center at Houston. The paper covers issues involved with course faculty, course content and format, and evaluation. At least half of the course time focused on general or case-study discussions of the students and faculty about ethical problems raised in course readings or the students' research experiences. An important issue for institutions trying to encourage students to recognize, reason about, and understand ethical concerns is how the institution itself becomes aware of the ethical implications of its own unconsciously or explicitly stated policies. Such reflection among institutional leaders is critical to fostering the public trust necessary for a profession to sustain its right to self-regulation and its claim of authenticity.

The era of the patient. Using the experience of illness in shaping the missions of health care.

The emergence of an era that focuses on the experiences of individuals with illness to provide an alternative voice in health care is explored. Antecedent events that caused the eclipse of the patient and challenged the authenticity of personal experience in establishing medical facts--the introduction of the concept of diseases and the technologic revolution in medicine--are examined. Recent events that returned the patient's views to the center of medical attention--the medical ethics and outcomes movements--are analyzed and connected. Recommendations are presented to make the experience of individuals with illness significant features of health care practice, education, research, and policy, and to reverse the view of patients and subjects as individuals benefited by medicine, but unable to help it.