Reflections on the principle of life, medical theory and ethics, and the limitations of science

The knowledge of modern science is based on and limited to data from the material world. It does not cover all levels of reality. Its achievements have been striking. It continues to amass at an ever increasing pace information about the physical basis of "life" in respect of its essential structures and their functions. Nonetheless there are questions which it cannot answer. The idea of the "vital spirit", according to Greek and Medieval philosophers and theologians the principle that imbues mortal flesh with life, transcends the limits of its empirical thinking, as do questions about traditional values and ethical issues, like the topical problems in medicine brought to the fore by recent and ongoing developments in molecular genetics. Their resolution will require vision wider than the empiric and knowledge broader than the exclusively scientific.

Politics, society and medicine in the 18th century

Medical theory and practice in the 18th century reflected the thought and culture that the Renaissance had fashioned. This article draws attention to the political and social changes of the period and notes their inter-relationship with the changes that occurred in medicine.

Reflections on funding the National Health Service: from illusion to reality?

Opinions differ about how best we organise our services to promote and preserve it, meet their costs and apportion them between the individual and the state. The well-being of the NHS is imperilled and its development is impeded by underfunding, a state of affairs likely to persist as long as it depends exclusively on Exchequer monies. To break the impasse the public should reconsider its attitude to the imposition of health charges, the marketing of health services, and coll raboration between the NHS, public bodies and private groups. The able-bodied might well, within their means, bear some of the costs of the services they use. The NHS would profit from a rapprochement with private medicine. A more prompt and positive response by the NHS to clinical and social challenges might be facilitated if its ties to government were loosened and it was overseen by an independent agency. Free health is a Utopian ideal. In the real world the best we are likely to achieve is an up-to-date health service which gives a fair deal to patients, who are its raison d'etre, and to those who provide the money to pay for it; it should syncretise the art and science of medicine.

Doctors as decision-makers: a computer-assisted study of diagnosis as a cognitive skill

When viewed as a sequence of decisions clinical diagnosis becomes amenable to detailed investigation in terms of standard statistical concepts. A study of six clinicians diagnosing identical sets of cases of non-toxic goitre is used to illustrate an objective technique for studying the diagnostic process with the aid of a digital computer. Considerable variation in clinicians' routes to correct diagnosis is shown when these routes are compared in detail by five statistical measures related to the effective use of the information available to the clinicians. For rapid analysis of diagnostic skill two visual methods are presented. These can be developed for teaching undergraduates the interpretative skills involved in diagnosis and for studying such skills in experienced clinicians.

Investigation of Nithsdale goitre

As a sequence to a survey which showed that the prevalence of goitre was higher in schoolchildren in Nithsdale (30%) than in Dumfries (16%), a total of 181 adult subjects from these 2 areas were examined and the plasma inorganic iodide concentrations (PII) were determined.

The large majority of PII values in subjects from both areas were within the normal range and the overall conclusions are that iodine deficiency severe enough to account for a high prevalence of small goitre or a low prevalence of large goitre does not exist in the South West of Scotland.

Since this area is likely to be representative of the U.K. in general, it is also concluded that there is no practical justification for general dietary iodine supplementation meanwhile.

Evaluation of discordant laboratory data in patients with thyroid disorders

The usefulness of the various tests of thyroid function has been evaluated over a three-year period. It is concluded that an uptake test and estimation of the serum protein-bound radioactive iodine (PB (131)I), supplemented as required by the protein-bound iodine (PBI), remain the best routine tests of thyroid function. Forty-five patients who gave discordant results on these tests over this period have been studied in detail and the value of other tests of thyroid function has been explored.

Hypothyroidism due to enzyme defects

Defects in thyroid hormone production, transport and utilization are classified.

Particular attention is given to inherited intrathyroidal defects in hormone synthesis which impair thyroid function and lead to goitre formation and hypothyroidism. Anomalies in biosynthesis may also result from disease or drugs.

Reference is made to the derangement of iodine metabolism that results from iodine deficiency and from insufficient TSH.

Illustrative clinical problems with regard to transport and utilization are quoted, and it is inferred that they lie in rather neglected areas.

Throughout an attempt has been made to show how the clinical problems that are encountered in practice may, by the techniques of investigation available to us, be related to the theoretical list of defects that are included in the classification.