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Biomedical subjects

Martyn Evans

Publications and source records attributed to Martyn Evans.

6 recordsLinked to original sources

Orexins and feeding: special occasions or everyday occurrence?

Neurons expressing prepro-orexin, the precursor of orexin-A and -B, are found in the lateral hypothalamic area, a region classically implicated in driving feeding. Orexin-A induces feeding transiently when injected centrally, and food intake can be decreased when orexin action is disrupted by immunoneutralization of orexin-A, or by pharmacological blockade of orexin receptors, or by transgenic knockout of orexin. Here, we argue that orexin neurons may act to stimulate feeding in the short term, and that important regulatory signals may be a fall in plasma glucose (stimulatory), countered by satiety signals generated by eating, such as gastric distention (inhibitory).

Animals↗

Reflections on the humanities in medical education.

BACKGROUND: In recognition of the views advanced by the philosopher Maurice Merleau-Ponty, this paper considers some of the implications for medical practice and, hence, medical education, of recognizing the human body as an 'intertwining' of the natural (or physical) and the existential (or experiential) - something which is taken for granted in ordinary experience, but which becomes the medium through which disease can manifest itself in illness and disability. Our condition is the condition of creatures of frail flesh. Perhaps because this 'intertwining' is taken for granted, we tend to overlook the extent to which it is metaphysically astounding, even though it constitutes the daily arena and phenomena of clinical medicine. Clinical medicine is, among other things, the routine intervention in this intertwining. This fact is largely discounted by biomedical science, which concentrates on 'the natural' at the expense of neglecting 'the existential'. Such neglect arguably underlies the perceived deficiencies in medical education that the GMC sought to redress in its landmark document Tomorrow's Doctors. PROPOSAL: If the humanities disciplines concern themselves with recording and interpreting human experiences, the 'medical humanities' do so for the human experiences of illness, disability and medical intervention. This paper argues for an integrated conception of the medical humanities, and for their incorporation into the core medical curriculum. The paper concludes by outlining a proposed core module in medical humanities, based around a syllabus divided not into the characteristic enquiries of constituent disciplines, but rather into groups of topics relating to key philosophical questions prompted by the 'intertwining' in embodied human nature.

Clinical Competence↗

The inter-role confidentiality conflict in recruitment for clinical research.

Recruiting patients into clinical research is essential for the advancement of medical knowledge. However, when the physician undertaking the care of the patient is also responsible for recruitment into clinical research, a situation arises of an inter-role breach of confidentiality which is distinguishable from other conflicts of interest. Such discord arises as the physician utilizes confidential information obtained within the therapeutic relationship beyond its primary objective, and safeguards ought to be observed in order to avert this important, and generally overlooked, problem. The moral worth of the pledge of confidentiality is based not on its innate value but on its being a promise on which subsequent interactions and disclosures are founded. Within the patient-doctor interaction, confidentiality is an important facet of the promised fidelity and, as such, a loose interpretation of the notion threatens the essence of the relationship, and any violation thereof requires compelling moral justification. To avoid conflict, patients' confidential information ought not be used for the purpose of recruitment, which needs to be undertaken through general education and non-directed appeals, and a preliminary consent to be approached for research should be obtained from the patient prior to her being identified as a suitable research subject. Securing this prior consent would avoid one source of potential, albeit unintended, coercion.

Biomedical Research↗

A plea for the heart.

Martyn Evans believes that it is a 'shocking feature' of brain-centred conceptions of death that they require us to regard as dead a person whose heart may continue to beat spontaneously. When it comes to neocortical conceptions of death, we might even be burying or cremating a 'breathing corpse'. If proponents of neocortical definitions of death suggest active interventions to stop the remaining spontaneous functions, in what sense, asks Evans, is this different from killing? Also, does it make sense to accept, as many proponents of brain-centred conceptions of death do, that it is proper to 'explant' organs from 'beating-heart cadavers', whilst squirming at the thought of cremating a 'breathing corpse'?

Attitude to Death↗