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The Mechanical Patient: Finding a More Human Model of Health
Glouberman, Sholom
Productivity Press / CRC Press / Hardcover / 2018-06-01 / 1138549940
Workplace / Organisations / Medicine: General Medicine
reg price: $71.95 our price: $ 61.16 (may be subject to change)
190 pages
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Features • The book names a current problem with health care that has been widely felt but not actually named: the chemical/mechanical model of health. • It for the first time describes how the model originated and uses the circumstances of Robert Boyle to explain the allure of the model and why it was pursued. • It retells the story of scurvy and identifies a logical problem with controlled trials that has so far not been seen. • It describes the circumstances that led to the academic acceptance of the chemical/mechanical model of health in the late 19th Century • It presents a coherent explanation of increased global longevity that relies on social and relational factors as well as chemical/mechanical ones. • It attempts an early version of a social/ relational model of health.

Summary

Healthcare is very much dependent on the model of the patient that is assumed by healthcare providers. The current model derives from a chemical/mechanical view of the patient body. Simply put: we are healthy if all of our mechanical parts are working properly and if all of the chemicals in our body are in the right proportions and have the appropriate reactions. This view is based on philosophical accounts of the body that go back to Paracelsus, Descartes, Boyle and others. It became the central basis of medical practice only in the late 19th Century after several hundred years of research and professional politics.

The Mechanical Patient traces the intellectual development of the chemical/mechanical model of the patient and its implementation. This book names the problem that we have with the mechanical patient and prepares us to respond to its exaggerated place in our society. It provides a historical and conceptual background and explains how the chemical/mechanical model of health gained such a strong hold over our thinking and took the place of the earlier Galenic humoral model. It sketches a promising outline of a more humanized model for understanding health and calls for help to fully articulate it. In that way, it joins a growing movement to go beyond our current chemical/mechanical orientation.

Table of Contents Contents List of Figures …………………………………………………………… xi List of Tables ……………………………………………………………xiii Acknowledgments ……………………………………………………. xv Author …………………………………………………………………….. xix 1 Introduction …………………………………………………….1 2 Aristotle and a Good Life ………………………………….7 Aristotle (384–322 BC) ……………………………………………….. 7 How Aristotle’s Ideas Can Help Us Understand More about Health …………………………………………………….12 3 Galen’s Four Humors: The First Medical Model ….15 Galen (AD 129–c.210) ……………………………………………….16 4 The Renaissance and Roots of the Mechanical Patient …………………………………………………………..25 Paracelsus (1493–1541) ……………………………………………..26 Francis Bacon (1561–1626) ………………………………………. 28 William Harvey (1578–1657) ……………………………………….31 Renι Descartes (1596–1650) ………………………………………32 Pierre-Simon Laplace (1749–1827)………………………………..35 5 Robert Boyle: The First Mechanical Patient ……….37 Robert Boyle (1627–1691) ………………………………………….37 Boyle and Samuel Hartlib ………………………………………….40 Boyle and George Starkey (1628–1665) ………………………43 Boyle and William Petty (1623–1687) ………………………….45 Boyle and John Wilkins (1614–1672) ………………………… 46 Boyle and Thomas Willis (1621–1675) ………………………..47 Boyle and Robert Hooke (1635–1703) ………………………. 48 Boyle and Thomas Hobbes (1588–1679) …………………….51 Boyle and Arthur Coga (1631–1691) …………………………..53 Boyle and John Locke (1632–1704) …………………………….53 Boyle and Isaac Newton (1642–1727) …………………………55 6 The Story of Scurvy and the First Failed Controlled Trial ……………………………………………..59 George Anson, 1st Baron Anson (1697–1762) ……………..60 James Lind (1716–1794) …………………………………………….61 James Cook (1728–1779) ………………………………………….. 64 John Pringle (1707–1782) …………………………………………..65 Sir Gilbert Blane (1749–1834) …………………………………….66 Almroth Wright (1861–1947) ………………………………………69 Axel Holst (1860–1931) and Theodor Frolich (1870–1947) ………………………………………………………………70 Ancel Keys (1904–2004) …………………………………………….71 7 Surgery and the Mechanical Patient ………………….73 John Hunter (1728–1793) …………………………………………..74 Fanny Burney (1772–1840) ………………………………………..75 Ignaz Semmelweis (1818–1865) ………………………………… 77 Joseph Lister (1827–1912) ………………………………………….81 Wilhelm Rφntgen (1845–1923) ……………………………………82 Abraham Flexner (1866–1959) ………………………………….. 84 The Mechanical Patient in the Modern Hospital …………..85 Nurses in the Modern Hospital …………………………………. 86 Lili Elbe (1882–1931) …………………………………………………87 Christiaan Barnard (1922–2001) ………………………………… 88 Surgical Techniques ……………………………………………… 90 PROMs ………………………………………………………………… 90 8 Medicine and the Chemical Patient …………………..93 Lady Mary Wortley Montagu (1689–1762) ……………………93 Edward Jenner (1749–1823) ……………………………………….95 Louis Pasteur (1822–1895) ………………………………………… 96 Robert Koch (1843–1910), Ferdinand Cohn (1829–1898), and Maurice Hilleman (1919–2005) …………. 98 Mary Mallon (Typhoid Mary) (1869–1938) ………………….. 99 Charles Best (1899–1978), Sir Frederick Banting (1891–1941), and James Collip (1892–1965) ………………101 The Tuskegee Syphilis Study (1932–1972) and Ethics …101 Gerhard Domagk (1895–1964) ………………………………….102 Alexander Fleming (1881–1955), Howard Florey (1898–1968), and Ernst Chain (1906–1979) ………………….103 Henrietta Lacks (1920–1951) …………………………………….104 Ali Maow Maalin (1954–2013) ……………………………………106 Sam Wagstaff (1921–1987) and Robert Mapplethorpe (1946–1989) ……………………………………………………………..106 WHO Atlas ……………………………………………………………..107 Brenda Zimmermann (1956–2014) ……………………………. 110 9 Genetics and the Return of Individualized Medicine ……………………………………………………..113 Charles Darwin (1809–1882) ……………………………………. 114 An Aside on the Evolution of Human Consciousness … 115 Francis Galton (1822–1911) ………………………………………. 115 Wilhelm Beiglbφck (1905–1963), Karl Brandt (1904–1948), and Josef Mengele (1911–1979) ………………. 116 Rosalind Franklin (1920–1958), Francis Crick (1916–2004), and James Watson (1928–) ……………………. 118 Herbert Boyer (1936–) and Stanley Cohen (1935–) ……… 118 Charles DeLisi (1941–), Pete Domenici (1932–), and Craig Venter (1946–) …………………………………………. 119 Angelina Jolie (1975–) ………………………………………………120 Emmanuelle Charpentier (1968–) and Jennifer Doudna (1964–) ……………………………………………………….120 10 The Great Mortality Shift ………………………………123 Edwin Chadwick (1800–1890) ………………………………….124 John Snow (1813–1858) …………………………………………..126 Joseph Bazalgette (1818–1891) …………………………………127 John Simon (1816–1876) ………………………………………….127 Aneurin Bevan (1897–1960) ……………………………………..128 Rachel Carson (1907–1964) ………………………………………130 Thomas McKeown (1912–1988) ………………………………..131 Hubert Laframboise (1924–1991) and Marc Lalonde (1929–) ……………………………………………….132 11 Humanizing Health: The Social/Relational Person …………………………………………………………139 The Great Chain of Being ……………………………………….. 141 Voltaire (1694–1778), Rousseau (1712–1778), Diderot (1713–1784), and Hume (1711–1776)……………….142 The Enlightenment and Reform …………………………….142 James Edward Oglethorpe (1696–1785) …………………….143 Jeremy Bentham (1748–1832) and John Stuart Mill (1806–1873) ……………………………………………………………..144 Richard Wilkinson (1943–) ……………………………………….146 Michael Marmot (1945–) ………………………………………….. 147 Amartya Sen (1933–) ………………………………………………. 150 Thomas Piketty (1971–) …………………………………………… 151 Finding a More Human Model of Health ……………….. 151 Bibliography ……………………………………………………… 157 Index ………………………………………………………………..163

About the Author:

Sholom Glouberman is Philosopher in Residence at Baycrest Health Sciences in Toronto. He has a PhD in Philosophy from Cornell University. His early experience in healthcare was caring for his dying father. He was a planner and adviser at the McGill University Health Centre in Montreal, a Fellow at the King’s Fund in London England, the director of Health Policy for Canadian Policy Research Networks, the director of the International Health Management Program at McGill University and the founder of Patients Canada. He has been an adviser to many healthcare organizations in Canada and the UK. He has spoken before more than 25,000 people around the world. In the last few years he has worked extensively with patients and organizations to create patient partnerships and identify performance targets to humanize healthcare experiences.

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