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      Possibilities and paradoxes in medicine: love of order, loveless order and the order of love

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          Abstract

          We have a desire to discover and create order, and our constitution, including our rational faculties, indicates that we are predisposed for such productivity. This affinity for order and the establishment of order is fundamental to humans and naturally also leaves its mark on the medical discipline. When this profession is made subject to criticism, frequently in terms of well-used reproofs such as reductionism, reification and de-humanisation, this systematising productivity is invariably involved in some way or other. It is, however, problematic that we rarely delve deeper and ask what order means, or reflect on its underlying, omnipresent and self-evident role. In order to approach this challenge, we initially and briefly place order in a conceptual and historical context. In what follows, we examine order explicitly, i.e. made an object of study, by taking a closer look at extensive multidisciplinary efforts to uncover the secrets of all its facets. Here we also try to identify some systems of order in medical science, including methodological and procedural order, which are indispensable as well as a source of problems. In the sections that follow, order is not defined as an explicit object of study, but comes to light in some exploratory and philosophising projects based on physics, mathematics and phenomenology . Each of these lets order and that which is ordered emerge in ways that may also shed light on opportunities and paradoxes in the medical domain. Key themes here include the Gordian knot of psyche – soma, the order of disorder and the patient as Other.

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          A literature review on the representativeness of randomized controlled trial samples and implications for the external validity of trial results

          Randomized controlled trials (RCTs) are conducted under idealized and rigorously controlled conditions that may compromise their external validity. A literature review was conducted of published English language articles that reported the findings of studies assessing external validity by a comparison of the patient sample included in RCTs reporting on pharmaceutical interventions with patients from everyday clinical practice. The review focused on publications in the fields of cardiology, mental health, and oncology. A range of databases were interrogated (MEDLINE; EMBASE; Science Citation Index; Cochrane Methodology Register). Double-abstract review and data extraction were performed as per protocol specifications. Out of 5,456 de-duplicated abstracts, 52 studies met the inclusion criteria (cardiology, n = 20; mental health, n = 17; oncology, n = 15). Studies either performed an analysis of the baseline characteristics (demographic, socioeconomic, and clinical parameters) of RCT-enrolled patients compared with a real-world population, or assessed the proportion of real-world patients who would have been eligible for RCT inclusion following the application of RCT inclusion/exclusion criteria. Many of the included studies concluded that RCT samples are highly selected and have a lower risk profile than real-world populations, with the frequent exclusion of elderly patients and patients with co-morbidities. Calculation of ineligibility rates in individual studies showed that a high proportion of the general disease population was often excluded from trials. The majority of studies (n = 37 [71.2 %]) explicitly concluded that RCT samples were not broadly representative of real-world patients and that this may limit the external validity of the RCT. Authors made a number of recommendations to improve external validity. Findings from this review indicate that there is a need to improve the external validity of RCTs such that physicians treating patients in real-world settings have the appropriate evidence on which to base their clinical decisions. This goal could be achieved by trial design modification to include a more representative patient sample and by supplementing RCT evidence with data generated from observational studies. In general, a thoughtful approach to clinical evidence generation is required in which the trade-offs between internal and external validity are considered in a holistic and balanced manner. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-1023-4) contains supplementary material, which is available to authorized users.
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            Quantum Theory

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              Mind-body Dualism: A critique from a Health Perspective**

              Philosophical theory about the nature of human beings has far reaching consequences on our understanding of various issues faced by them. Once taken as self-evident, it becomes the foundation on which knowledge gets built. The cause of concern is that this theoretical framework rarely gets questioned despite its inherent limitations and self-defeating consequences, leading to crisis in the concerned field. The field, which is facing crisis today, is that of medicine, and the paradigmatic stance that is responsible for the crisis is Cartesian dualism—a view that mind and body are essentially separate entities. This paper discusses Cartesian dualism in the context of the practice of medicine. Focusing more closely on how disease, health and treatment are defined through this position, the paper builds up its critique by throwing light on its accomplishments, limitations and self-defeating consequences. The paper also seeks to understand why this dualism is still alive despite its disavowal from philosophers, health practitioners and lay people.
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                Author and article information

                Contributors
                thor.eirik.eriksen@unn.no
                Journal
                Med Health Care Philos
                Med Health Care Philos
                Medicine, Health Care, and Philosophy
                Springer Netherlands (Dordrecht )
                1386-7423
                1572-8633
                9 June 2022
                9 June 2022
                2022
                : 25
                : 3
                : 465-482
                Affiliations
                [1 ]GRID grid.412244.5, ISNI 0000 0004 4689 5540, Department of Occupational and Environmental Medicine, , University Hospital of North Norway, ; Tromsø, Norway
                [2 ]GRID grid.10919.30, ISNI 0000000122595234, Department of Community Medicine, Faculty of Health Sciences, , UiT – The Arctic University of Norway, ; Tromsø, Norway
                Author information
                http://orcid.org/0000-0001-6341-1120
                Article
                10093
                10.1007/s11019-022-10093-0
                9427896
                35680702
                976e3fab-1570-44f1-8381-d0d1119f69f0
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 9 February 2022
                : 9 February 2022
                : 4 May 2022
                Funding
                Funded by: UiT The Arctic University of Norway (incl University Hospital of North Norway)
                Categories
                Scientific Contribution
                Custom metadata
                © Springer Nature B.V. 2022

                Medicine
                order,order of order,love,explicate,implicate,symmetry,asymmetry,organic,loveless,psyche-soma,disorder,the other
                Medicine
                order, order of order, love, explicate, implicate, symmetry, asymmetry, organic, loveless, psyche-soma, disorder, the other

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