Medicine/ja: Difference between revisions

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== Medical ethics ==

{{Main|Medical ethics}}

[[File:HippocraticOath.jpg|thumb|upright|A 12th-century [[Byzantine empire|Byzantine]] manuscript of the [[Hippocratic Oath]]]]

Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology. Six of the values that commonly apply to medical ethics discussions are:

* [[Justice (ethics)|justice]] – concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).

* [[Primum non nocere|non-maleficence]] – "first, do no harm" (''primum non-nocere'').

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Values such as these do not give answers as to how to handle a particular situation, but provide a useful framework for understanding conflicts. When moral values are in conflict, the result may be an ethical [[dilemma]] or crisis. Sometimes, no good solution to a dilemma in medical ethics exists, and occasionally, the values of the medical community (i.e., the hospital and its staff) conflict with the values of the individual patient, family, or larger non-medical community. Conflicts can also arise between health care providers, or among family members. For example, some argue that the principles of autonomy and beneficence clash when patients refuse [[blood transfusions]], considering them life-saving; and truth-telling was not emphasized to a large extent before the HIV era.

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{{Main|History of medicine}}

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[[File:Imhotep-Louvre.JPG|thumb|left|upright|Statuette of ancient Egyptian physician [[Imhotep]], the first physician from antiquity known by name]]

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[[Prehistoric medicine]] incorporated plants ([[herbalism]]), animal parts, and minerals. In many cases these materials were used ritually as magical substances by priests, [[shamans]], or [[medicine man|medicine men]]. Well-known spiritual systems include [[animism]] (the notion of inanimate objects having spirits), [[spiritualism]] (an appeal to gods or communion with ancestor spirits); [[shamanism]] (the vesting of an individual with mystic powers); and [[divination]] (magically obtaining the truth). The field of [[medical anthropology]] examines the ways in which culture and society are organized around or impacted by issues of health, health care and related issues.

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Early records on medicine have been discovered from [[ancient Egyptian medicine]], [[Babylonian Medicine]], [[Ayurveda|Ayurvedic]] medicine (in the [[Indian subcontinent]]), [[classical Chinese medicine]] (predecessor to the modern [[traditional Chinese medicine]]), and [[ancient Greek medicine]] and [[Medicine in ancient Rome|Roman medicine]].

In Egypt, [[Imhotep]] (3rd millennium BCE) is the first physician in history known by name. The oldest [[Egyptian medical papyri|Egyptian medical text]] is the ''[[Kahun Gynaecological Papyrus]]'' from around 2000 BCE, which describes gynaecological diseases. The ''[[Edwin Smith Papyrus]]'' dating back to 1600 BCE is an early work on surgery, while the ''[[Ebers Papyrus]]'' dating back to 1500 BCE is akin to a textbook on medicine.

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In China, archaeological evidence of medicine in Chinese dates back to the [[Bronze Age]] [[Shang Dynasty]], based on seeds for herbalism and tools presumed to have been used for surgery. The ''[[Huangdi Neijing]]'', the progenitor of Chinese medicine, is a medical text written beginning in the 2nd century BCE and compiled in the 3rd century.

In India, the surgeon [[Sushruta]] described numerous surgical operations, including the earliest forms of [[plastic surgery]]. Earliest records of dedicated hospitals come from Mihintale in [[Sri Lanka]] where evidence of dedicated medicinal treatment facilities for patients are found.

[[File:HSAsclepiusKos retouched.jpg|thumb|upright=1.1|Mosaic on the floor of the [[Asclepieion]] of Kos, depicting [[Hippocrates]], with [[Wikipedia:Asklepius|Asklepius]] in the middle (2nd–3rd century)]]

In Greece, the [[Ancient Greek medicine|Greek physician]] [[Hippocrates]], the "father of modern medicine", laid the foundation for a rational approach to medicine. Hippocrates introduced the [[Hippocratic Oath]] for physicians, which is still relevant and in use today, and was the first to categorize illnesses as [[Acute (medical)|acute]], [[Chronic (medicine)|chronic]], [[Endemic (epidemiology)|endemic]] and epidemic, and use terms such as, "exacerbation, [[relapse]], resolution, crisis, [[paroxysm]], peak, and [[convalescence]]". The Greek physician [[Galen]] was also one of the greatest surgeons of the ancient world and performed many audacious operations, including brain and eye surgeries. After the fall of the [[Western Roman Empire]] and the onset of the [[Wikipedia:Early Middle Ages|Early Middle Ages]], the Greek tradition of medicine went into decline in Western Europe, although it continued uninterrupted in the [[:en:Eastern Roman Empire|Eastern Roman (Byzantine) Empire]].

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Most of our knowledge of ancient [[Hebrew medicine]] during the [[:en:1st millennium BC|1st&nbsp;millennium&nbsp;BC]] comes from the [[Wikipedia:Torah|Torah]], i.e.&nbsp;the Five Books of [[Moses]], which contain various health related laws and rituals. The Hebrew contribution to the development of modern medicine started in the [[Wikipedia:Byzantine Era|Byzantine Era]], with the physician [[Wikipedia:Asaph the Jew|Asaph the Jew]].

[[File:Al-Risalah al-Dhahabiah.JPG|thumb|left|A manuscript of ''[[Wikipedia:Al-Risalah al-Dhahabiah|Al-Risalah al-Dhahabiah]]'' by [[Wikipedia:Ali al-Ridha|Ali al-Ridha]], the eighth Imam of [[Twelver|Shia Muslims]]. The text says: "Golden dissertation in medicine which is sent by Imam Ali ibn Musa al-Ridha, peace be upon him, to [[Wikipedia:al-Ma'mun|al-Ma'mun]]."]]

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The concept of hospital as institution to offer medical care and possibility of a cure for the patients due to the ideals of Christian charity, rather than just merely a place to die, appeared in the [[Wikipedia:Byzantine Empire|Byzantine Empire]].

Although the concept of [[uroscopy]] was known to Galen, he did not see the importance of using it to localize the disease. It was under the Byzantines with physicians such of [[Theophilus Protospatharius]] that they realized the potential in uroscopy to determine disease in a time when no microscope or stethoscope existed. That practice eventually spread to the rest of Europe.

After 750 CE, the Muslim world had the works of Hippocrates, Galen and Sushruta translated into [[Wikipedia:Arabic|Arabic]], and [[Islamic medicine|Islamic physicians]] engaged in some significant medical research. Notable Islamic medical pioneers include the [[:en:Persians|Persian]] [[Wikipedia:polymath|polymath]], [[Wikipedia:Avicenna|Avicenna]], who, along with Imhotep and Hippocrates, has also been called the "father of medicine". He wrote ''[[Wikipedia:The Canon of Medicine|The Canon of Medicine]]'' which became a standard medical text at many medieval European [[:en:University|universities]], considered one of the most famous books in the history of medicine. Others include [[:en:Abu al-Qasim al-Zahrawi|Abulcasis]], [[Wikipedia:Ibn Zuhr|Avenzoar|Ibn Zuhr|Avenzoar]], [[Wikipedia:Ibn al-Nafis|Ibn al-Nafis]], and [[Wikipedia:Averroes|Averroes]]. Persian  physician [[:en:Muhammad ibn Zakarīya Rāzi|Rhazes]] was one of the first to question the Greek theory of [[Wikipedia:humorism|humorism]], which nevertheless remained influential in both medieval Western and medieval [[Islamic medicine]]. Some volumes of [[:en:Muhammad ibn Zakarīya Rāzi|Rhazes]]'s work ''Al-Mansuri'', namely "On Surgery" and "A General Book on Therapy", became part of the medical curriculum in European universities. Additionally, he has been described as a doctor's doctor, the father of [[pediatrics]], and a pioneer of [[ophthalmology]]. For example, he was the first to recognize the reaction of the eye's pupil to light. The Persian [[Wikipedia:Bimaristan|Bimaristan]] hospitals were an early example of [[Wikipedia:public hospital|public hospital]]s.

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In Europe, [[Wikipedia:Charlemagne|Charlemagne]] decreed that a hospital should be attached to each cathedral and monastery and the historian [[Wikipedia:Geoffrey Blainey|Geoffrey Blainey]] likened the [[:en:Catholic Church and health care|activities of the Catholic Church in health care]] during the Middle Ages to an early version of a welfare state: "It conducted hospitals for the old and orphanages for the young; hospices for the sick of all ages; places for the lepers; and hostels or inns where pilgrims could buy a cheap bed and meal". It supplied food to the population during famine and distributed food to the poor. This welfare system the church funded through collecting taxes on a large scale and possessing large farmlands and estates. The [[Wikipedia:Benedictine|Benedictine]] order was noted for setting up hospitals and infirmaries in their monasteries, growing medical herbs and becoming the chief medical care givers of their districts, as at the great [[Wikipedia:Abbey of Cluny|Abbey of Cluny]]. The Church also established a network of [[Wikipedia:cathedral schools|cathedral schools]] and universities where medicine was studied. The [[Wikipedia:Schola Medica Salernitana|Schola Medica Salernitana]] in Salerno, looking to the learning of [[:en:Greeks|Greek]] and [[Wikipedia:Arab|Arab]] physicians, grew to be the finest medical school in Medieval Europe.

[[File:SantaMariaDellaScalaSienaBack.JPG|thumb|upright=1.2|Siena's [[:en:Santa Maria della Scala (Siena)|Santa Maria della Scala Hospital]], one of Europe's oldest hospitals. During the Middle Ages, the Catholic Church established universities to revive the study of sciences, drawing on the learning of Greek and Arab physicians in the study of medicine.]]

However, the fourteenth and fifteenth century [[Wikipedia:Black Death|Black Death]] devastated both the Middle East and Europe, and it has even been argued that Western Europe was generally more effective in recovering from the pandemic than the Middle East. In the early modern period, important early figures in medicine and anatomy emerged in Europe, including [[Wikipedia:Gabriele Falloppio|Gabriele Falloppio]] and [[Wikipedia:William Harvey|William Harvey]].

The major shift in medical thinking was the gradual rejection, especially during the [[Wikipedia:Black Death|Black Death]] in the 14th and 15th centuries, of what may be called the "traditional authority" approach to science and medicine. This was the notion that because some prominent person in the past said something must be so, then that was the way it was, and anything one observed to the contrary was an anomaly (which was paralleled by a similar shift in European society in general – see [[:en:Nicolaus Copernicus|Copernicus]]'s rejection of [[Wikipedia:Ptolemy|Ptolemy]]'s theories on astronomy). Physicians like [[Vesalius]] improved upon or disproved some of the theories from the past. The main tomes used both by medicine students and expert physicians were [[Wikipedia:Materia Medica|Materia Medica]] and [[Wikipedia:Pharmacopoeia|Pharmacopoeia]].

[[Wikipedia:Andreas Vesalius|Andreas Vesalius]] was the author of ''[[Wikipedia:De humani corporis fabrica|De humani corporis fabrica]]'', an important book on [[human anatomy]]. Bacteria and microorganisms were first observed with a microscope by [[Wikipedia:Antonie van Leeuwenhoek|Antonie van Leeuwenhoek]] in 1676, initiating the scientific field [[microbiology]]. Independently from [[Wikipedia:Ibn al-Nafis|Ibn al-Nafis]], [[Wikipedia:Michael Servetus|Michael Servetus]] rediscovered the [[pulmonary circulation]], but this discovery did not reach the public because it was written down for the first time in the "Manuscript of Paris" in 1546, and later published in the theological work for which he paid with his life in 1553. Later this was described by [[Wikipedia:Renaldus Columbus|Renaldus Columbus]] and [[Wikipedia:Andrea Cesalpino|Andrea Cesalpino]]. [[Wikipedia:Herman Boerhaave|Herman Boerhaave]] is sometimes referred to as a "father of physiology" due to his exemplary teaching in Leiden and textbook 'Institutiones medicae' (1708). [[Wikipedia:Pierre Fauchard|Pierre Fauchard]] has been called "the father of modern dentistry".

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[[File:Paul-Louis Simond injecting plague vaccine June 4th 1898 Karachi.jpg|thumb|left|[[Wikipedia:Paul-Louis Simond|Paul-Louis Simond]] injecting a plague vaccine in [[Wikipedia:Karachi|Karachi]], 1898]]

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Veterinary medicine was, for the first time, truly separated from human medicine in 1761, when the French veterinarian [[Wikipedia:Claude Bourgelat|Claude Bourgelat]] founded the world's first veterinary school in Lyon, France. Before this, medical doctors treated both humans and other animals.

Modern scientific [[biomedical research]] (where results are testable and [[reproducible]]) began to replace early Western traditions based on herbalism, the Greek "[[Wikipedia:humorism|four humours|humorism|four humours]]" and other such pre-modern notions. The modern era really began with [[Wikipedia:Edward Jenner|Edward Jenner]]'s discovery of the [[smallpox vaccine]] at the end of the 18th century (inspired by the method of [[inoculation]] earlier practiced in Asia), [[Wikipedia:Robert Koch|Robert Koch]]'s discoveries around 1880 of the transmission of disease by bacteria, and then the discovery of [[antibiotic]]s around 1900.

The post-18th century [[modernity]] period brought more groundbreaking researchers from Europe. From [[Wikipedia:Germany|Germany]] and Austria, doctors [[Wikipedia:Rudolf Virchow|Rudolf Virchow]], [[Wikipedia:Wilhelm Conrad Röntgen|Wilhelm Conrad Röntgen]], [[Wikipedia:Karl Landsteiner|Karl Landsteiner]] and [[Wikipedia:Otto Loewi|Otto Loewi]] made notable contributions. In the [[Wikipedia:United Kingdom|United Kingdom]], [[Wikipedia:Alexander Fleming|Alexander Fleming]], [[:en:Joseph Lister, 1st Baron Lister|Joseph Lister]], [[Wikipedia:Francis Crick|Francis Crick]] and [[Wikipedia:Florence Nightingale|Florence Nightingale]] are considered important. [[:en:Spain|Spanish]] doctor [[Wikipedia:Santiago Ramón y Cajal|Santiago Ramón y Cajal]] is considered the father of modern [[neuroscience]].

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From New Zealand and Australia came [[Wikipedia:Maurice Wilkins|Maurice Wilkins]], [[Wikipedia:Howard Florey|Howard Florey]], and [[Wikipedia:Frank Macfarlane Burnet|Frank Macfarlane Burnet]].

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Others that did significant work include [[Wikipedia:William Williams Keen|William Williams Keen]], [[Wikipedia:William Coley|William Coley]], [[Wikipedia:James D. Watson|James D. Watson]] (United States); [[Wikipedia:Salvador Luria|Salvador Luria]] (Italy); [[Wikipedia:Alexandre Yersin|Alexandre Yersin]] (Switzerland); [[Wikipedia:Kitasato Shibasaburō|Kitasato Shibasaburō]] (Japan); [[Wikipedia:Jean-Martin Charcot|Jean-Martin Charcot]], [[Wikipedia:Claude Bernard|Claude Bernard]], [[Wikipedia:Paul Broca|Paul Broca]] (France); [[Wikipedia:Adolfo Lutz|Adolfo Lutz]] (Brazil); [[Wikipedia:Nikolai Korotkov|Nikolai Korotkov]] (Russia); [[:en:William Osler|Sir William Osler]] (Canada); and [[Wikipedia:Harvey Cushing|Harvey Cushing]] (United States).

As science and technology developed, medicine became more reliant upon [[medication]]s. Throughout history and in Europe right until the late 18th century, not only animal and plant products were used as medicine, but also human body parts and fluids. [[Pharmacology]] developed in part from [[herbalism]] and some drugs are still derived from plants ([[atropine]], [[ephedrine]], [[warfarin]], [[aspirin]], [[digoxin]], [[vinca alkaloid|''vinca'' alkaloids]], [[taxo]]l, [[hyoscine hydrobromide|hyoscine]], etc.). [[Vaccine]]s were discovered by [[Wikipedia:Edward Jenner|Edward Jenner]] and [[Wikipedia:Louis Pasteur|Louis Pasteur]].

The first antibiotic was [[arsphenamine]] (Salvarsan) discovered by [[Wikipedia:Paul Ehrlich|Paul Ehrlich]] in 1908 after he observed that bacteria took up toxic dyes that human cells did not. The first major class of [[antibiotic]]s was the [[Sulfonamide (medicine)|sulfa drugs]], derived by German chemists originally from [[azo dye]]s.

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[[File:Sydänlääkkeen pakkausta lääketehdas Starilla vuonna 1953. Kuva Vapriikin kuva-arkisto. (16248845637).jpg|thumb|Packaging of [[Cardiology|cardiac medicine]] at the Star pharmaceutical factory in [[Wikipedia:Tampere|Tampere]], [[Wikipedia:Finland|Finland]] in 1953.]]

Pharmacology has become increasingly sophisticated; modern [[biotechnology]] allows drugs targeted towards specific physiological processes to be developed, sometimes designed for compatibility with the body to reduce [[Side effect|side-effects]]. [[Genomics]] and knowledge of [[human genetics]] and [[human evolution]] is having increasingly significant influence on medicine, as the causative [[gene]]s of most monogenic [[genetic disorder]]s have now been identified, and the development of techniques in [[molecular biology]], [[evolution]], and [[genetics]] are influencing medical technology, practice and decision-making.

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Evidence-based medicine is a contemporary movement to establish the most effective [[algorithms]] of practice (ways of doing things) through the use of [[systematic review]]s and [[meta-analysis]]. The movement is facilitated by modern global [[information science]], which allows as much of the available evidence as possible to be collected and analyzed according to standard protocols that are then disseminated to healthcare providers. The [[Wikipedia:Cochrane Collaboration|Cochrane Collaboration]] leads this movement. A 2001 review of 160 Cochrane systematic reviews revealed that, according to two readers, 21.3% of the reviews concluded insufficient evidence, 20% concluded evidence of no effect, and 22.5% concluded positive effect.

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[[Evidence-based medicine]], prevention of [[medical error]] (and other "[[iatrogenesis]]"), and avoidance of [[unnecessary health care]] are a priority in modern medical systems. These topics generate significant political and public policy attention, particularly in the United States where healthcare is regarded as excessively costly but [[population health]] metrics lag similar nations.

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Globally, many [[:en:Developing country|developing countries]] lack access to care and [[access to medicines]]. As of 2015, most wealthy developed countries provide [[Universal health care|health care to all citizens]], with a few exceptions such as the United States where lack of [[health insurance]] coverage may limit access.

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