MBBS Curriculum 2020

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Placebo-Controlled Surgical Trials
1 October 2015 - 18:30-20:00

Lecture: David Beard, Professor of Musculoskeletal Sciences, University of Oxford
Comment: David Papineau, Professor of Philosophy, King’s College London

K2.31, King’s Building, Strand, King’s College London

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Lies, Damn’d Lies, and Statistics: Is it possible to communicate cancer risk accurately?
15 October 2015 - 18:30-20:00

Lecture: Steve John, Lecturer, History and Philosophy of Science, University of Cambridge
Comment: Deborah Ruddy, Consultant in Clinical Genetics, Guy’s and St. Thomas’ Hospital

Henriette Raphael House, Function Room, Guy’s Campus

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Abstract:

 

The fact that different ways of presenting the same risk information can have very different effects on patients’ choices raises an ethical challenge: how, if at all, should medical professionals use such “perlocutionary knowledge”? In this paper, I suggest that reflection on the nature of risk estimates poses an even harder problem: which reference classes should physicians use to calculate patients’ risks in the first place? I then sketch one answer to this challenge, based on an account of rational gambling. Unfortunately, this answer seems to conflict with much current medical practice. In the final part of the paper, I try to justify current practice. I conclude with some remarks on the implications of my argument both for clinical ethics and for the philosophy of science.

Abstract
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”Just because I’m paranoid doesn’t mean they’re not out to get me”: The Problem of Defining Delusion
12 November 2015 - 18:30-20:00

Lecture: Dr. Abdi Sanati, Consultant Inpatient Psychiatrist, North East London NHS Foundation Trust
Comment: Dr. Luis Flores, MD, MA, MPhil

King’s Building, K2.31, Strand

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Abstract:

 

Delusions have long been seen as a hallmark of madness, but what makes something a delusion? People have mistaken beliefs without being called deluded, and the beliefs of deluded people can be true. In this talk, these and other difficulties with defining delusion will be explored from the points of view of both theory and clinical practice.

Abstract Video Recording


Annual Sowerby Lecture -- All Welcome
26 November 2015 - 18:30-20:00

“If I had to live like you, I think I’d kill myself”: Explaining the Disability Paradox

Lecture: Havi Carel, Professor of Philosophy, University of Bristol
Comment: Brian Hurwitz, Professor of Medicine and the Arts, King’s College London
 
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Abstract:

 

The ‘disability paradox’ identifies a significant difference in how ill and disabled people rate their wellbeing, compared with healthy people asked to imagine how happy they would be if they were unwell. Ill and disabled people’s wellbeing rating is only slightly lower than that of healthy people. However, healthy people rate their hypothetical wellbeing as much lower when asked to imagine themselves as ‘hypothetical patients’. There are three possible explanations: either patients misreport their wellbeing due to adaptation, or healthy people mis-imagine ill-health, or both.

 

In this paper I examine these explanations and suggest that it is healthy people who misimagine ill-health. I also claim that it is impossible to claim that ill people are misreporting their wellbeing due to adaptaion without this having general consequences for any subjective wellbeing measurements. I also claim that the phenomenon of adaptation to illness raises important questions for health economics, and that the psycho-social mechanisms involved in adaptation can be illuminated by a phenomenological analysis.

Abstract
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Cause or Correlation? Causal Evidence in Medicine and Law
28 January 2016 - 18:30-20:00

Lecture: Brendan Clarke, Department of Science and Technology Studies, UCL
Comment: Nicki Cohen, Neuropathologist, GKT Department of Medical Education, KCL

Anatomy Lecture Theatre, Hodgkin Building, Guy’s Campus

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Abstract:

 

How can medical researchers generate reliable knowledge about treatment outcomes? The usual answer to this question is that randomised clinical trials are the best way of doing this. But there are many cases where doing a trial is not possible. In such cases, researchers must rely on other kinds of evidence. However, as is well-known, these kinds of evidence have many shortcomings, such as suffering from confounding and various species of bias. This talk uses methods drawn from the law to explore improved ways of working with imperfect evidence in medicine.

Abstract Video Recording


Symposium: Self-Knowledge in and out of Illness -- Video links below
3 May 2016 - 4 May 2016 - 09:00-17:30

Self-knowledge has always played a role in health care since a person needs to be able to accurately assess her body or behaviour in order to determine whether to seek medical help. But more recently it has come to play a larger role, as health care has moved from a more paternalistic model to one where the patient is expected to take charge of her health; as we realized that early detection, and hence self-examination, can play a crucial role in outcomes; as medical science improves and makes more terminal illnesses into chronic conditions requiring self-management; as genetic testing makes it possible to have more information about our futures; and with the advent of personal electronic devices that make it easy for a person to gather accurate real-time information about her body.

It can be hard to get good information about oneself, and even harder to know what to do it. Sometimes self-knowledge is needed for a good outcome, but sometimes it is useless, or worse. Breast self-examination can lead to over-treatment, learning that one has a predisposing gene can create a detrimental illusion of knowing more about the future than one does, and data about one’s vital signs can be meaningless if taken out of a context of interpretation. We look at how these and other issues play out in a variety of medical contexts.

In conjunction with the Symposium, the Palgrave Communications journal will publish a special issue based on the same topic. More details and the Call for Papers can be found at: http://philosophyandmedicine.org/call-for-papers-self-knowledge//

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Programme

Abstracts PDF

3 May – Greenwood Lecture Theatre

Morning: 9:00-12:30
 

Welcome: Stuart Carney, Dean of the GKT School of Medical Education
 
Introduction: Sherri Roush, Peter Sowerby Chair in Philosophy and Medicine (Video)
 

Chair: Gareth Owen, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London

Tony David, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London

Self-Reflection in illness and health – literal and metaphorical? (Video)

Nick Shea, Department of Philosophy, King’s College London

Metacognition for acting and deciding together (Video)

Fiona Johnson, University College London

Self-Perception of Weight: Is a little knowledge a dangerous thing? (Video)

Matthew Hotopf, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London

Big data, Big Brother and the internet of things: the challenges of implementing mobile health (Video)

 

Afternoon: 2:30-5:30 – followed by reception
 

Chair: Sherri Roush, King’s College London

Fiona Cowdell and Judith Dyson, University of Hull

Skin Self-examination (Video)

Quassim Cassam, Department of Philosophy, University of Warwick

Self-knowledge in Diagnosis and Self-Diagnosis (handout) (Video)

Paul Norman, University of Sheffield

Psychological aspects of Breast Self-examination (Video)

 
Reception: 5:30
 
 
 

4 May 2016 – Harris Lecture Theatre, Hodgkin Building

Morning: 9:00 – 12:00
 

Introduction: Simon Howell, Dean of Biomedical Sciences
 

Chair: Abdi Sanati, Consultant Inpatient Psychiatrist, North East London NHS Foundation Trust

Christine Patch, Guy’s and St. Thomas’ Hospitals

Genetic Testing and Screening: tales from the real world (Video)

Sherri Roush, Department of Philosophy, King’s College London

Hypochondria and self-recalibration (Video)

Sacha Golob, Department of Philosophy, King’s College London

Self-Cultivation and Self-Knowing: Knowledge as Style (Video)

 

Afternoon: 2:00-5:00
 

Chair: Sacha Golob, Department of Philosophy, KCL

Veronika Williams, University of Oxford

“I just know” – experiences of self-managing acute exacerbations in COPD (Video)

Havi Carel, University of Bristol

What kind of knowledge can illness promote? (Video)

Tim Holt, University of Oxford

Sailing close to the wind: models and metaphors for the self-management of diabetes (Video)

 

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Mortality
29 September 2016 - 16:30-18:00

LectureDavid Galloway, KCL Philosophy

Anatomy Lecture Theatre, Hodgkin Building, Guy’s Campus

Abstract:

Would it be a good thing for us if we were able to lengthen our lives indefinitely, in excellent physical health? Or would we all, even in the most favourable circumstances, choose eventually to die? If we would so choose, then our mortality is not in itself a bad thing, and immortality is not to be desired. I will discuss factors we might consider in making this choice.

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Essay Contest
Reading Group Video Recording


Were you a part of your mother? The Metaphysics of Pregnancy
13 October 2016 - 16:30-18:00

LectureElselijn Kingma, Department of Philosophy, University of Southampton
Comment: Dr. Shree Datta, Consultant Obstetrician and Gynecologist, King’s College Hospital

New Hunt’s House, G.12, Guy’s Campus

Abstract:

What is the metaphysical relationship between the gestating organism and its embryo/fetus? I compare two views: (1) the fetal container model: the fetus is not part of but merely contained within or surrounded by the gestating organism; (2) the part-whole model: the fetus is part of its gestator. The fetal container model appears to be the received view. It is widely assumed but, I argue, without good argument; this model needs substantial support if it is to be taken seriously. The part-whole model is not presently defended, but I argue that it derives considerable support from a range of biological and physiological considerations. I conclude that the part-whole model has the upper hand and that, if true, this has important consequences for the metaphysics of persons and organisms and, perhaps, ethics and law.

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Video Recording


Delusional Reasoning
27 October 2016 - 16:30-18:00

LectureMatthew Parrott, KCL Philosophy

King’s Building, K-1.56, Strand Campus

Abstract:

In psychiatric textbooks and diagnostic manuals delusions are typically characterized in terms of impaired reasoning or as manifestations of irrationality. Yet it remains unclear what precisely is irrational about delusional patterns of thinking. In this presentation, we will examine several styles of reasoning exhibited in cases of delusion, some of which, as we shall see, appear surprisingly rational. This suggests, I shall claim, that delusional cognition is far more nuanced than standard textbooks and manuals might lead us to believe.

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Video Recording


Surviving the Sirens: Should there be advance directives for people with bipolar?
10 November 2016 - 17:00-18:30

LectureTania Gergel, IoPPN
Comment: Alex Ruck Keene, Barrister

New Hunt’s House, Lecture Theatre 2, Guy’s Campus

Abstract:

Bipolar Affective Disorder is a cyclical condition, with periods of remission and periods of illness, which often involve loss of decision-making capacity and damaging behaviour. For people with Bipolar, a self-binding (advance) directive (SBD), which commits them to treatment during future episodes, even if unwilling, can seem the most rational solution for an imperfect predicament. Nevertheless, efforts to establish a provision for SBDs are hampered by valid, but also paralysing, ethical, clinical and legal concerns. Paradoxically, the rights of people with Bipolar are being ‘protected’ through being denied an opportunity to protect themselves. We will present and discuss a model of an SBD which could represent a legitimate and ethically coherent form of self-determination.

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Video Recording


What's wrong with pragmatic trials?
26 January 2017 - 17:00-18:30

LectureNancy Cartwright, University of Durham and University of California, San Diego (Work with Sarah Wieten)

Video Recording

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Abstract:

In principle nothing is wrong with pragmatic trials: trials that ‘seek to determine the effectiveness of an intervention in a real-world setting to inform clinical decision making’ (Roland and Torgerson, 1998). In aid of this, pragmatic trials eliminate some of the exclusion conditions that are usual in what are labelled ‘ideal’ or ‘explanatory’ trials. The trouble comes with the concepts of ‘effectiveness’ and ‘external validity’. Positive results in well-conducted trials, whether ideal or pragmatic, show only that the treatment has worked for some members of the population enrolled in the trial. They cannot establish that it works in general nor what other factors help or hinder. Similarly, a pragmatic trial can establish that the treatment worked in the particular ‘real world’ setting – the one in which it was conducted, not that it works in ‘real world clinical practice’. Nor can they tell us what, if anything, is causally relevant in those settings. What can they do then? We shall argue that pragmatic trial results can be used in just the same way as ‘explanatory’ trial results: in tandem with a great deal of other evidence and theory, especial ‘midrange’ theory, to build credible local claims about how specific populations – or possibly even a specific individual – in specific places and circumstances may respond.
 


Manic Temporality and Decision-Making: A Phenomenological Approach
2 March 2017 - 17:00-18:30

LectureWayne Martin, Department of Philosophy, University of Essex.

Video Recording

Abstract:

The symptom scales and diagnostic criteria for mania are peppered with temporally inflected language: increased rate of speech, racing thoughts, flight of ideas, hyperactivity. But what is the underlying phenomenological structure of temporal experience in manic episodes? We identify a set of hypotheses about manic temporality formulated by two pioneers in 20th century clinical phenomenology: Eugène Minkowski (1885-1972) and Ludwig Binswanger (1881-1966). We then test, critique, and refine these hypothesis using methods of “second-person phenomenology” in an interview-based study of persons with a history of bipolar disorder and a current diagnosis of mania. We show that Minkowski and Binswanger were wrong to claim that persons experiencing acute mania are somehow trapped in the present moment. But we provide evidence that supports their hypothesis that disturbance in the formal structure of temporal experience is a core feature of mania. Developing a suggestion from Binswanger, we propose an interpretation of manic temporality as involving a distinctive form of protention. We identify consequences of this temporal disturbance for the assessment of decision-making capacity under conditions of mania.

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Privacy, consent and health data: using identifiable health data for secondary purposes ethically, but without consent
16 March 2017 - 17:00-18:30

LectureJames Wilson, Department of Philosophy, UCL

Video Recording

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Abstract:

A number legal regimes (e.g. England’s section 251 of the NHS Act 2006), have a mechanism that allows research involving identifiable health information to proceed without consent for a large population on grounds of the impracticability of gaining consent, even though the same research project would require the consent of all participants were the number of participants significantly smaller. This paper examines the cogency of the reasoning involved in such decisions, arguing that it seems difficult to justify on the assumption that in usual circumstances individuals have a right that their identifiable health information not be used without their consent. If using someone’s identifiable information without their consent would violate their rights if they were a member of a small group, why should it stop being a violation of that person’s rights if the group they are in becomes sufficiently large? I propose instead a new ethical justification for such use of health data, which I call the reasonable trespass account.