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Exploring consciousness
only when there was H pylori infection, and especially in those with severe inflammation (N Sakaki et al, Tokyo). A study by H Lamouliatte et al (Bordeaux) provided more direct
tric cancer. Although the CagA proconsciousness tein is one of the immunodominant antigens of H pylori, its functional There are "easy" questions about consciousness being answered in laboratories properties remain unclear. Interestaround the globe: what neural mechaingly both Blaser’s and Crabtree’s nisms underpin perception and cognition, groups showed that isogenic CagA- what is the difference between waking and negative mutant strains of H pylori do how anaesthetics work? Then sleeping, retained similar pro-inflammatory there are the "hard" questions: how are properties, implying that the CagA we conscious of any perceptions, what are thoughts or feelings, and how do we expegene itself may not be the key virurience a unified self? These are starting to lence determinant, but is a marker move from the domain of philosophy into for an as yet uncharacterised gene : that of science. In a new journal, Harman’ closely associated with it. argues that the epistemology that underReports that the non-toxic cholera pins natural science is inadequate for the B-subunit was an effective adjuvant study of consciousness since it labels inner for a cell sonicate vaccine for H felis : experiences as subjective and "unknowin the mouse model were followed by able" and is premised upon an external observer independent of the data collectpreliminary data of a therapeutic vaced. He then outlines the attributes of a cine showing long-term protection provisional epistemology that permits (C Doidge et al, Sydney). This conresearch into the structure and evolution trasts with antimicrobial treatment, of consciousness. where protection was not demon: A volatile mixture of refereed articles, strated when ferrets were challenged interviews, and conference reports from with H mustelae a G Fox et al, Camall camps (reductionist to mystical)
Exploring
support these observations. Although no control group was studied, a follow-up of patients in whom H pylori had been eradicated up to 3 years previously showed that gastric atrophy either disappeared completely or improved, but did not progress. Since there have been no other reports on resolution of gastric atrophy after eradication of H pylori, : and since it is still unclear whether intestinal metaplasia is reversible, intervention studies should include : patients with gastric atrophy. The 128 kDa CagA product of Of7 : pylori (which is closely associated with the vacuolating cytotoxin) has been proposed as an important virulence factor. Using a recombinant CagA ELISA, M J Blaser et al bridge, Massachusetts,). Reports of (Nashville) found that CagA-antibody-positive subjects had twice the therapeutic vaccination using the recombinant B subunit of H pylori risk of developing distal intestinalfrom Switzerland (P type gastric cancer, compared with urease came Michetti et al, Lausanne), where sucinfected antibody-negative patients. cessful eradication may be associated However, J E Crabtree et al (Leeds) with an enhanced gastric mucosal have shown that in seronegative patients with gastric cancer, gastric IgA response, suggesting that, if host stimulated, mucosal antibody response still appropriately be mucosal can the kDa This 128 responses sufficiently protein. recognises up-regulated to overcome the infecfinding, together with Blaser’s, high: lights the importance of both the tion. mucosal and systemic immunological responses in the development of gas-Robert P H Logan
evidence
to
;
;
;
;
investigation
Gene Feder 1
Harman W. The scientific exploration of consciousness: towards an adequate epistemology. J Consciousness Studies 1994; 1: 140-48. Subscription rates are
US$25/£15 (individuals), $48/£28 (institutions). Details from Imprint Academia, PO Box 1, Thoverton, Exeter EX5 5YX, UK.
and (ii) the action in negligence failed because, although a patient
MEDICINE AND THE LAW
Consent when
launches the 6-monthly journal into the centre of heated debates in the (newly named) field of "consciousness studies". Those of us on the outside can finally enjoy at first hand one of the most exciting areas of research and theory-making.
is
interrupted
may consent to the renewal
or con-
tinuation of a test, she must be informed of any material change in the circumstances that could alter her assessment of the cost or benefit of continuing with the procedure. Here there had been no material change in the circumstances and a valid consent had been given to the continuation of the process. Once an angiogram was initiated, the analysis of the risks inherent in continuing, as opposed to stopping, the procedure became a matter of medical judg-
The Supreme Court of Canada has: investigation was concluded some dismissed an appeal against findings 10-15 minutes later. The plaintiff that there had been no battery or became quadriplegic very soon after. ; The trial judge found that the negligence in the case of a patient who became quadriplegic after an: plaintiff’s consent was suspended angiogram. :: when she asked for the test to be In December, 1980, the plaintiff, halted but that she consented to the Mrs Ciarlariello, underwent a second completion of the angiogram and cerebral angiogram at Mount Sinai: there had been no battery. The claim Hospital, Toronto, after a diagnosis in negligence was also dismissed. of a subarachnoid haemorrhage.: After her death, her estate appealed Before the first angiogram a week to the Court of Appeal in Ontario, ment. earlier, the neurosurgeon had fully: which unanimously upheld the deciexplained the risks associated with son of the trial judge.’ The final subarachnoid haemorrhage and with: appeal to the Supreme Court of . the procedure. During the second Canada last year has just been pubDiana Brahams angiogram, the plaintiff became agi- : lished.2 The Court held (i) that the 1 Brahams D. Informed consent when an tated and demanded that the test be action in battery failed because the investigation is interrupted. Lancet 1992; stopped. When she calmed down the: patient had consented to the 339: 51-52, and [1991] 2 Med LR 391. final injection was given and the angiogram and to its continuation, 2 [1994] 5 Med LR 213.
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tric cancer. Although the CagA proconsciousness tein is one of the immunodominant antigens of H pylori, its functional There are "easy" questions about consciousness being answered in laboratories properties remain unclear. Interestaround the globe: what neural mechaingly both Blaser’s and Crabtree’s nisms underpin perception and cognition, groups showed that isogenic CagA- what is the difference between waking and negative mutant strains of H pylori do how anaesthetics work? Then sleeping, retained similar pro-inflammatory there are the "hard" questions: how are properties, implying that the CagA we conscious of any perceptions, what are thoughts or feelings, and how do we expegene itself may not be the key virurience a unified self? These are starting to lence determinant, but is a marker move from the domain of philosophy into for an as yet uncharacterised gene : that of science. In a new journal, Harman’ closely associated with it. argues that the epistemology that underReports that the non-toxic cholera pins natural science is inadequate for the B-subunit was an effective adjuvant study of consciousness since it labels inner for a cell sonicate vaccine for H felis : experiences as subjective and "unknowin the mouse model were followed by able" and is premised upon an external observer independent of the data collectpreliminary data of a therapeutic vaced. He then outlines the attributes of a cine showing long-term protection provisional epistemology that permits (C Doidge et al, Sydney). This conresearch into the structure and evolution trasts with antimicrobial treatment, of consciousness. where protection was not demon: A volatile mixture of refereed articles, strated when ferrets were challenged interviews, and conference reports from with H mustelae a G Fox et al, Camall camps (reductionist to mystical)
Exploring
support these observations. Although no control group was studied, a follow-up of patients in whom H pylori had been eradicated up to 3 years previously showed that gastric atrophy either disappeared completely or improved, but did not progress. Since there have been no other reports on resolution of gastric atrophy after eradication of H pylori, : and since it is still unclear whether intestinal metaplasia is reversible, intervention studies should include : patients with gastric atrophy. The 128 kDa CagA product of Of7 : pylori (which is closely associated with the vacuolating cytotoxin) has been proposed as an important virulence factor. Using a recombinant CagA ELISA, M J Blaser et al bridge, Massachusetts,). Reports of (Nashville) found that CagA-antibody-positive subjects had twice the therapeutic vaccination using the recombinant B subunit of H pylori risk of developing distal intestinalfrom Switzerland (P type gastric cancer, compared with urease came Michetti et al, Lausanne), where sucinfected antibody-negative patients. cessful eradication may be associated However, J E Crabtree et al (Leeds) with an enhanced gastric mucosal have shown that in seronegative patients with gastric cancer, gastric IgA response, suggesting that, if host stimulated, mucosal antibody response still appropriately be mucosal can the kDa This 128 responses sufficiently protein. recognises up-regulated to overcome the infecfinding, together with Blaser’s, high: lights the importance of both the tion. mucosal and systemic immunological responses in the development of gas-Robert P H Logan
evidence
to
;
;
;
;
investigation
Gene Feder 1
Harman W. The scientific exploration of consciousness: towards an adequate epistemology. J Consciousness Studies 1994; 1: 140-48. Subscription rates are
US$25/£15 (individuals), $48/£28 (institutions). Details from Imprint Academia, PO Box 1, Thoverton, Exeter EX5 5YX, UK.
and (ii) the action in negligence failed because, although a patient
MEDICINE AND THE LAW
Consent when
launches the 6-monthly journal into the centre of heated debates in the (newly named) field of "consciousness studies". Those of us on the outside can finally enjoy at first hand one of the most exciting areas of research and theory-making.
is
interrupted
may consent to the renewal
or con-
tinuation of a test, she must be informed of any material change in the circumstances that could alter her assessment of the cost or benefit of continuing with the procedure. Here there had been no material change in the circumstances and a valid consent had been given to the continuation of the process. Once an angiogram was initiated, the analysis of the risks inherent in continuing, as opposed to stopping, the procedure became a matter of medical judg-
The Supreme Court of Canada has: investigation was concluded some dismissed an appeal against findings 10-15 minutes later. The plaintiff that there had been no battery or became quadriplegic very soon after. ; The trial judge found that the negligence in the case of a patient who became quadriplegic after an: plaintiff’s consent was suspended angiogram. :: when she asked for the test to be In December, 1980, the plaintiff, halted but that she consented to the Mrs Ciarlariello, underwent a second completion of the angiogram and cerebral angiogram at Mount Sinai: there had been no battery. The claim Hospital, Toronto, after a diagnosis in negligence was also dismissed. of a subarachnoid haemorrhage.: After her death, her estate appealed Before the first angiogram a week to the Court of Appeal in Ontario, ment. earlier, the neurosurgeon had fully: which unanimously upheld the deciexplained the risks associated with son of the trial judge.’ The final subarachnoid haemorrhage and with: appeal to the Supreme Court of . the procedure. During the second Canada last year has just been pubDiana Brahams angiogram, the plaintiff became agi- : lished.2 The Court held (i) that the 1 Brahams D. Informed consent when an tated and demanded that the test be action in battery failed because the investigation is interrupted. Lancet 1992; stopped. When she calmed down the: patient had consented to the 339: 51-52, and [1991] 2 Med LR 391. final injection was given and the angiogram and to its continuation, 2 [1994] 5 Med LR 213.
1079