Humane Medicine

151 that IRBs are political rather than ethical creatures and safeguard the interests of researchers above patients. He makes suggestions for the reorganization of IRBs to make them more democratic. McNeill's arguments illustrate that Snow's analysis still holds true. His position is that IRBs, staffed mostly by medical workers, exist so that research can be approved. To a non-scientist, the businesslike nature of IRBs is disconcerting because the very deper-sonalization of the review process cannot safeguard the interests of the individual without special protections. McNeill ignores the fact that medical personel are people in addition to being doctors; people for whom ethics are important. Those who do the research usually do not sit on IRBs. Moreover, as ongoing enterprises, IRBs tend toward institutional conservatism if only to avoid debacles like that which happened in Los Angeles several years ago when a group of schizophrenics were taken off their medications so a true placebo group could be formed for a drug trial. This conservatism is perhaps the best safeguard of patients' rights. McNeill's book, however, remains a valuable tract for exploring the problems inherent in the shotgun marriage of ethics and medicine. In Humane Medicine we are told by the publisher, "a leading surgeon examines what doctors do, what patients expect of them and how the expectations of both are not being met." The author's main thesis is that the aforesaid "expectations" are the product of flawed communication between doctors and their patients and can perhaps be remedied through improved interaction between the two groups. A secondary theme involves the context of this difficult communication, with reference to ethics, linguistics and proba-bilistic medical outcomes analysis. Mies Little, clearly an admirer of Karl Popper, uses Popper's model of the scientific method to describe the nature of the clinical process, the interaction between the patient and doctor. This process involves an initial problem, a first trial solution, a phase of error elimination and a residual problem remaining after error elimination. Thus it would appear that, by analogy, the clinical encounter is a trial-and-error process of verbal error elimination. Little has much to say about this encounter, in particular, the necessity of truly human doctors to confront the human problems (not only medical problems) of their patients. He writes, "Clinicians who are widely read and broadly educated, who have grappled with research as part of their training and with literature, philosophy, science, or anything …