Abraham Fuks

McGill University, Medicine, Faculty Member

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Papers by Abraham Fuks

The Nature of Metaphor

Oxford University Press eBooks, Nov 22, 2021

Metaphors are ubiquitous features of spoken and written language that permit us to experience one... more Metaphors are ubiquitous features of spoken and written language that permit us to experience one thing in terms of another. “Seeing is believing” helps us understand the abstract concept of belief in terms of the concrete sense of sight. Derived from two Greek words that mean “to transfer,” metaphors transfer certain attributes from the source domain, in our example, Seeing to the target domain of Believing. The chapter explores how metaphors have cognitive properties and allow us to learn new things and to express abstract ideas and complex relations. Metaphors are a powerful trope of figurative language and commonly appear in both formal medical writings and the informal daily interactions of doctors, patients, and the public more generally. The chapter describes how metaphors connect abstract and concrete domains and offers an array of examples that helps us decipher how metaphors originate from human experiences and how they evolve. It explores how metaphors frame perceptions and shape reality and their potency in the language of the clinic.

William Osler and McGill: a continuing resonance

PubMed, 2007

Isolation and structure of HLA antigens

PubMed, 1978

1. Birth Defects Orig Artic Ser. 1978;14(2):235-46. Isolation and structure of HLA antigens. Stro... more

Reticuloendothelial system Fc receptor function in systemic lupus erythematosus

PubMed, May 1, 1982

Reticuloendothelial system Fc receptor function was measured in 10 patients with systemic lupus e... more Reticuloendothelial system Fc receptor function was measured in 10 patients with systemic lupus erythematosus (SLE) taking corticosteroids, 10 SLE patients not receiving corticosteroids and in 19 controls, 9 of whom were corticosteroid-dependent asthmatics and 10 of whom were healthy. Clearance studies were performed using autologous 51 Cr-labeled erythrocytes that had been sensitized with human IgG anti-Rh(D) [6,700 molecules/cell]. The clearance curves could be split into a fast (t1/2 fast) and a slow (t1/2 slow for any of the groups of patients. The results were correlated with serum C3, C4, DNA-binding, fluid phase 125I-Clq binding, a disease activity index, corticosteroid dose and duration of therapy with corticosteroids. The only significant correlation was an inverse correlation of C4 with the t1/2 slow in SLE patients not on corticosteroids (r=- 0.71, p less than 0.05). The t1/2 slow of the 3 SLE patients with active nephritis (86 +/- 40 min) was significantly different from the 17 SLE patients with inactive nephritis or normal renal function (37 +/- 5 min) (P less than 0.05). We conclude that there is no overall defect of Fc receptor function in our patients with SLE although there is decreased clearance in patients with active lupus nephritis.

A single dose of the MHC-linked susceptibility determinant associated with the RT1u haplotype is permissive for insulin-dependent diabetes mellitus in the BB rat

PubMed, 1990

Syndromes of insulin-dependent diabetes mellitus (IDDM) have been described in the mouse, in the ... more Syndromes of insulin-dependent diabetes mellitus (IDDM) have been described in the mouse, in the rat and in man. In all three species, the presence of one or more specific alleles of the major histocompatibility complex is a prerequisite for the appearance of the disease. In the BB rat, diabetes is associated with the RT1u haplotype. We have performed a series of intercrosses of diabetic BB rats with normal Lewis and Buffalo rats and examined the offspring of all litters producing at least one diabetic animal. Forty-five of the 250 rats that developed diabetes were heterozygous for the RT1u haplotype by serotyping. Furthermore, the diabetic rats heterozygous by serotyping at the RT1A class I loci were also heterozygous at the RT1B and RT1D loci of the class II region and did not show evidence of a recombinant haplotype when examined by Southern blot analyses using molecular probes for class I and class II genes. Diabetic rats heterozygous or homozygous for RT1u were phenotypically indistinguishable with respect to age of onset and severity of disease. Therefore, in the rat, as in the human, a single dose of the high-risk allele at the major histocompatibility complex is sufficient for the development of IDDM if other susceptibility factors and the appropriate environmental factors are in place.

Immunologic and genetic studies of diabetes in the BB rat

PubMed, 1989

The spontaneous development of diabetes in the Bio-Breeding (BB) rat is an excellent model of hum... more The spontaneous development of diabetes in the Bio-Breeding (BB) rat is an excellent model of human insulin-dependent diabetes mellitus (IDDM). Disease expression is dependent on several genetically determined abnormalities, including specific major histocompatibility complex (MHC) genes. At least one MHC class II locus of the U haplotype is a necessary, but not sufficient, condition for disease expression. The immune system of BB rats is markedly abnormal. There is a striking reduction in the number and function of mature cytotoxic/suppressor T cells, a poor proliferative response to mitogens and in mixed lymphocyte culture, poor interleukin-2 production, and a reduced ability to reject skin allografts. While these immune system abnormalities are closely related to the development of diabetes, the immune recognition and effector mechanisms resulting in islet cell destruction are still poorly understood. The hypothesis that MHC class II induction on pancreatic beta cells serves to target these lymphokines, natural killer (NK) cells, macrophages, etc.) have been implicated in islet cell killing. The incidence of IDDM is reduced by immunosuppressive therapy in both rats and humans, further supporting the role of immune mechanisms in this disease.

Placebos and Metaphors

Perspectives in Biology and Medicine, Jun 1, 2023

ABSTRACT: The objective of this essay is to develop the argument that placebos are a species of m... more ABSTRACT: The objective of this essay is to develop the argument that placebos are a species of metaphor and to demonstrate that an analysis of the figurative trope can help us elucidate the power of the placebo response. The cognitive and embodied responses to both metaphors and placebos stem from the transfer of meaning between two domains, each with rich allusive properties that in turn depend on highly ramified and interconnected neural webs. Metaphors and placebos require an appropriate cultural backdrop for their linguistic and cognitive work and are dependent on shared social forms of life. More specifically, metaphors rely on an intersubjective connection and imply that a relational entanglement between doctor and patient is necessary to the effect of placebos in the clinical setting.

Major Histocompatibility Complex Restriction of T-Lymphocyte Responses to Islet Cell Antigens in IDDM Rats

Diabetes, Feb 1, 1987

BBUF rats, derived from BB rats, spontaneously develop a form of insulin-dependent diabetes melli... more BBUF rats, derived from BB rats, spontaneously develop a form of insulin-dependent diabetes mellitus (IDDM) associated with infiltration of the islets of Langerhans by lymphocytes (insulitis). BBUF rats bear the RT1 U major histocompatibility complex (MHC) haplotype that we have shown to be necessary for the expression of this form of IDDM. A T-lymphocyte line obtained from the pancreas of a diabetic rat (UPCC.5) and three T-lymphocyte hybridomas derived by fusing T-lymphocytes of BBUF rats (MUS1.2, MUS1.13, and MUP3.21) respond to islet cell antigens in an MHC-restricted way. UPCC.5 responds to a combination of islet cell antigens (ICAg) and antigen-presenting cells by proliferation, whereas the T-hybridoma responses are detected on the basis of IL-2 production in a similar assay. This study reveals that an antiserum against \xhaplotype MHC antigens or a monoclonal antibody against the product of the D class II subregion of the rat MHC could inhibit ICAg recognition. A monoclonal antibody against the product of the B class II MHC subregion of the rat was not inhibitory. These results suggest that RT1.D antigens (analogous to human DR and mouse I-E) restrict islet cell recognition in this rat model of spontaneous IDDM.

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HLA-D associated alloantisera react with molecules similar to Ia antigens

Proceedings of the National Academy of Sciences of the United States of America, Aug 1, 1977

Two human alloantisera specific to bone marrow-derived Iymphocytes (B cells) were shown to precip... more Two human alloantisera specific to bone marrow-derived Iymphocytes (B cells) were shown to precipitate polypeptide chains of 29,000 and 34,000 daltons from human lymphoblastoid B cell lines. These molecules are similar to murine Ia antigens and are also precipitated by a rabbit B-cell specific heteroantiserum. Since the alloantisera are thought to recognize determinants coded by HLA-D or closely linked loci, these data support the hypothesis that these B-cell specific alloantigens are the human counterpart of the mouse Ia antigens and may be the products of HLA-D.

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Caring for the Older Person

CRC Press eBooks, Nov 30, 2022

The Lens of Language

Oxford University Press eBooks, Nov 22, 2021

Words are the ties that bind patient and physician in the clinical relationship in which medical ... more Words are the ties that bind patient and physician in the clinical relationship in which medical care is enacted. The first chapter, “The Lens of Language,” shows how language mediates both the communicative and relational aspects of the practice of medicine. It compares the descriptive mode of language used to transmit straightforward factual information with figurative language. The latter uses metaphors and allusions with multiple meanings that require interpretation and enable the creation of new ideas and thoughts. Figurative language is suited to communication of nuances and emotions and is dependent on context to provide meaning. Clinical stories told by patients are rich with words that are linked to past experiences and reveal to an attentive physician the important concerns of the patient, such as the shock of illness and the fear of disease. The chapter explores the idea that language constitutes what can be called the “house of being.”

Listening

Oxford University Press eBooks, Nov 22, 2021

This chapter examines the importance of listening in clinical care. Our society values speaking o... more This chapter examines the importance of listening in clinical care. Our society values speaking over listening, yet patients and their families consistently yearn for a physician who will listen. Listening leads to the garnering of important information and concurrently signals respect for the patient. The chapter explores why listening is poorly understood and underappreciated; it describes the modes of social listening and offers a taxonomy of clinical listening. Attentive listening is undermined by the increasing speed of social interactions and the rapid pace of patient visits, to the detriment of optimal health care. The chapter showcases the maieutic quality of listening in giving birth to the words of the speaker and the interpretive nature of hearing. Clinicians must learn the features of attentive listening that signal authentic engagement with patients and the nature of its power to heal. The chapter concludes with a comparison of the two traditional scholarly frameworks for knowing the world.

Carcinoembryonic Antigen

Humana Press eBooks, 1992

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An empirical and philosophical exploration of clinical practice

Philosophy, Ethics, and Humanities in Medicine, Feb 21, 2019

Background: Previous empirical work among physicians has led us to propose that clinical practice... more Background: Previous empirical work among physicians has led us to propose that clinical practice is experienced by clinicians as an engagement-in-the-clinical-situation. In this study, we pursue our exploration of clinical practice 'on its own terms' by turning to the experience of patients. Methods: Phenomenological analysis of in-depth individual interviews with 8 patients. Results: We describe the patient experience as a set of three motifs: the shock on the realization of the illness, the chaos of the health care environment, and the anchor point provided by an engaged physician. We draw on Heidegger's notion of solicitude to show that patients are actively ascertaining the physician's engagement in their care. Conclusions: These findings lead us to question the classical "dual discourse" of medicine that offers a dichotomous account of clinical practice as the addition of care to cure, art to science, humanism to technique, and person to medical case. We found no such distinctions in our empirical investigation of clinical practice. Rather, in our synthesis, practice appears as a unitary experience. The physician's solicitude for the patient entrains engagement in the clinical situation. Moreover, the solicitous, engaged physician constitutes an anchor point for the patient.

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Educational Blueprint

Oxford University Press eBooks, Mar 22, 2018

We provide the overall framework for the Physicianship Curriculum. It is based on common clinical... more We provide the overall framework for the Physicianship Curriculum. It is based on common clinical presentations, as described in the medical literature. We develop the fundamental questions and issues that are likely to be in the minds of a patient and physician during a medical encounter. These issues frame clinical thinking with respect to assessment and treatment and inform the content of the educational program. The primary objectives of each curricular phase are outlined. We articulate the specific roles of teachers and mentors and propose a set of teaching methods, adopted, in part, from the broader literature in educational research.

Competency-Based Education

Oxford University Press eBooks, Mar 22, 2018

The historical roots of competency-based approaches to education are presented. The word competen... more The historical roots of competency-based approaches to education are presented. The word competency and its cognates competence, competent, and competencies are defined. The conditions that have permitted the competency-based movement to become entrenched in many national and pan-national institutions are discussed. There is an overwhelming perception by opinion leaders that learners are currently not subject to sufficiently valid and robust assessments of clinical performance. Competency-based approaches are considered promising as they provide protocols for frequent assessments. Clinical teachers sometimes visualize these assessment strategies as providing “educational biopsies” of learners’ skills and so-called competencies. Design considerations in competency-based approaches, namely, the concepts of entrustability, graded levels of proficiency, and performance milestones, are discussed. The chapter ends with opinions on the theoretical advantages and disadvantages of this approach.

Interferon-γ Induces Transcription and Differential Expression of MHC Genes in Rat Insulinoma Cell Line RINm5F

Diabetes, Jul 1, 1989

We have reported that enhanced levels of class I major histocompatibility complex (MHC) antigen a... more We have reported that enhanced levels of class I major histocompatibility complex (MHC) antigen are expressed throughout the islets of prediabetic and newly diabetic BB rats and that the endocrine cells of the islet remained class II negative. In this study we investigated the molecular biology of lymphokineinduced expression of the class I and II MHC genes in subclones of the rat insulinoma cell line RINm5F. Treatment of a particular subclone of RINm5F cells (which are normally class II negative, class I low expressors) with crude lymphokine preparation or various doses of recombinant interferon-7 resulted in enhancement of MHC class I antigen expression but no detectable induction of class II antigen expression. This enhancement of class I antigen expression was a dose-dependent phenomenon and was preceded by a dose-dependent increase in class l-specific RNA. Both class I and II genes were induced at the transcriptional level, as determined by Northern blotting and in vitro nuclear transcription assays, but exhibited strikingly different induction kinetics. Supernatants from concanavalin A-stimulated splenocytes had a similar class l-restricted inductive effect on MHC gene expression. This subclone of RINm5F cells, which exhibits a class I lymphokine response-positive, class II response-negative phenotype, 7) mimics the behavior of p-cells in the prediabetic and newly diabetic pancreas and 2) represents a valuable system for probing the similarities and differences in the lymphokine-mediated induction pathways for class I and II MHC genes.

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Characterization of monoclonal antibodies to carcinoembryonic antigen with increased tumor specificity

PubMed, 1986

Nine monoclonal antibodies reacting with carcinoembryonic antigen (CEA) were produced after immun... more Nine monoclonal antibodies reacting with carcinoembryonic antigen (CEA) were produced after immunization of mice with either purified CEA or a CEA-producing human cell line. Their specificities were assessed by immunohistochemistry on tissue sections of neoplastic and nonneoplastic lesions. These monoclonal antibodies have different patterns of tissue reactivity. Two of them, D14 and B18, were found to have a high degree of specificity for colonic carcinoma and did not react with formalin-fixed paraffin-embedded sections of normal colon with standardized staining conditions. Most cases of noncolonic adenocarcinomas and normal epithelial structures were not stained by these two monoclonal antibodies. The specificity of the monoclonal antibodies was further investigated immunochemically using intact, reduced, and alkylated or chemically fragmented CEA. Liquid phase radioimmunoassays and antibody competition immunoenzymatic assays confirmed that the antibodies recognize different epitopes of CEA. These data support the concept of CEA heterogeneity and the reactivity of the D14 and B18 monoclonal antibodies with colonic adenocarcinomas indicates that they are useful immunohistochemical probes.

Bibliography and Supplemental Bibliography

CRC Press eBooks, Nov 30, 2022

In Other Words

The Language of Medicine

Words both describe and shape our reality. When the aging of the population is labeled the gray t... more Words both describe and shape our reality. When the aging of the population is labeled the gray tsunami, the prospect evokes fear and casts the elderly as an unwanted burden. We cannot eliminate figurative speech; therefore, this chapter examines alternative metaphors to those that are aggressive and warlike and, in many instances, deleterious to patients. These include the concepts of flows and harmonies from traditional Chinese medicine and equilibrium, balance, and homeostasis based on Western physiology. In the latter framing, illness is a condition of dystasis with stories of chaos, and health is resilience and the ability to return to a new equilibrium, a tale of restitution. A common metaphor in clinical settings is the journey or narrative of quest in which patients may choose to be passengers or navigators. The chapter underlines the duty of the physician to accompany the patient and ensure safe conduct on the voyage that may venture onto uncharted paths.

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