Ecological Bodies and Relational Anatomies: Toward a Transversal Foundation for Planetary Health Education
Round 1
Reviewer 1 Report
Re: Manuscript ID: challenges-1790916
This is a well written review dealing with the intriguing topic of planetary health education, with a special attention to the role of physiotherapy education. The authors have expertise in this field. The authors have experimental expertise in this field. Some changes are suggested to improve the paper.
Points of criticism
Line 57. Replace “Materials and Methods” with “Methods”.
Line 81. What is figure 2?
Line 143. “images of skeletons, joints, and muscles free-floating on white background”. Indeed, this is the modern and scientific way to illustrate anatomical details. Nevertheless, especially in XVI and XVII centuries, human bodies were not printed on white sheets, but had a landscape background (rivers, trees, villages, etc.). A famous example of this technique is in De Humani corporis fabrica by Andreas Vesalius (1514-1564).
Line 210. “of” not in italics.
Tables must be graphically restyled. Some words can be vertically arranged.
Did the authors find whether this transversal ecologic approach is well present in Oriental medicine?
When mentioning planetary ecosystem or human bodies with less clearly defined boundaries, the authors can include the Gaia hypothesis?
Author Response
Dear reviewer, thank you for your gracious feedback and comments on our manuscript. Please find individual responses for how we dealt with each of the points you have raised listed below. Other amendments were made corresponding to the other reviewer’s comments. Kind regards, the authors.
Review point 1: Line 57. Replace “Materials and Methods” with “Methods”. Amended.
Review point 2: Line 81. What is figure 2?
It seems that some of the formatting has been changed and there are some differences between the document we submitted and the document that was passed on to reviewers. These differences are particularly in the tables and text in close proximity to them. We resubmit the corrected formatting and hope this will not happen again.
Review point 3: Line 143. “images of skeletons, joints, and muscles free-floating on white background”. Indeed, this is the modern and scientific way to illustrate anatomical details. Nevertheless, especially in XVI and XVII centuries, human bodies were not printed on white sheets, but had a landscape background (rivers, trees, villages, etc.). A famous example of this technique is in De Humani corporis fabrica by Andreas Vesalius (1514-1564).
Thank you for this pointer and additional reference. We have made a small amendment to the text to the first paragraph of section 3.2 to reflect this historical background (including a new reference, numbered 30) and picked up this point again briefly at the very end of section 4.1.
Review point 4: Line 210. “of” not in italics.
Amended.
Review point 5: Tables must be graphically restyled. Some words can be vertically arranged.
It seems that some of the formatting has been changed and there are some differences between the document we submitted and the document that was passed on to reviewers. These differences are particularly in the tables and text in close proximity to them. We resubmit the correct formatting, with additional adjustments to arrange some words vertically, and hope this will not happen again.
Review point 6:
- Did the authors find whether this transversal ecologic approach is well present in Oriental medicine?
- When mentioning planetary ecosystem or human bodies with less clearly defined boundaries, the authors can include the Gaia hypothesis?
A valid point raised that we should have considered, especially given that one of us has extensive training in Oriental medicine and has done research into some of its ethical implications and potential. We have added a brief insertion on oriental medicine toward the end of the introduction, alongside a new reference (numbered 17). The same reference is also listed in section 3.2 where traditional and indigenous knowledges are mentioned. Similarly, we have also added a reference (numbered 53) for Lovelock and Margulis’ Gaia hypothesis in the final paragraph of section 3.2 where there is mention of ‘more recent work reaching across biology, sociology, technology, philosophy, the arts, and other fields … highlights that the ecological nature of bodies ‘challenges the ways in which the biological subdisciplines have characterized living entities’ as singular and separable from their environment’. We felt that this sentence implicitly refers to resonant developments like the Gaia hypothesis without necessarily requiring that they all be made explicit.
Reviewer 2 Report
The AA present a study mainly focused on the importance of introducing contents and new teaching methods aimed at increasing the ecological awareness of the medical students during the study of Anatomy. Their conclusions, even if supported by an adequate methodological approach, may be understood as generic or theoretical. Such an equivocation, indeed, may be related to fact that the AA seem do not take into consideration that the study of Human Anatomy in Medical Faculties is sided and often integrated with a wide panel of biological disciplines, that provide extensive contents on Nature, Environment and ecological issues as well. Therefore, I would suggest to the AA to review or compare their conclusions at the light of an evaluations of the study programs of the other basic science disciplines where ecological awareness may be equally and perhaps more appropriately transmitted to students. The risk to introduce wider contents in the Human Anatomy curricula is to create distraction and lack of attention on the morphological focal points that must be learned from students in order to reach the adequate professional competence.
Author Response
Dear reviewer, thank you for your gracious feedback and comments on our manuscript. Please find individual responses for how we dealt with each of the points you have raised listed below. Other amendments were made corresponding to the other reviewer’s comments. Kind regards, the authors.
Review point 1: Their conclusions, even if supported by an adequate methodological approach, may be understood as generic or theoretical.
Our study and manuscript are built around concrete instances in healthcare professional (here initially: physiotherapy) anatomy education alongside corresponding, empirical data, which lead to the explorative and decidedly theoretical development of a perspective human bodies in line with the emergent paradigm of planetary health. On this basis, we also make some concrete suggestions for implementation and accentuation of the ecological and relational foundations of human anatomy and physiology in the context of anatomy education in healthcare professional training.
Our suggestions remain relatively tentative, because the theoretical suggestions and challenges we are raising here, in the wake of planetary health have, as the reviewer notes, potentially, incisive implications for how human anatomy and physiology (first and foremost in the healthcare professions) are understood and taught so far. We believe that it is first this fundamental theoretical shift that this would bring about, that needs further development and deliberation within the broader professional debate of the international, planetary health/care community. It is to this end that our study and manuscript, indeed, make a first and foremost theoretical contribution, or in other words, raise a theoretical challenge that needs to be addressed in the international planetary health/care professional discourse.
We have tried to make this demarcation in scope clearer in our manuscript by adding to the final paragraph of the introduction and reiterating this at the very end of our discussion and in the conclusion of our study (also in partial response to the other points raised by the reviewer).
Review point 2:
- … the AA seem do not take into consideration that the study of Human Anatomy in Medical Faculties is sided and often integrated with a wide panel of biological disciplines, that provide extensive content on Nature, Environment and ecological issues as well.
- I would suggest to the AA to review or compare their conclusions in the light of an evaluation of the study programs of the other basic science disciplines where ecological awareness may be equally and perhaps more appropriately transmitted to students.
As per our response to the foregoing point, the primary focus, or scope of our study is on healthcare professional, rather than medical education, and our theoretical contribution is developed on the back of our extensive involvement in physiotherapy education. Though drawing comparisons with medical education is beyond the scope of our study, the idea that anatomy education can simply be sided with ecological content is also what we question here, precisely because such siding risks exacerbating the distinction between bodies and their ongoing entanglement and functioning in an ecological context. With this in mind then, we believe that exactly raising this theoretical debate, from within our context in planetary health and healthcare professional education, is what is necessary for colleagues in other medical and health specialties to consider its relevance and implications to their respective areas of specialization and engagement, and this would also include debate about how much and what elements of this might be appropriate.
Review point 3: The risk to introduce wider contents in the Human Anatomy curricula is to create distraction and lack of attention on the morphological focal points that must be learned from students in order to reach the adequate professional competence.
There is no question that this risk is present, and maybe even more obviously so in medical education and practice, where the focus of interventions (e.g. surgical) can often be on morphological structures inside the body. In distinction to this however, allied health professions like physiotherapy and occupational therapy are more focused on the ways in which bodies and their morphology interacts with the environment (or, as per the ICF, how its structures function and participate). This also gives way to the argument we are making here, which implies shifting the focus of corresponding education on these interactional, or relational aspects, at least partially in favor of morphological details.
Because we are aware of the difficulties that come with such challenge, in our manuscript, we have opted to show (1) some fairly ‘minimally invasive’ additions that could easily be made in anatomy and physiology education without any fundamental changes (these are especially the examples in section 3.2) and, (2) theoretically explore some more incisive implications in section 3.3 that more radically follow through with some of the theoretical implications of planetary health and its call for transformative change. We thought it necessary to show this spectrum of possibilities to open for diverse debate, rather than take a definitive side on which way would be right for other contexts. We hope the reviewer will agree with this and support this decision.
