The programme of physicians and surgeons during the ‘late’ phase of the Paris Hospital incorporated efforts to codify the most efficient ways of defining disease. Those efforts involved reckoning the probability, the specificity, and most consistently, the localization of disease entities. One of the most frequently encountered of such entities was pleuritis. Pleuritis is therefore used here as a ‘marker’ through which to investigate how Auguste Chomel and others carried forward the programme of codification. A conspicuous feature of (...) that programme was a highly ritualized system of pedagogical organization in the clinique médicale. (shrink)

Throughout human history illness has been socially interpreted before its range of meanings could be understood and disseminated. Writers of diverse types have been as active in constructing these meanings as doctors, yet it is only recently that literary traditions have been recognized as a rich archive for these interpretations. These essays focus on the methodological hurdles encountered in retrieving these interpretations, called 'framing' by the authors. Framing and Imagining Disease in Cultural History aims to explain what (...) has been said about these interpretations and to compare their value. (shrink)

Prior research in judgment and decision making (JDM) has investigated the effect of problem framing on human preferences. Furthermore, research in JDM documented the absence of such reversal of preferences when making decisions from experience. However, little is known about the effect of context on preferences under the combined influence of problem framing and problem format. Also, little is known about how cognitive models would account for human choices in different problem frames and types (general/specific) in the experience (...) format. One of the primary objectives of this research is to investigate the presence of preference reversals under the influence of problem framing (gain/loss), problem format (experience/description), and problem type (general/specific). Another objective of this research is to develop cognitive models to account for human choices across different problem frames and types in the experience format. A total of 320 participants from India were randomly assigned to one of eight between-subjects conditions that differed in problem frame, format, and type. Results revealed preference reversals in the description condition; however, they were absent in the experience condition. Moreover, preference reversals were less pronounced in the general problem framing compared to the specific problem framing. Furthermore, specific problems influenced risk-seeking behavior among participants. We developed cognitive and heuristics models using instance-based learning theory and natural mean heuristic. Results reveal models’ dependency on recent and frequent observations during information sampling. These experience-based cognitive models could help build artificial intelligence models with fewer preference reversals. (shrink)

The prevalence of negative representations of Alzheimer’s disease reinforces the stigma and negative attitudes toward this dementia. To mitigate these negative views, campaigns have been launched by several organizations. This study aims to explore the effect of framing in AD campaigns on attitude change. For this purpose, several posters were designed with framed messages defining dementia and 189 participants were shown the posters. In order to analyze the effect of the different frames, a repeated-measures design was used, in (...) which attitudes toward dementia were measured three times. The impact of the campaign and the emotions it produced were recorded as well as the effects of the participants’ experience with AD and the importance they attached to it. Posters with unity-framed messages produced a positive and lasting change in attitudes toward dementia and higher levels of happiness, while dualism-framed messages had a greater impact and produced feelings of sadness, anger, and fear but did not change the audience’s attitude. Although more research is needed on persuasion in campaigns, the findings can serve to guide the design of AD campaigns. (shrink)

Language used to describe measles in the press has altered significantly over the last sixty years, a shift that reflects changing perceptions of the disease within the medical community as well as broader changes in public health discourse. California, one of the most populous U.S. states and seat of the 2015 measles outbreak originating at Disneyland, presents an opportunity for observing these changes. This article offers a longitudinal case study of five decades of measles news coverage by the Los (...) Angeles Times and the San Francisco Chronicle, which represented two of the largest news markets in California when the measles vaccine was released, in 1963, and during the 2015 outbreak. Measles reporting during this period displays patterns pointing to an active role for journalists in shaping public understanding of health and medical matters, especially as they recede from public memory, through the employment of available and circulating political and cultural frames. Moreover, journalistic frames in this period of reporting incorporated presentist descriptions of the disease, which imposed present values on the medical past, and which were constructed of decontextualized historical references that supported prevailing contemporary notions of the disease. Framing and the tendency toward presentism, in the context of shifting public health discourse, had the effect of communicating an increasingly severe sounding disease over time, and of shifting blame for that disease’s spread from nature to government to individuals. Journalistic framing and causal stories have much power to shape public understanding of medical matters as they recede from public memory. (shrink)

Securitization of infectious diseases may involve suspension of ordinary human rights and liberties. In the event of an epidemic, therefore, it is important to limit the occasions upon which draconian disease control measures are implemented in the name of security. The term ‘security’, moreover, should not be used too loosely if it is to retain force and meaning in political discourse. It may be argued that the bar for disease securitization should be set high so that it is (...) limited to contexts involving rapidly spreading pathogens. Such an approach, however, would rule out securitization of more slowly spreading, endemic diseases such as HIV/AIDS. An advantage of characterizing HIV/AIDS as a security threat in developing countries, where the burden of the disease is concentrated, is that this is likely to mobilize resources needed to improve the situation there. That is, if HIV/AIDS is convincingly framed as a security threat, then governments may recognize self‐interested reasons to ramp up control measures. Following consideration of arguments for narrow (excluding HIV/AIDS) versus broad (including HIV/AIDS) conceptions of security, we conclude that the legitimacy of ‘securitizing’ HIV/AIDS ultimately turns on empirical and semantic issues, and we emphasize the importance of distinguishing (1) the nature of the threat posed by HIV/AIDS and (2) the measures required to address that threat. (shrink)

Frames and framing make one dimension of a decision problem particularly salient. In the simplest case, framesprimeresponses (as in, e.g., the Asian disease paradigm, where the gain frame primes risk-aversion and the loss frame primes risk-seeking). But in more complicated situations frames can function reflectively, by making salient particular reason-giving aspects of a thing, outcome, or action. For Shakespeare's Macbeth, for example, his feudal commitments are salient in one frame, while downplayed in another in favor of his personal (...) ambition. The role of frames in reasoning can give rise torational framing effects. Macbeth can prefer fulfilling his feudal duty to murdering the king, while also preferring bravely taking the throne to fulfilling his feudal duty, knowing full well that bravely taking the throne just is murdering the king. Such patterns ofquasi-cyclicalpreferences can be correct and appropriate from the normative perspective of how one ought to reason. The paper explores three less dramatic types of rational framing effects: (1) Consciously framing and reframing long-term goals and short-term temptations can be important tools for self-control. (2) In the prototypical social interactions modeled by game theory, allowing for rational framing effects solves longstanding problems, such as the equilibrium selection problem and explaining the appeal of non-equilibrium solutions (e.g., the cooperative solution in the Prisoner's Dilemma). (3) Processes for resolving interpersonal conflicts and breaking discursive deadlock, because they involve internalizing multiple and incompatible ways of framing actions and outcomes, in effect create rational framing effects. (shrink)

I explore the role that values and interests, especially ideological interests, play in managing and balancing epistemic risks in medicine. I will focus in particular on how diseases are identified and operationalized. Before we can do biomedical research on a condition, it needs to be identified as a medical condition, and it needs to be operationalized in a way that lets us identify sufferers, measure progress, and so forth. I will argue that each time we do this, we engage in (...) epistemic risk balancing that inevitably draws upon values and interests, often including social and ideological values. My main interest here is in the conceptualization of infertility as a disease. Infertility is a rich test case for exploring the interplay between interests and epistemic risk management. There is no uncontested or standardized definition of infertility. The various definitions of it are internally ambiguous and tension-ridden, and in spectacular contradiction with one another. Many interest groups who are invested in framing infertility as a pressing problem deserving of social and medical redress are quick to insist that it is a legitimate ‘disease,’ but they cannot agree on which disease it is, what its symptoms or diagnostic markers are, or even what its basic ontology is. I suggest that there are political explanations for this epistemic mess. Indeed, I contend that there are good scientific and ethical reasons to reduce away the category of ‘infertility,’ especially understood as a scientific or medical category; I argue that we should excise the concept from our research and clinical practices. (shrink)

Classification shapes medicine and guides its practice. As clinicians classify symptoms and illnesses, they trigger a range of actions and consequences. The assignment of particular disease labels is linked to both therapeutic and social responses. However, the classifications of medicine, natural though they may seem, contain significant social content, and are arrived at via a number of cultural framing devices (Aronowitz 2008). This article will explore the social intent and construction of classification and their embodiment in medical diagnosis.Effective (...) classification recognizes difference as well as similarity. By classifying, we are putting items together that have more in common with one another than they .. (shrink)

Der Autor fasst die sehr unterschiedlichen, empirisch beobachteten Framing-Effekte zu drei Typen zusammen. Bei diesen Typen sind jeweils spezifische Entstehungsprozesse und Entscheidungsdeterminanten relevant, die im Rahmen der Rational-Choice-Theorie (RCT) vernachlassigt werden. Fur jeden der Problembereiche wird daher eine allgemeine theoretische Erweiterung der RCT vorgeschlagen und deren Prognosen am Beispiel des "Asian Disease Problem" empirisch getestet. Die experimentellen Ergebnisse mit rund 2000 Versuchspersonen zeigen, dass sich die Unterschiede in der Informationsdarstellung gleichzeitig vermittelt durch alle drei Framing-Prozesse auf das (...) Entscheidungsverhalte". (shrink)

When communication is not disinterested, seemingly inconsistent preferences are predictable from language pragmatics and information non-equivalence. In addition, the classic risky choice framing effect found in the Asian disease task – risk-aversion with gains and risk-seeking with losses – applies to gambles, but tends to be overgeneralized to non-gambling situations.

In lieu of an abstract, here is a brief excerpt of the content:The Diseased Body Politic, Athenian Public Finance, and the Massacre at Mykalessos (Thucydides 7.27–29)Lisa KalletIn the midst of his account of the Sicilian expedition Thucydides pauses to describe the economic and financial effects of the Spartan fortification of Dekeleia in Attica in 413 (7.27–28); one result of signal importance for the empire was Athens' decision to abolish tribute, and in its place to levy a harbor tax, the eikostē. (...) Following this digression the historian relates an episode emblematic of the atrocity of war, the wholesale slaughter of the inhabitants of the defenseless Boiotian town of Mykalessos by 1,300 Thracian mercenaries. Most scholars would not adhere to Eduard Schwartz's view that the financial/economic digression has nothing to do with the representation of the Thracians' savagery;1 nevertheless, the two sections have tended to be examined separately, the former by historians of the Athenian empire and finance2 or by Thucydidean scholars looking at the passage historiographically but as distinct from 7.29,3 and the latter by Thucydidean scholars exploring its function in the History.4 There are, however, strong grounds for reading them together: in particular, a degree of detail in each not otherwise warranted by the narrative, a framing device, and the shared use of language common to the description of disease, all suggest that Thucydides was intentionally linking the two sections. By this linkage, I propose, Thucydides not only draws a connection between Athenian public finance and human suffering, but also develops themes central to the work as a whole, namely, those of moral responsibility, human nature, [End Page 223] the conflict between reason and passion, and the nexus of finances, leadership, and military power.First, the detail in both the fiscal digression and the episode at Mykalessos immediately stands out, given their placement within the Sicilian account, the most self–contained and focused part of the History.5 Much of the substance of 7.27–28 concerns a gradual process of fiscal and economic deterioration, yet Thucydides is prompted to embed a diachronic, thematic account in the context of an event utterly trivial to the expedition and the entire course of the war, namely, the tardy arrival of Thracian mercenaries in Athens and the decision to send them home. Moreover, shocking atrocity that the massacre at Mykalessos was, it was peripheral to the war, a minor event that could have been easily omitted, or relegated to a sentence. It is relevant to note in this connection the differing treatments of Skione and Melos. What happened in those places, in 422 and 416 respectively, was identical—a siege and subsequent massacre of the males and enslavement of the women and children—yet Thucydides relates the information about Skione as a passing mention in one sentence (5.32.1), whereas he devotes pages to Melos (5.84–116).The prominence given to the fiscal digression and to what happened at Mykalessos, through such detailed narrative and especially the juxtaposition of the two sections, is in itself a sign that Thucydides intended a larger significance—through their interrelation—to be accorded to these events. The comparative example of Melos is again relevant, for its significance lies partly in its juxtaposition to the Sicilian books (which would explain why Thucydides chose to highlight it, rather than the identical case of Skione's treatment), as is similarly the case with the juxtaposition of the Funeral Oration and the plague (and Perikles' last speech).Thucydides constructs a second link between the two sections by using the subject of the Thracian mercenaries as a framing device for his digression on the economic effects of Dekeleia: in 27.1–2, the Thracians arrive in Athens too late for the expedition for which they had been intended, that of reinforcing the army in Sicily. The Athenians, Thucydides continues, decided to send them home, because "to keep them for the Dekeleian War seemed very costly; for each received a drachma a day" ( [End Page 224] ).6 Yet rather than immediately return to Sicilian events, or continue with the Thracian narrative, he instead undertakes a lengthy analysis of what was a gradual process of fiscal deterioration that could have... (shrink)

ABSTRACT In this article, we first document the virtually complete absence of infectious disease examples and concerns at the time bioethics emerged as a field. We then argue that this oversight was not benign by considering two central issues in the field, informed consent and distributive justice, and showing how they might have been framed differently had infectiousness been at the forefront of concern. The solution to this omission might be to apply standard approaches in liberal bioethics, such as (...) autonomy and the harm principle, to infectious examples. We argue that this is insufficient, however. Taking infectious disease into account requires understanding the patient as victim and as vector. Infectiousness reminds us that as autonomous agents we are both embodied and vulnerable in our relationships with others. We conclude by applying this reunderstanding of agency to the examples of informed consent and distributive justice in health care. (shrink)

ABSTRACT In this article, we first document the virtually complete absence of infectious disease examples and concerns at the time bioethics emerged as a field. We then argue that this oversight was not benign by considering two central issues in the field, informed consent and distributive justice, and showing how they might have been framed differently had infectiousness been at the forefront of concern. The solution to this omission might be to apply standard approaches in liberal bioethics, such as (...) autonomy and the harm principle, to infectious examples. We argue that this is insufficient, however. Taking infectious disease into account requires understanding the patient as victim and as vector. Infectiousness reminds us that as autonomous agents we are both embodied and vulnerable in our relationships with others. We conclude by applying this reunderstanding of agency to the examples of informed consent and distributive justice in health care. (shrink)

Framing effects occur when people respond differently to the same information, just because it is conveyed in different words. For example, in the classic ‘Disease Problem’ introduced by Amos Tversky and Daniel Kahneman, people’s choices between alternative interventions depend on whether these are described positively, in terms of the number of people who will be saved, or negatively in terms of the corresponding number who will die. In this paper, I discuss an account of framing effects based (...) on ‘fuzzy-trace theory’. The central claim of this account is that people represent the numbers in framing problems in a ‘gist-like’ way, as ‘some’; and that this creates a categorical contrast between ‘some’ people being saved (or dying) and ‘no’ people being saved (or dying). I argue that fuzzy-trace theory’s gist-like representation, ‘some’, must have the semantics of ‘some and possibly all’, not ‘some but not all’. I show how this commits fuzzy-trace theory to a modest version of a rival ‘lower bounding hypothesis’, according to which lower-bounded interpretations of quantities contribute to framing effects by rendering the alternative descriptions extensionally inequivalent. As a result, fuzzy-trace theory is incoherent as it stands. Making sense of it requires dropping, or refining, the claim that decision-makers perceive alternatively framed options as extensionally equivalent; and the related claim that framing effects are irrational. I end by suggesting that, whereas the modest lower bounding hypothesis is well supported, there is currently less evidence for the core element of the fuzzy trace account. (shrink)

I argue that the scope of rational framing effects may be broader than Bermúdez assumes. Even in many “canonical experiments,” the explanation of the judgment reversals or shifts may refer to reasons, including moral ones. Referring to the Asian disease paradigm (ADP), I describe how non-consequentialist reasons related to fairness and the distinction between doing and allowing may help explain and justify the typical pattern of choices in the cases like ADP.

In lieu of an abstract, here is a brief excerpt of the content:The Diseased Body Politic, Athenian Public Finance, and the Massacre at Mykalessos (Thucydides 7.27–29)Lisa KalletIn the midst of his account of the Sicilian expedition Thucydides pauses to describe the economic and financial effects of the Spartan fortification of Dekeleia in Attica in 413 (7.27–28); one result of signal importance for the empire was Athens' decision to abolish tribute, and in its place to levy a harbor tax, the eikostē. (...) Following this digression the historian relates an episode emblematic of the atrocity of war, the wholesale slaughter of the inhabitants of the defenseless Boiotian town of Mykalessos by 1,300 Thracian mercenaries. Most scholars would not adhere to Eduard Schwartz's view that the financial/economic digression has nothing to do with the representation of the Thracians' savagery;1 nevertheless, the two sections have tended to be examined separately, the former by historians of the Athenian empire and finance2 or by Thucydidean scholars looking at the passage historiographically but as distinct from 7.29,3 and the latter by Thucydidean scholars exploring its function in the History.4 There are, however, strong grounds for reading them together: in particular, a degree of detail in each not otherwise warranted by the narrative, a framing device, and the shared use of language common to the description of disease, all suggest that Thucydides was intentionally linking the two sections. By this linkage, I propose, Thucydides not only draws a connection between Athenian public finance and human suffering, but also develops themes central to the work as a whole, namely, those of moral responsibility, human nature, [End Page 223] the conflict between reason and passion, and the nexus of finances, leadership, and military power.First, the detail in both the fiscal digression and the episode at Mykalessos immediately stands out, given their placement within the Sicilian account, the most self–contained and focused part of the History.5 Much of the substance of 7.27–28 concerns a gradual process of fiscal and economic deterioration, yet Thucydides is prompted to embed a diachronic, thematic account in the context of an event utterly trivial to the expedition and the entire course of the war, namely, the tardy arrival of Thracian mercenaries in Athens and the decision to send them home. Moreover, shocking atrocity that the massacre at Mykalessos was, it was peripheral to the war, a minor event that could have been easily omitted, or relegated to a sentence. It is relevant to note in this connection the differing treatments of Skione and Melos. What happened in those places, in 422 and 416 respectively, was identical—a siege and subsequent massacre of the males and enslavement of the women and children—yet Thucydides relates the information about Skione as a passing mention in one sentence (5.32.1), whereas he devotes pages to Melos (5.84–116).The prominence given to the fiscal digression and to what happened at Mykalessos, through such detailed narrative and especially the juxtaposition of the two sections, is in itself a sign that Thucydides intended a larger significance—through their interrelation—to be accorded to these events. The comparative example of Melos is again relevant, for its significance lies partly in its juxtaposition to the Sicilian books (which would explain why Thucydides chose to highlight it, rather than the identical case of Skione's treatment), as is similarly the case with the juxtaposition of the Funeral Oration and the plague (and Perikles' last speech).Thucydides constructs a second link between the two sections by using the subject of the Thracian mercenaries as a framing device for his digression on the economic effects of Dekeleia: in 27.1–2, the Thracians arrive in Athens too late for the expedition for which they had been intended, that of reinforcing the army in Sicily. The Athenians, Thucydides continues, decided to send them home, because "to keep them for the Dekeleian War seemed very costly; for each received a drachma a day" ( [End Page 224] ).6 Yet rather than immediately return to Sicilian events, or continue with the Thracian narrative, he instead undertakes a lengthy analysis of what was a gradual process of fiscal deterioration that could have... (shrink)

The “One Health” initiative promises to combine different health-related issues concerning humans and animals in an overarching concept and in related practices to the benefit of both humans and animals. Far from dismissing One Health, this paper nevertheless argues that different veterinary interventions are determined by social practices and connected expectations and are, thus, hardly compliant with only one single conceptualization of health, as the One Health concept suggests. One Health relies on a naturalistic understanding of health focusing on similar (...) bodies that show a similar etiology. However, logics, normativity, and practices exhibit differences when it comes to combatting infectious diseases, maintaining productivity of livestock animals or preventing companion animals from suffering. Therefore, drawing from Charles Rosenberg’s groundbreaking texts on framing disease, we suggest to conceive of health as dispersed in different frames. Thus, this paper proposes to interpret health as complex and multi-layered concept. We distinguish and introduce an objectivist, a functional, and a sentientistic frame of health. Instead of reducing the differential veterinary practices to one paradigmatic understanding, health is seen as a model case of Wittgenstein’s concept of family resemblance. Different and distinct perspectives on veterinary medicine show sufficient overlapping that allows for a common conceptualization, but there is not one single underlying logic suitable to understand and ethically reflect all veterinary interventions. This differentiability promises to reduce moral stress in veterinary professionals since it allows the interpretation of various, seemingly contradicting practices as dependent on multi-layered and socially determined scopes of responsibility. (shrink)

The debate around lockdowns as a response to the recent pandemic is typically framed in terms of a tension between freedom and health. However, on some views, protection of health or reduction of virus‐related risks can also contribute to freedom. Therefore, there might be no tension between freedom and health in public health restrictions. I argue that such views fail to appreciate the different understandings of freedom that are involved in the trade‐off between freedom and health. Grasping these distinctions would (...) allow to appreciate why different people give more weight to different aspects of limitations of freedom, including whether certain options are made simply risky or impossible, whether limitations of freedom are posed intentionally or happen accidentally, whether risks are beyond a threshold of acceptability, and who gets to decide that. I provide a conceptual analysis of the relationship between different types of freedom, public health policies, viruses and diseases. As I argue, identifying what freedom‐based reasons count for and against different types of public health restrictions requires distinguishing between viruses and diseases, between lockdowns and other types of restrictive policies, and between risks posed by viruses and threats of penalties involved by restrictive policies. (shrink)

The susceptibility of decision-makers’ choices to variations in option framing has been attributed to individual differences in cognitive style. According to this view, individuals who are prone to a more deliberate, or less intuitive, thinking style are less susceptible to framing manipulations. Research findings on the topic, however, have tended to yield small effects, with several studies also being limited in inferential value by methodological drawbacks. We report two experiments that examined the value of several cognitive-style variables, including (...) measures of cognitive reflection, subjective numeracy, actively open-minded thinking, need for cognition, and hemispheric dominance, in predicting participants’ frame-consistent choices. Our experiments used an isomorph of the Asian Disease Problem and we manipulated frames between participants. We controlled for participants’ sex and age, and we manipulated the order in which choice options were presented to participants. In Experiment 1 (N = 190) using an undergraduate sample and in Experiment 2 (N = 316) using a sample of Amazon Mechanical Turk workers, we found no significant effect of any of the cognitive style measures taken on predicting frame-consistent choice, regardless of whether we analyzed participants’ binary choices or their choices weighted by the extent to which participants preferred their chosen option over the non-chosen option. The sole factor that significantly predicted frame consistent choice was framing: in both experiments, participants were more likely to make frame consistent choices when the frame was positive than when it was negative, consistent with the tendency towards risk aversion in the task. The present findings do not support the view that individual differences in people’s susceptibility to framing manipulations can be substantially accounted for by individual differences in cognitive style. (shrink)

In 1949, Linus Pauling and collaborators published in Science a paper provocatively titled: 'Sickle cell anemia, a molecular disease'. What was actually meant by 'molecular disease'? We interpret the concept of molecular disease in the frame of the traditional positions about the nature of diseases: the ontological and the physiological positions. We conclude that the physiological does not give an adequate account of what molecular diseases are. The ontological position, when correctly reinterpreted, leads to an understanding of (...) molecular diseases where the macromolecule is seen as a symptom or as a part of a mechanism leading to the symptoms of the disease. We then show that the concept of molecular disease leads to a particular view of therapy, emphasizing eugenics as a way of eliminating disease. On the individual level, this concept leads to an increased power of diagnosis, and especially predictive diagnosis, but has little therapeutic consequence. Lastly, we examine how this concept of disease unifies two contemporary classifications of diseases, one based on the location of the diseases, the other on the cause of the diseases. (shrink)

Lewis’ neurodevelopmental model provides a plausible alternative to the brain disease model of addiction that is a dominant perspective in the USA. We disagree with Lewis’ claim that the BDMA is unchallenged within the addiction field but we agree that it provides unduly pessimistic prospects of recovery. We question the strength of evidence for the BDMA provided by animal models and human neuroimaging studies. We endorse Lewis’ framing of addiction as a developmental process underpinned by reversible forms of (...) neuroplasticity. His view is consistent with epidemiological evidence of addicted individuals ‘maturing out’ and recovering from addiction. We do however hold some reservations about Lewis’ model. We do not think that his analysis of the neurobiological evidence is clearly different from that of the BDMA or that his neurodevelopmental model provides a more rigorous interpretation of the evidence than the BDMA. We believe that our understanding of the neurobiology of drug use is too immature to warrant the major role given to it in the BDMA. Our social research finds very mixed support for the BDMA among addicted people and health professionals in Australia. Lewis’ account of addiction requires similar empirical evaluation of its real-world implications. (shrink)

Conserved upstream open reading frames (uORFs) are found within many eukaryotic transcripts and are known to regulate protein translation. Evidence from genetic and bioinformatic studies implicates disturbed uORF‐mediated translational control in the etiology of human diseases. A genetic mouse model has recently provided proof‐of‐principle support for the physiological relevance of uORF‐mediated translational control in mammals. The targeted disruption of the uORF initiation codon within the transcription factor CCAAT/enhancer binding protein β (C/EBPβ) gene resulted in deregulated C/EBPβ protein isoform expression, associated (...) with defective liver regeneration and impaired osteoclast differentiation. The high prevalence of uORFs in the human transcriptome suggests that intensified search for mutations within 5′ RNA leader regions may reveal a multitude of alterations affecting uORFs, causing pathogenic deregulation of protein expression. (shrink)

BackgroundThe German guidelines for liver transplantation stipulate that every patient with alcohol-related liver disease needs to prove evidence of a 6-month abstinence period before they can be admitted to the waiting list for liver transplantation. This internationally widespread abstinence rule has been criticised as it prevents patients at least temporarily from receiving an effective and potentially life-saving therapy. This poses the question of how this abstinence rule is depicted and justified by transplantation professionals.ArgumentsIn case of the 6‑month abstinence rule, (...) guidelines are used as a tool for rationing health care. Four frames of interpretation can be reconstructed from the ethical and medical literature. Each linguistically mediated frame offers a different representation of the 6‑month abstinence rule. According to these different framings, the 6‑month waiting period is depicted (1) as a diagnostic tool to determine the regenerative capacity of the liver, (2) as a prognostic tool to determine the prospects of success of a transplantation, and (3) to determine the drinking behaviour after transplantation. In a further context, the abstinence rule (4) is interpreted as an expression of an obligation to avoid behaviour harmful to health.ConclusionThese four frames provide linguistically mediated patterns of interpretation that are used by different actors to limit the indication for liver transplantation. They give rise to different ethical questions that allow a systematic ethical assessment of the 6‑month abstinence rule. (shrink)

Nanotechnology promises to amend an understanding of elemental properties, alter the basic techniques of manufacturing, and improve disease diagnosis. There is a disconnect among the positive predictions of scientists and researchers, the fears of public interest groups, and the developers of products. A new framework for evaluating the social implications of nanotechnology will permit a dialogue among interest groups, who currently fail to effectively communicate with one another. Each instance of nanotechnology application will likely have its own unique attributes, (...) but this framework for evaluating the social implications of nanotechnology will address three questions: How do problems become visible to the social groups that contribute to the framing of technology? What kind of language do social groups use to express significance? How does risk standardization contribute to technology stabilization? The suggested framework compares the ways that risk is discussed in military applications, consumer products, and workplace safety. (shrink)

In argumentation, metaphors are often considered as ambiguous or deceptive uses of language leading to fallacies of reasoning. However, they can also provide useful insights into creative argumentation, leading to genuinely new knowledge. Metaphors entail a framing effect that implicitly provides a specific perspective to interpret the world, guiding reasoning and evaluation of arguments. In the same vein, emotions could be in sharp contrast with proper reasoning, but they can also be cognitive processes of affective framing, influencing our (...) reasoning and behavior in different meaningful ways. Thus, a double (metaphorical and affective) framing effect might influence argumentation in the case of emotive metaphors, such as “Poverty is a disease” or “Your boss is a dictator,” where specific “emotive words” (disease, dictator) are used as vehicles. We present and discuss the results of two experimental studies designed to explore the role of emotive metaphors in argumentation. The studies investigated whether and to what extent the detection of a fallacious argument is influenced by the presence of a conventional vs. novel emotive metaphor. Participants evaluated a series of verbal arguments containing either “non-emotive” or “emotive” (positive or negative) metaphors as middle terms that “bridge” the premises of the argument. The results show that the affective coherence of the metaphor's vehicle and topic plays a crucial role in participants' reasoning style, leading to global heuristic vs. local analytical interpretive processes in the interplay of the metaphorical and the affective framing effects. (shrink)

The traditional contrast between naturalist and normativist disease concepts fails to capture the most salient features of the health concepts debate. By using health concepts as a window on background notions of medical science and ethics, I show how Christopher Boorse (an influential naturalist) and Lennart Nordenfelt (an influential normativist) actually share deep assumptions about the character of medicine. Their disease concepts attempt, in different ways, to shore up the same medical model. For both, health concepts function like (...) demarcation criteria in the philosophy of science: they mark off the jurisdiction of medical science, and protect it from an inappropriate intrusion of socioeconomic factors, which threaten the integrity of modern medicine. These views are challenged by new developments in healthcare such as managed care and total quality review. To frame the health concepts debate in a way that better captures the issues integral to these new developments, I advance a new way of reading the distinction between weak and strong normativists. Strong normativists are skeptical of the demarcation project, think facts and values cannot be disentangled, and hold that socioeconomic conditions unavoidably influence how pathology is understood. The new health concepts debate should be framed as one between weak and strong normativists, and it concerns how we should respond to the current developments in health care. (shrink)

Debates about the concept of disease have traditionally been framed as a competition between two conflicting approaches: naturalism, on the one hand, and normativism or social constructivism, on the other. In this article, we lay the groundwork for a naturalistic form of social constructivism by dissociating the presumed link between value-free conceptions of disease and a broadly naturalistic approach; offering a naturalistic argument for a form of social constructivism; and suggesting avenues that strike us as especially promising for (...) filling in the details of an alternative approach and addressing the most obvious objections. (shrink)

One of the most pervasive messages in modern advertising, both public and private, is that good health is something to strive for. Thus, the condition of our bodies and how the medical fraternity can impact on us is never far from our thoughts. Central to this interaction between doctor, patient, and society is a core group of terms that frame our discussions of sickness and health. Of particular interest to philosophers of medicine, the way we use and recognise the differences (...) between these terms has implications for how we decode the medical encounter. In this essay, three terms, disease, illness, and symptoms will be analysed to develop an argument for the continued separation and appreciation of them as distinct, although imbricated, concepts crucial to the performance of modern medicine. (shrink)

Despite recent increasing support for the brain disease model of alcohol and drug addiction, the extent to which the model may clinically impact addiction treatment and client behaviour remains unclear. This qualitative study explored the views of community-based clinicians in Australia and examined: whether Australian community-based clinicians support the BDM of addiction; their attitudes on the impact the model may have on clinical treatment; and their views on how framing addiction as a brain disease may impact addicted (...) clients’ behaviour. Six Australian community-based clinicians participated in semi-structured in-depth interviews that were analysed using thematic analysis. Whilst the BDM was not fully supported by this purposive sample of Australian community-based clinicians, there was acceptance that addiction neuroscience formed a key part of a wider addiction framework. Participants believed the BDM ignored key social, psychological and environmental factors important for successful treatment. The BDM was seen as potentially irrelevant for certain client types, however the model was believed to integrate with particular therapies. Participants believed that for clients viewing their addiction in terms of a brain disease, there were potential positive and negative impacts on client behaviour. Implications for addiction treatment practice and public health policy are discussed. (shrink)

This article applies some ofthe insights from framing studies in policyresearch, metaphor analysis, and the history ofmedicine to a cultural understanding ofagriculture, using the 2001 outbreak of footand mouth disease in the UK as a case study.The article will show how metaphors of war wereused as a “rhetorical frame” by the media andas an implicit “action frame” by policy makers.It will be argued that although the war framemight initially have been useful in rallyingsupport for the slaughter policy, the (...) metaphorlater backfired, when a metaphorical war turnedinto a literal holocaust. This might haveencouraged the public to perceive the policy asmedieval, brutal, and misguided, thuspotentially undermining the willingness ofsections of the public to support the slaughterpolicy in future outbreaks. If, on the otherhand, a vaccination policy were adopted in thefuture, care would need to be taken to avoidmetaphorical linkages with other controversiesover vaccination in other domains. (shrink)

Many experts have warned that environmental degradation is increasing the likelihood of future pandemics like COVID-19, as habitat loss and poaching increase close contact between wildlife and people. This fact has been framed as a reason to increase wildlife conservation efforts. We have many good reasons to step up conservation efforts, but arguments for doing so on the basis of pandemic prevention are rhetorically, ethically, and empricially flawed.

Our understanding of gender carries significant bioethical implications. An errant account of gender-specific disease can lead to overgeneralizations, undergeneralizations, and misdiagnoses. It can also lead to problems in the structure of health-care delivery, the creation of policy, and the development of clinical curricula. In this volume, Cutter argues that gender-specific disease and related bioethical discourses are philosophically integrative. Gender-specific disease is integrative because the descriptive roles of gender, disease, and their relation are inextricably tied to their (...) prescriptive roles within frames of reference. An integrative account of gender-specific disease carries ethical implications because our understanding of gender-specific disease is evaluative, and our evaluations of gender-specific disease entail judgments concerning the praiseworthiness and blameworthiness of a clinical event. Cutter supports a "both/and" emphasis on context and integration in relation to gender-specific disease and bioethical analyses. While the text mainly focuses on gender-specific diseases that affect women, Cutter also includes examples involving men, children, and members of the LGBT community. (shrink)

Individual differences on a variety of framing and conjunction problems were examined in light of Slovic and Tversky's (1974) understanding/acceptance principle-that more reflective and skilled reasoners are more likely to affirm the axioms that define normative reasoning and to endorse the task construals of informed experts. The predictions derived from the principle were confirmed for the much discussed framing effect in the Disease Problem and for the conjunction fallacy on the Linda Problem. Subjects of higher cognitive ability (...) were disproportionately likely to avoid each fallacy. Other framing problems produced much more modest levels of empirical support. It is conjectured that the varying patterns of individual differences are best explained by two-process theories of reasoning (e.g. Evans, 1984, 1996; Sloman, 1996) conjoined with the assumption that the two processes differentially reflect interactional and analytic intelligence. (shrink)

This chapter considers how one should frame and deal with the policy decisions that are raised by the prospect of a new generation of technologies with enhanced capabilities for changing and extending the normal human lifespan. The focus on policy decisions is intended to emphasize a contrast with a related set of questions about the desirability of what we stand to gain as individuals by an enhanced capability to intervene in the aging process. The chapter discusses the following questions: Should (...) public funds be committed to support the development or use of this capability to intervene in the aging process in humans? Should legal restraints be imposed on private attempts to develop or use such a capability? The chapter considers the fairness of allowing some individuals to purchase for themselves technologies that could substantially extend their lifespan if it is decided not to make public funds available for this purpose. (shrink)

Modern scholarship has drawn hasty and numerous parallels between the Yellow Peril discourses of the 19th- and 20th-century plagues and the recent racialization of infectious disease in the 21st-century. While highlighting these similarities is politically useful against Sinophobic epidemic narratives, Michel Foucault argues that truly understanding the past’s continuity in the present requires a more rigorous genealogical approach. Employing this premise in a comparative analysis, this work demonstrates a critical discontinuity in the epidemic imaginary that framed the Chinese as (...) pathogenic. Consequently, those seeking to prevent future disease racialization must understand modern Sinophobia as fundamentally distinct from that of the past. (shrink)

The “Asian disease” problem (Tversky & Kahneman, 1981) demonstrated behaviour in contradiction to the invariance axiom of EU theory. However, the risky choice behaviour was simply seen by the equate-to-differentiate model as a choice between the best possible outcomes or a choice between the worst possible outcomes. It was then argued that a way in which frame influences choice is through the perceived difference between possible outcomes. A “judgement” task was designed to examine whether the knowledge of “the value (...) difference between each possible outcome and the certain outcome” will permit prediction of preference in the choice pattern related to the Asian disease problem. Participants were exposed to an anthrax disease problem (the original or probabilistic version of the Asian disease problem) and a SARS problem (the fuzzy version of the Asian disease problem). It was shown that the empirical evidence in relation to the Asian disease problem could be satisfactorily accounted for by the generalised weak dominance strategy revealed by the judgement results. (shrink)

ABSTRACT:This article examines two medical journal research articles on tuberculosis, one published in 1938 and the other in 2014. The two articles, which use animal models to understand aspects of tuberculosis mycobacteria survival in the lungs, rely on markedly different research and biotechnological techniques, reach somewhat opposite conclusions, and reflect different paradigms of tuberculosis pathogenesis: the 1938 article (indirectly invoking Koch’s postulates) was written before the paradigm of so-called “latent” and “reactivation” tuberculosis became widely adopted, while the 2014 article (indirectly (...) invoking the molecular equivalents to Koch’s postulates) works within that paradigm but implicitly questions it. Despite this, both articles exhibit fascinating similarities in terms of how their authors tackled their research questions, formulated their results, and framed their research methodologies. These similarities reflect both the reliance on tenets of the scientific method but also the value of paradigms of disease causation. Using tuberculosis as an example, this article concludes with remarks about how disease paradigms evolve and can stimulate research that leads to advances in disease understanding. (shrink)

Christopher Boorse’s Health care ethics: an introduction, Temple University Press, Philadelphia, pp 359–393, 1987; in Humber, Almeder, Totowa What is disease?, Humana Press, New York City, pp 1–134, 1997; J Med Philos, 39:683–724, 2014) Bio-Statistical Theory comprehends diseases in terms of departures from natural norms, which involve an objectively describable deviation from the proper physiological or psychological functioning of parts of the human organism. I argue that while recent revisions and additional considerations shield the BST from a number of (...) issues raised by critics, they give rise to significant new challenges. These are related to the attribution of epistemic authority, the possibility of multiple concepts in the authoritative literature, and the framing of BST as “philosophical explication.” The conclusion is that, in its current form, the BST is unable to provide a robust framework for a naturalist classification. (shrink)

The term `bioethics' was coined in 1971, just as interest in the medical humanities claimed a prominent place in medical education. Out of this interest, a substantial area of research and scholarship took shape: the philosophy of medicine. This field has been directed to the epistemological, ontological, and value-theoretical issues occasioned by medicine and the biomedical sciences. Bioethics is nested in this field and can only be fully understood in terms of the foundational issues it addresses. This collection of essays (...) in honor of Stuart F. Spicker, one of the individuals who gave shape to the philosophy of medicine, lays out the broad scope of concerns from the philosophy of embodiment, to issues of the role of ethics consultants, to concepts of disease, equity and the meaning of history. (shrink)

How can we effectively promote the public’s prevention of coronavirus disease 2019 infection? Jordan et al. found with United States samples that emphasizing either self-interest or collective-interest of prevention behaviors could promote the public’s prevention intention. Moreover, prosocially framed messaging was more effective in motivating prevention intention than self-interested messaging. A dual consideration of both cultural psychology and the literature on personalized matching suggests the findings of Jordan et al. are counterintuitive, because persuasion is most effective when the frame (...) of the message delivered and the recipient of the message are culturally congruent. In order to better understand the potential influence of culture, the current research aimed to replicate and extend Jordan et al. findings in the Japanese context. Specifically, we examined the question whether the relative effectiveness of the prosocial appeal is culturally universal and robust, which types of ‘others’ especially promote prevention intention, and which psychological mechanisms can explain the impact of messaging on prevention intention. In Study 1, we confirmed that self-interested framed, prosocially framed, and the combination of both types of messaging were equally effective in motivating prevention intention. In Study 2, we found that family-framed messaging also had a promoting effect similar to that from self-interested and prosocial appeals. However, the relative advantage of prosocial appeals was not observed. Further, a psychological propensity relevant to sensitivity to social rejection did not moderate the impact of messaging on prevention intention in both studies. These results suggest that since engaging in the infection control itself was regarded as critical by citizens after public awareness of COVID-19 prevention has been sufficiently heightened, for whom we should act might not have mattered. Further, concerns for social rejection might have had less impact on the prevention intentions under these circumstances. These results suggest that the relative advantage of a prosocial appeal might not be either culturally universal or prominent in a collectivistic culture. Instead, they suggest that the advantages of such an appeal depends on the more dynamic influence of COVID-19 infection. (shrink)

When health budgets are insufficient to provide care for all, allocating resources to treat a person with a rare and expensive disorder entails that we cannot treat at least one person with a more common, less expensive disorder. Since any allocation scheme will entail such trade‐offs, how should prudent policy‐makers, concerned about justice and fairness, allocate their community's health resources? In their article in this issue of the Hastings Center Report, Emily Largent and Steven Pearson frame this problem as a (...) conflict between the “rule of rescue” and utilitarian allocation schemes that try to maximize the benefits produced by a given budget. In his article, Norman Daniels discusses the related problem of the “identified victim bias.” I doubt that the problem of crafting an equitable health policy regarding orphan diseases maps onto either of these factors in a way that sheds light on the key moral issues. (shrink)

Infertility patients and patient advocates have long argued for classifying infertility as a disease, in the hopes that this recognition would improve coverage for and access to fertility treatment. However, for many fertility patients, including older women, single women and same-sex couples, infertility does not represent a true disease state. Therefore, while calling infertility a ‘disease’ may seem politically advantageous, it might actually exclude patients with ‘social’ or ‘relational’ infertility from treatment. What is needed is a new (...) conceptual framing of infertility that better reflects the profound significance of being infertile for many people and the importance of addressing infertility in order to improve their lives. In this paper, we argue that the capability approach provides this moral underpinning. The capability approach is concerned with what people are able todo, and whether they are able to act in a way that is in keeping with their own values and goals. The ability to procreate and build a family is a fundamental capacity and can be a major part of self-fulfilment, regardless of sexual orientation or family arrangement. Since the capability approach asks us to conceive of equality in terms of equal capabilities, it provides a strong ethical impetus for society to help those who cannot conceive on their own to do so with assisted reproduction. (shrink)

Upon entering clinical medicine in the 1940s, antibiotic therapy seemed to complete a transformation of hospitals that originated in the late nineteenth century. Former death sinks had become harbingers of therapeutic progress. Yet this triumph was short-lived. The arrival of pathologies caused by resistant bacteria, and of nosocomial infections whose spread was helped by antibiotic therapies, seemed to be intimately related to modern anti-infective therapy. The place where such problems culminated were hospitals, which increasingly appeared as dangerous environments where attempts (...) to combat infectious diseases had instead created hothouses of disease evolution. This paper will focus on one aspect of that history. It caused clinical medicine and hospital hygiene in particular to pay attention to a dimension of infectious disease it had previously paid little attention to thus far: The evolution of infectious disease—previously a matter of mostly theoretical interest—came to be useful in explaining many phenomena observed. This did not turn hospital hygienists into geneticists, though it did give them an awareness that the evolution of infectious disease in a broad sense was something that did matter to them. The paper advances its argument by looking at three phases: The growing awareness of the hospital as a dangerous environment in the 1950s, comprehensive attempts at improving antibiotic therapy and hospital hygiene that followed from the 1960s and lastly the framing of such challenges as risk factors from the 1970s. In conclusion, I will argue that hospital hygiene, being inspired in particular by epidemiology and risk factor analysis, discussed its own specific version of disease emergence and therefore contributed to the 1980s debates around such topics. Being loosely connected to more specialized studies, it consisted of a re-interpretation of infectious disease centred around the temporality of such phenomena as they were encountered in day-to-day dealings of clinical wards. (shrink)

In six chapters of uneven length, Peter Lewis Allen, a former literature professor and public policy activist, offers a highly readable romp through two millennia of beliefs and attitudes regarding sin, sex, and disease. In particular, Allen draws on religious, medical, and popular literature from different eras in order to exemplify how particular “diseases”—lovesickness, leprosy, syphilis, bubonic plague, and masturbation—were causally connected with thoughts of punishment for sinful behavior. He then extends this theme into a lengthy chapter describing how (...) the same belief contributed to the chasm between conservative and activist perspectives on AIDS in the United States over the past two decades.Allen, who is admittedly not a historian, picks and chooses a “series of portraits of disease,” offering little contextualization as he creates a “tableau” of perspectives drawn from European and American discourse throughout Christianity. He flavors his chronological narrative with personal experiences drawn from his work in gay health groups. The most significant personal experiences he intersperses stem from thoughts about his one‐time lover, now dead from complications associated with AIDS. He interjects key episodes from this relationship into the book to affirm that “in its fight about how to respond to AIDS,” American society has reenacted a “drama that had been written centuries before” .Allen's engaging writing stands much more firmly as chronologically arranged comparative literature than as historical scholarship. His greatest historiographical faux pas lies in his anachronistic writing about disease. For example, he introduces his chapter on medieval leprosy with a description of the pathological destruction caused by the leprosy bacterium. Then, in selecting situations drawn from Herodotus through the sixteenth‐century “contagionist” Girolamo Fracastoro, he erroneously assumes that “leprosy” implied a singular, consistent disorder throughout this long period. Similar concerns arise regarding his coverage of syphilis. Such errors may have originated from his drawing too exclusively from pre‐1990 historical writings. Works like Charles E. Rosenberg and Janet Golden's Framing Disease: Studies in Cultural History and Linda Merian's edited volume The Secret Malady: Venereal Disease in Eighteenth‐Century Britain and France , and the voluminous literature on the history of the body, would have provided contextual concepts within which to place more concrete views about the intersections between diseases and culture. The author's desire to flash forward from particular historical periods to AIDS in our society too often leads to weakly substantiated connections between time periods.Allen's strengths lie in his ability to draw on works of literature, especially popular literature. His particular emphasis on French works reflects his own background in medieval French literature. His arguments are also strong when comparing church and society in the medieval period. For example, his chapter on lovesickness clearly delineates the persistent position of the Church Fathers against medics who regularly prescribed a “coital cure” for the disorder, without specifying what partners to select, instead of welcoming disease as a divine corrective.Allen's writing on plague, the shortest chapter of the book, clearly depicts the once‐common view that this epidemic disaster was inflicted by God as a punishment for mankind's sinful nature. However, the omission of any discussion of sex in a chapter of a work subtitled “Sex and Disease, Past and Present,” is somewhat puzzling. Even more conspicuous is the author's failure to expand upon the 1530 poem regarding the plight of the impious shepherd, Syphilis, from whom the disease in question received its name. Why would a literary scholar prone to draw on popular writings not give more than a single‐sentence mention to this historically relevant poem?Of the works Allen has drawn upon, he offers a pleasant mix of primary and secondary accounts that, like all good literary criticism, gives original sources a clear voice. Any work so selectively focused on a few diseases will leave some readers wondering about others that might have been perceived in terms of sex and sin. Were such associations discussed in regard to madness in the eighteenth century, tuberculosis in the nineteenth century, or the wide range of twentieth‐century STDs prior to AIDS? Why was no mention made of leprosy in the twentieth‐century context? Its AIDS‐like stigma has been historically contextualized in several works, including Stephanie J. Castillo's award‐winning 1992 documentary Simple Courage. Similarly, one wonders why the author chose not to drawn on standard medical history accounts on AIDS, including Elizabeth Fee and Daniel M. Fox's edited volume AIDS: The Burden of History and, perhaps more important for the Francophile Allen, Mirko D. Grmek's Histoire du SIDA: Début et origine d'une pandémie actualle .Apart from my historiographical criticisms, The Wages of Sin is a most delightful popular rendering of key relations between disease and Christianity. Works like this are extremely useful in reminding the reading public in an articulate, informative, and entertaining manner that they are part of humanity's continuum that has long sought connections between physical health and moral living. Indeed, Allen's apt description of the underlying usefulness of history underscores the importance of his own writing: “We value history because, whatever its distortions and inaccuracies, it is a way of understanding and giving value to our collective human experience and collective human memory”. (shrink)

The outbreak of syphilis in Europe elicited a variety of responses concerning the disease's origins and cure. In this essay, I examine the theory of the origins of syphilis advanced by the 16th-century Italian surgeon Leonardo Fioravanti. According to Fioravanti, syphilis was not new but had always existed, although it was unknown to the ancients. The syphilis epidemic, he argued, was caused by cannibalism among the French and Italian armies during the siege of Naples in 1494. Fioravanti's strange and (...) novel theory is connected with his view of disease as corruption of the body caused by eating improper foods. His theory of bodily pollution, a metaphor for the corruption of society, coincided with Counter-Reformation concepts about sin and the social order. (shrink)

Biomedicine is typically defined as the branch of medicine that is based on the principles of biology and biochemistry. A central tenet for biomedicine is the notion of disease and therapeutic specificity, i.e. the idea of tailored treatments for discrete disorders underpinned by specific pathologies. The present paper is concerned with how notions of disease and therapeutic specificity guide biomedical reasoning. To that end, the author proposes a model – the specificity triad – that draws on late philosopher (...) and physician Ludwik Fleck’s concept of “style of thought” to offer a frame for investigating the intricate process through which links between disorders, mechanisms, and therapeutics are established by biomedicine. Next by applying the specificity triad model to scrutinize research efforts in two discrete areas of medicine—psychiatry and regenerative medicine—this paper seeks to stimulate pertinent discussions in and about biomedicine. These include discussions on the ambiguous epistemic status of psychiatry within contemporary biomedicine, as well as the relationship between developmental biology — historically relatively disjointed from biomedical enterprise — and the burgeoning field of regenerative medicine. (shrink)

The convergence of libraries, archives, and museums into monolithic organizations has been framed as a retreat from "silos," or isolated, hierarchical institutions that are increasingly irrelevant in a networked age. The emerging prevalence of digital technology and mass digitization are also identified as primary motivators behind convergence. However, much of the literature on convergence is couched in business terminology that favors top-down management approaches and works to create non-democratic structures with more power in fewer hands, with many of the pro-convergence (...) arguments having little to no evidential support. Furthermore, many real-life examples of LAM convergence have been problematic and under-examined in the literature. This paper looks at LAM convergence from the perspective of working librarians, archivists, curators, and related staff and offers a re-evaluation and critique of convergence practices in Canada and abroad. The links between LAM convergence and the corporatization of the LAM sector within a broader context of free market ascendancy are also explored. (shrink)

Hospitalization is a unique health-illness transition for most elderly people. Whether the patient's health-related needs are met or not often iiifluence his or her appraisal of quality of life during hospitalization. This qualitative study explored the health needs of elderly Chinese male cardiac patients during their hospitalization. Eighteen subjects were recruited from a veterans' hospital in northern Taiwan. These men all lived alone before their hospital admission. Data were gathered using semistructured interviews and then analysed by content analysis. Ninety-four per (...) cent of the subjects described up to three categories of needs: met needs (72%), unmet needs (78%), and expected needs (50%0). Needs that participants believed were met were those for psychological support, spiritual support, tangible support and information. Unmet needs were those for participation in decision making, maintaining daily activities and resuming a preadmission lifestyle. The expected needs included those for learning self-care strategies to maintain their daily activities after discharge from the hospital. The factors that framed the participants' perceptions of different health needs were identified to be lack of family support and locus of control. Finally, a discussion of the context background of this phenomenon, as well as some suggestions for its implications, are provided from a culturally sensitive ethical aspect. (shrink)

Next SectionThe current focus on early intervention trials in Alzheimer's disease research raises particular ethical issues. These arise out of problems of validating study results and translating them into general practice for one thing and out of unwanted effects of an uncertain diagnosis for diagnosed people for another. The first addresses the demands of scientific research compared to those of medical practice, questioning how the medical value of clinical trials is evaluated. The second relates the scientific and medical value (...) of early intervention trials to the normative value of an uncertain diagnosis. Are people who are diagnosed with a potential early form of AD in clinical studies patients proper—although they would not have been diagnosed with the given “disease” in non-research-oriented medical settings? The very problem of framing this question in terms of diagnostic misconceptions connects conceptual with ethical issues of research into preclinical stages of neurodegenerative diseases. (shrink)