Public health ethics, like the field of public health it addresses, traditionally has focused more on practice and particular cases than on theory, with the result that some concepts, methods, and boundaries remain largely undefined. This paper attempts to provide a rough conceptual map of the terrain of public health ethics. We begin by briefly defining public health and identifying general features of the field that are particularly relevant for a discussion of public health ethics.Public health is primarily concerned with (...) the health of the entire population, rather than the health of individuals. Its features include an emphasis on the promotion of health and the prevention of disease and disability; the collection and use of epidemiological data, population surveillance, and other forms of empirical quantitative assessment; a recognition of the multidimensional nature of the determinants of health; and a focus on the complex interactions of many factors—biological, behavioral, social, and environmental—in developing effective interventions. (shrink)

The U.S. Food and Drug Administration's rationale for supporting the development and approval of BiDil for heart failure specifically in black patients was based on under-powered, post hoc subgroup analyses of two relatively old trials , which were further complicated by substantial covariate imbalances between racial groups. Indeed, the only statistically significant difference observed between black and white patients was found without any adjustment for potential confounders in samples that were unlikely to have been adequately randomized. Meanwhile, because the accepted (...) baseline therapy for heart failure has substantially improved since these trials took place, their results cannot be combined with data from the more recent trial amongst black patients alone. There is therefore little scientific evidence to support the approval of BiDil only for use in black patients, and the FDA's rationale fails to consider the ethical consequences of recognizing racial categories as valid markers of innate biological difference, and permitting the development of group-specific therapies that are subject to commercial incentives rather than scientific evidence or therapeutic imperatives. This paper reviews the limitations in the scientific evidence used to support the approval of BiDil only for use in black patients; calls for further analysis of the V-HeFT I and II data which might clarify whether responses to H-I vary by race; and evaluates the consequences of commercial incentives to develop racialized medicines. We recommend that the FDA revise the procedures they use to examine applications for race-based therapies to ensure that these are based on robust scientific claims and do not undermine the aims of the 1992 Revitalization Act. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Notes on Psychodramatic Treatment of a Person with SchizophreniaJonathan D. Moreno, PhD (bio)I have enjoyed reflecting on Mr. Chapy’s account of work in psychodrama with a patient with schizophrenia.Although at one time many years ago I was interested in phenomenological psychiatry, and especially the writings of Ludwig Binswanger and Medard Boss, I am not an authority on dasein-analysis, so I have nothing to add to the discussion. I should (...) say, however, that my father had little interest in this approach, which was far too abstract for his taste. He proceeded from the standpoint of the theater, of action and enactment. He believed that the drama itself provided the insight.For the purposes of this response, I take it as a given that the patient in question has been accurately diagnosed, although in the description of the scene with his father he does not exhibit the usual symptoms, such as auditory hallucinations. People with schizophrenia often find it difficult to manage the voices they are hearing without substantial preparation for a psychodrama. According to psychodramatic method, one way to prepare them is to externalize the voices, allowing a different therapist to take the role of each one as the protagonist instructs them how to play that role. Chair may be set up so that each “voice,” personified by an auxiliary ego, can sit in each chair in an array. This preparation may require a number of sessions. If the scene is to be enacted with a significant other, like the father in this instance, the patient may not be able to warm up to a direct encounter, especially with all the different voices competing for his internal attention. So he may be directed to observe each voice in the encounter with his father, preferably played by a therapist of his choosing and trained for the role, usually by giving the father-player certain lines so that they can learn something about the father and the way he addresses his son.Or consider the patient whose illness manifests itself as delusions, often of a megalomaniac character. They may be a messiah, for example, or the rightful heir of a royal line whose identity is being suppressed by governmental forces. The patient might be invited to choose key therapists to play the roles of key members of their circle, [End Page 225] enacting critical scenes like the sermon on the mount or speeches to their oppressed followers. In this way the patient’s “act hunger” may be to some degree satiated and have a calming effect on their anxiety and irritation with the frustrating world around them that refuses to accept their “authentic” identity and belief system.In these ways, psychodrama therapy can take advantage of one of the remarkable advantages of this method for such patients, who are generally recalcitrant to talk therapy alone and for whom medication is at best modestly effective. Still, these disorders are among the most challenging for psychotherapists. Although the process of treating them may open up insights into the nature of the human mind, as Chapy has pursued in this paper, we await the neuroscience that can affect the kind of long-term remission they and their families so desperately wish. [End Page 226]Jonathan D. MorenoUniversity of Pennsylvania [email protected] D. Moreno Jonathan D. Moreno is a philosopher and historian who specializes in the intersection of bioethics, culture, science, and national security, and has published seminal works on the history, sociology and politics of biology and medicine. He is an elected member of the National Academy of Medicine.submitted on January 27, 2023Accepted on January 30, 2023Copyright © 2023 Johns Hopkins University Press... (shrink)

Modernism has been a celebration of the present. Why does it need a legacy ? Why should that which was born in the spirit of rebellion perpetuate itself as tomorrow’s past? Modernism has been profoundly reflective of late nineteenth- and twentieth-century cultural values. Is that not enough? It is not that modernism has forgotten the past—an art that rebels against its past must understand its adversary—but rather that it asks us not to forget the present. The revolt of modernism was (...) made possible, if not inevitable, by the rediscovery of the past. In earlier, eras, when the past was less readily accessible, artists worked for their present with little thought about their heritage. Renaissance composers, for example, generally knew little of music even two generations old; much medieval music theory and composition were based on misconceptions of Greek models. Yet by the nineteenth century, works from the past were available and understood. Virtually all composers agreed with Johannes Brahms, who reputedly said of Ludwig van Beethoven, “You have no idea how the likes of us feel when we hear the tramp of a giant like him behind us.” Historical consciousness had entered the arts, and artists were both threatened by competition with the past and seduced by the powerful idea that their works might outlive them. The Romantic artist became a genius speaking to posterity. Gustav Mahler was not the only Romanticist to pin his hopes on the future: “My time will yet come.” Small wonder that, once the future came to be, its artists rebelled against pronouncements from their past—the time rightfully belonged to them and no longer to Mahler’s generation. While many twentieth-century artists continued to create for their future, the most extreme modernists rejected not only their past but also the quest for immortality. They have written of their day and for their day. The real legacy of modernism is that it has no legacy. Jonathan D. Kramer is professor of music theory and composition at the College-Conservatory of Music at the University of Cincinnati and also program annotator and new music advisor of the Cincinnati Symphony Orchestra. He is currently working on Time and the Meanings of Music . His previous contribution to Critical Inquiry, “New Temporalities in Music,” appeared in Spring 1981. (shrink)

In Matthew 23:1-3, Jesus commands His disciples and the crowd to listen to the scribes and Pharisees even while not imitating their actions. Many modern interpreters have lessened the force of Matthew 23:1-3 by an assumption of irony on the part of Jesus. We presume that God could never ordain this for His people. However, this easier reading may not be the best reading. A more straightforward interpretation, but one that is difficult to hear, suggests that at times we may (...) need to sit under bad leadership as means of receiving God’s Word. Pre-critical and modern interpreters provide an understanding of the words of Jesus that is consistent with a theology of God’s providence in times of transition and bad leadership. In addition, there are instances of His direction in both the Old and New Testaments that reinforce this challenging path. It is through this more faithful stance that we grow and flourish in difficult times. (shrink)

The cellular processes of transport, division and, possibly, early development all involve microtubule‐based motors. Recent work shows that, unexpectedly, many of these cellular functions are carried out by different types of kinesin and kinesin‐related motor proteins. The kinesin proteins are a large and rapidly growing family of microtubule‐motor proteins that share a 340‐amino‐acid motor domain. Phylogenetic analysis of the conserved motor domains groups the kinesin proteins into a number of subfamilies, the members of which exhibit a common molecular organization and (...) related functions. The kinesin proteins that belong to different subfamilies differ in their rates and polarity of movement along microtubules, and probably in the particles/organelles that they transport. The kinesins arose early in eukaryotic evolution and gene duplication has allowed functional specialization to occur, resulting in a surprisingly large number of different classes of these proteins adapted for intracellular transport of vesicles and organelles, and for assembly and force generation in the meiotic and mitotic spindles. (shrink)

The authors consider the nature of explanatory models in the social sciences in order to suggest ways in which conceptual systems differ. They suggest that, in many cases, theorists, researchers and clinicians can utilize insights from rival models in building their own models, without sacrificing the integrity of their own work.

Recent efforts to support state regulation of risky behavior like cigarette smoking, alcohol consumption, driving without seatbelts and riding motorcycles without helmets have focused on economic justifications—the costs to society of the consequences of these activities. However, opponents have successfully argued that the economic burdens of regulation outweigh the social benefits. To reduce the toll on society of these behaviors, we need justification for regulation that asserts the moral primacy of health and the well‐being of the community.

Of the many genes mutated on the road to tumor formation, few have received as much attention as p53. The gene has come to occupy center stage for the simple reason that it is more frequently altered in human tumors than any other known gene, undergoing mutation at a significant rate in almost every tumor type in which it has been studied. This association between p53 mutation and tumorigenesis has spurred a flurry of research attempting to delineate the normal function (...) of p53 and, by extension, the role of p53 mutation in tumor formation. At the cellular level, p53 has been shown to suppress growth. Recent efforts to further discern the function of p53 have centered on the underlying molecular basis for this growth suppression. In particular, research has focused on the identification of cellular molecules (specifically DNA and proteins) with which the p53 protein associates. p53 has now been shown to bind DNA in a sequence‐specific manner, and mounting evidence suggests that p53 acts as a transcription factor, perhaps regulating the expression levels of genes involved in the inhibition of cell growth. The logical next step in understanding p53 function involves the resolution of two questions: (1) what are the physiological transcriptional targets of p53, and (2) what cellular proteins regulate or mediate the ability of p53 to modulate transcription? Some initial clues to these puzzles are now emerging, and these form the subject of this review. (shrink)

As this century has found new temporalities to replace linearity, discontinuities have become commonplace. Discontinuity, if carried to a pervasive extreme, destroys linearity…There were two enormous factors, beyond the general cultural climate, that promoted composers' active pursuit of discontinuities. These influences did not cause so much as feed the dissatisfaction with linearity that many artists felt. But the impact has been profound. One factor contributing to the increase of discontinuity was the gradual absorption of music from totally different cultures, which (...) had evolved over the centuries with virtually no contact with Western ideas…Cross-cultural exchange in music will, of course, never destroy aesthetic boundaries, but music of non-Western cultures continues to show Western composers new ways to use and experience time. The second tremendous influence on twentieth-century musical discontinuity was technological rather than sociological: the invention of recording techniques. Recording has not only brought distant and ancient musics into the here and now, it has also made the home and the car environment just as viable for music listening as the concert hall. The removal of music from the ritualized behavior that surrounds concertgoing struck a blow to the internal ordering of the listening experience. Furthermore, radios, records, and, more recently, tapes allow the listener to enter and exit a composition at will. An overriding progression from beginning to end may or may not be in the music, but the listener is not captive to that completeness. We all spin the dial, and we are more immune to having missed part of the music than composers might like to think. Jonathan D. Kramer is an associate professor of music theory and composition and director of electronic music at the College-Conservatory of Music of the University of Cincinnati. The present essay is part of his book, Time and Meaning in Music. (shrink)

A growing number of philosophers and logicians advocate for plural languages in which we can refer to and quantify over pluralities of individuals. Some go further, advocating for higher-level languages in which we can refer to and quantify over, not just pluralities of individuals, but pluralities of pluralities, pluralities of pluralities of pluralities, and so on. These languages suggest a metaphysical picture on which even a small pool of individuals gives rise to a potentially infinite hierarchy of distinct pluralities. Most (...) higher-levellists would be loathe to take that picture seriously, but avoiding it turns out to be more difficult than it appears. Fortunately, we can develop a ‘one-level’ plural language which has all the benefits of higher-level ones but which avoids any commitment to the hierarchy. (shrink)

In this paper I argue that a certain understanding of “animality” – or that a certain problematization of the traditional human-animal hierarchy and divide – is central to Nietzsche’s account of the good life. Nietzsche’s philosophical project is primarily directed against those “metaphysical oppositions of values” that traditionally structure how we think, feel and live, and in this paper I submit that, for Nietzsche, the classical opposition between the human and the animal is the most basic and the most pernicious, (...) for it undergirds the oppositional hierarchy between rationality and irrationality that has turned human life against itself. I draw primarily from Nietzsche’s second “Untimely Meditation” and from a passage from Daybreak in order to make the case that, for Nietzsche, we must reject any facile ontological opposition between human beings and non-human animals and that we must recognize and live in consonance with the “animal” conditions of our existence: human beings must recuperate and reintegrate rather than suppress their “animality” in order to thrive. For Nietzsche, we can say that virtue is a certain cultivated balance between our “humanity” and our “animality.”. (shrink)

Western society today is less unified by a set of core values than ever before. Undoubtedly, the concept of moral consensus is a difficult one in a liberal, democratic and pluralistic society. But it is imperative to avoid a rigid majoritarianism where sensitive personal values are at stake, as in bioethics. Bioethics has become an influential part of public and professional discussions of health care. It has helped frame issues of moral values and medicine as part of a more general (...) effort to find consensus about some of the most perplexing questions of our time. But why is it thought that a moral consensus is important or that it deserves respect? How does moral consensus acquire legitimacy in a society that includes diverse value systems? How is moral consensus possible and how do small groups help create or distort consensus processes? Written by a medical school professor trained in philosophy, this timely work tackles these questions from philosophical, historical, and social scientific standpoints. It begins by describing the traditional ambivalence about consensus in Western culture as well as the uncertain relationship in modernity between consensus and expertise. After outlining the current bioethical consensus, the book gives philosophical and political analyses of the idea of consensus, then assesses the role of consensus in national ethics commissions and in the ethics committee movement. Moreno constructs an original, naturalistic philosophy of moral consensus, referred to as "bioethical naturalism", and then applies sociology and social psychology to actual consensus processes. The book concludes with an account of bioethics as a consensus-oriented social reform movement. This insightful volume will be essential reading for bioethicists, philosophers, physicians, members of ethics committees, and all those concerned with ethical and social issues in health care. (shrink)

Introduces and reflects upon the major themes of Jewish life as expressed in a full year of holidays in the Jewish calendar.

Convinced that armed conflict with the Soviet Union was all but inevitable, that such conflict would involve unconventional atomic, biological, and chemical warfare, and that research with human subjects was essential to respond to the threat, in the early 1950s the U.S. Department of Defense promulgated a policy governing human experimentation based on the Nuremberg Code. Yet the policymaking process focused on the abstract issue of whether human experiments should go forward at all, ignoring the reality of humans subjects research (...) already under way and leaving unanswered ethical questions about how to conduct such research. Documents newly released to the Advisory Committee on Human Radiation Experiments tell the story of the Pentagon policy. (shrink)

Three claims are widely held and individually plausible, but jointly inconsistent: (1) Negative actions (intentional omissions, refrainments, etc.) are genuine actions; (2) All actions are events; (3) Some, and perhaps all, negative actions aren't events, but absences thereof (when I omit to raise my arm, no omission-event occurs; what happens is just that no arm-raising occurs). Drawing on resources from metaphysics and the philosophy of language, I argue that (3) is false. Negative actions are events, just as ordinary actions are. (...) Moreover, each token negative action is identical to a token positive event, so we can adopt this realist view of negative actions without adding metaphysically negative entities (absences, negative states of affairs) to our ontology. (shrink)

This paper draws upon research on a complementary currency to explore the ethical dimensions of that community economic development work. In doing so, the paper argues that the figure of the stranger is increasingly important to understand in theorizing community, especially given increased attention to the discourse of the stranger in theories of ethics and identity in a globalizing world. As such, the paper lays out three modes of the strange—economic, geographic and ethical—which emerge out of this complementary currency project. (...) In identifying these three modes of being strange, the paper validates ways of articulating strangers and strangeness without essentializing the strange, ignoring the power relations that produce strangers, or pushing aside the strange in favor of blas communion. (shrink)

The notion of essence in psychology is examined from a constructivist viewpoint. The constructivist position is summarized and differentiated from social constructionism, after which constructs are distinguished from concepts in order to position ontology and epistemology as modes of construing. After situating constructivism in relation to philosophical approaches to essences, the distinction between essences and kinds is examined and the presumed constructivist critique of essences in psychology outlined. It is argued that criticizing constructivism as an “anything goes” form of antirealism (...) fails to grasp how constructivist psychology, by emphasizing structure and viability, does indeed place limits on the constructions people may hold. In applying a constructivist understanding of essences in general to those fundamental to human psychology, people can be seen as having three essential psychological qualities: they are closed systems, active meaning-makers, and irreducibly social beings. Yet a constructivist view also maintains that these psychological essences only hold while operating within and committed to a constructivist perspective. In other words, what counts as an essence always depends on one's assumptions, or how one construes events. Finally, a personal construct theory model of essentialist and nonessentialist construing is introduced based on the assumption that everyone construes in both essentialist and nonessentialist ways at different times because doing so is pragmatically viable. 2012 APA, all rights reserved). (shrink)

This book explains why the increasingly popular idea of “white fragility” worsens rather than improves the conversation on how to reduce racial inequality.

it is mandatory that in building up our strength, we enlarge upon our technical superiority by an accelerated exploitation of the scientific potential of the United States and our allies. National Security Council, NSC-G8: United States Objectives and Program for National Security April 14, 1950 Innovation within the armed forces will rest on experimentation with new approaches to warfare, strengthening joint operations, exploiting U.S. intelligence advantages, and takingfull advantage of science and technology. George W Bush, The National Security Strategy of (...) the United States of America, September 17,2002. (shrink)

I explore two accounts of properties within a dispositional essentialist (or causal powers) framework, the pure powers view and the powerful qualities view. I first attempt to clarify precisely what the pure powers view is, and then raise objections to it. I then present the powerful qualities view and, in order to avoid a common misconception, offer a restatement of it that I shall call the truthmaker view. I end by briefly defending the truthmaker view against objections.

Possible worlds, concrete or abstract as you like, are irrelevant to the truthmakers for modality—or so I shall argue in this paper. First, I present the neo-Humean picture of modality, and explain why those who accept it deny a common sense view of modality. Second, I present what I take to be the most pressing objection to the neo-Humean account, one that, I argue, applies equally well to any theory that grounds modality in possible worlds. Third, I present an alternative, (...) properties-based theory of modality and explore several specific ways to flesh the general proposal out, including my favored version, the powers theory. And, fourth, I offer a powers semantics for counterfactuals that each version of the properties-based theory of modality can accept, mutatis mutandis. Together with a definition of possibility and necessity in terms of counterfactuals, the powers semantics of counterfactuals generates a semantics for modality that appeals to causal powers and not possible worlds. (shrink)

Book reviewed in this article: The Insanity Defense and the Trial of John W. Hinckley, Jr. By Lincoln Caplan.