That there is a heritable or familial component of susceptibility to chronic non‐communicable diseases such as type 2 diabetes, obesity and cardiovascular disease is well established, but there is increasing evidence that some elements of such heritability are transmitted non‐genomically and that the processes whereby environmental influences act during early development to shape disease risk in later life can have effects beyond a single generation. Such heritability may operate through epigenetic mechanisms involving regulation of either imprinted or non‐imprinted genes but (...) also through broader mechanisms related to parental physiology or behaviour. We review evidence and potential mechanisms for non‐genomic transgenerational inheritance of ‘lifestyle’ disease and propose that the ‘developmental origins of disease’ phenomenon is a maladaptive consequence of an ancestral mechanism of developmental plasticity that may have had adaptive value in the evolution of generalist species such as Homo sapiens. BioEssays 29: 145–154, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

When attempting to answer the question, in the context of clinical healthcare, one might be tempted to leap to either of two rather obvious, but seemingly contradictory conclusions. On the one hand, we might have a general impression of religion not making much of a distinctive and clear difference, at least in the actions and outcomes of most cases of clinical interaction. Those of us in the bioethics world of discourse are likely to think only of the less common cases (...) of Christian Scientists, Jehovah's Witnesses, Orthodox Jews, or certain religious groups who seem to the majority of the population to hold especially sectarian, if not beliefs about medical matters. The so-called mainstream religious groups do not get much attention because they largely don't cause much trouble ; they have learned to bracket their religious commitments from at least any professional settings ; or they don't hold views entailing consequences any different from those of most nonbelieving, generally upright individuals. Furthermore, although religious believers may have some distinctive views, these views don't often noticeably manifest themselves in distinctive or significant ways. (shrink)

We examined attitudes as one potential influence on the behavioral intentions of three stakeholder groups commonly in conflict. Business managers (n = 97), government environmental regulators (n = 69), and active members of pro-environmental groups (n = 49) were surveyed to assess the differences among these groups in their attitudes toward property rights, environmental regulation, and technology. We compared the influence of these attitudes and stakeholder group affiliation on intentions to engage in pro-environmental behavior. The attitudes measures explained a significant (...) amount of the variance in behavioral intention, even after group membership was controlled. Theoretical implications of these findings for stakeholder theory are discussed along with some practical applications of these findings for stakeholder negotiations and management practices. (shrink)

Conducting or overseeing research in correctional settings requires knowledge of specific federal rules and regulations designed to protect the rights of individuals in incarceration. To investigate the extent to which relevant groups possess this knowledge, using a 10-item questionnaire, we surveyed 885 IRB prisoner representatives, IRB members and chairs with and without experience reviewing HIV/AIDS correctional protocols, and researchers with and without correctional HIV/AIDS research experience. Across all groups, respondents answered 4.5 of the items correctly. Individuals who have overseen or (...) conducted correctional research had the highest scores; however, even these groups responded correctly only to slightly more than half of the items. These findings emphasize the need for ongoing training in federal guidelines governing correctional research, particularly for those individuals who are embarking on this type of research. (shrink)

Debates over health care have focused for so long on economics that the proper goals for medicine seem to be taken for granted; yet problems in health care stem as much from a lack of agreement about the goals and priorities of medicine as from the way systems function. This book asks basic questions about the purposes and ends of medicine and shows that the answers have practical implications for future health care delivery, medical research, and the education of medical (...) students. The Hastings Center coordinated teams of physicians, nurses, public health experts, philosophers, theologians, politicians, health care administrators, social workers, and lawyers in fourteen countries to explore these issues. In this volume, they articulate four basic goals of medicine — prevention of disease, relief of suffering, care of the ill, and avoidance of premature death — and examine them in light of the cultural, political, and economic pressures under which medicine functions. In reporting these findings, the contributors touch on a wide range of diverse issues such as genetic technology, Chinese medicine, care of the elderly, and prevention and public health. The Goals of Medicine clearly demonstrates the importance of clarifying the purposes of medicine before attempting to change the economic and organizational systems. It warns that without such examination, any reform efforts may be fruitless. (shrink)

The biotechnology industry's intellectual property claims contribute to a subtle but not insignificant encroachment of commodification within health care. Drawing on the conceptual framework of Margaret Jane Radin, I argue that patent claims on human biological materials may commodify that with which our personhood and individuality is intertwined but that such commodification is broad and incomplete. Patents on nonhuman biological organisms contribute to a more materialistic understanding of them but do not significantly change our relationship to them. The systemic effects (...) of biotechnology's commodification within health care are various and may compromise the goal of good health. The morally problematic aspects of patent claims entail certain obligations to inhibit commodification from becoming more egregious, but on balance, those aspects are currently insufficient to justify denying the benefits the patent system promotes. (shrink)

Theories of consciousness have a long and controversial history. One well-known proposal — integrated information theory — has recently been labeled as ‘pseudoscience’, which has caused a heated open debate. Here we discuss the case and argue that the theory is indeed unscientific because its core claims are untestable even in principle.

The UK government has recently committed to adopting a new policy—dubbed ‘Martha’s Rule’—which has been characterised as providing patients the right to rapidly access a second clinical opinion in urgent or contested cases. Support for the rule emerged following the death of Martha Mills in 2021, after doctors failed to admit her to intensive care despite concerns raised by her parents. We argue that framing this issue in terms of patient rights is not productive, and should be avoided. Insofar as (...) the ultimate goal of Martha’s Rule is the provision of a clinical service that protects patient safety, an approach that focuses on the obligations of the health system—rather than the individual rights of patients—will better serve this goal. We outline an alternative approach that situates rapid clinical review as part of a suite of services aimed at enhancing and protecting patient care. This approach would make greater progress towards addressing the difficult systemic issues that Martha’s Rule does not, while also better engaging with the constraints of clinical practice. (shrink)

Early life adversity, such as child maltreatment or child poverty, engenders problems with emotional and behavioral regulation. In the quest to understand the neurobiological sequelae and mechanisms of risk, the amygdala has been of major focus. While the basic functions of this region make it a strong candidate for understanding the multiple mental health issues common after ELA, extant literature is marked by profound inconsistencies, with reports of larger, smaller, and no differences in regional volumes of this area. We believe (...) integrative models of stress neurodevelopment, grounded in “allostatic load,” will help resolve inconsistencies in the impact of ELA on the amygdala. In this review, we attempt to connect past research studies to new findings with animal models of cellular and neurotransmitter mediators of stress buffering to extreme fear generalization onto testable research and clinical concepts. Drawing on the greater impact of inescapability over unpredictability in animal models, we propose a mechanism by which ELA aggravates an exhaustive cycle of amygdala expansion and subsequent toxic-metabolic damage. We connect this neurobiological sequela to psychosocial mal/adaptation after ELA, bridging to behavioral studies of attachment, emotion processing, and social functioning. Lastly, we conclude this review by proposing a multitude of future directions in preclinical work and studies of humans that suffered ELA. (shrink)

Engaging the thought of the Danish thinker Søren Kierkegaard, I challenge a tendency within the analytic tradition of philosophy on the subject of meaning in life. Taking as a starting point Kierkegaard's insights about meaning in life, the striving needed to attain an imagined ideal self, and his paradoxical conception of the perfection available to human life, I claim that meaning in life is a function of an individual's striving for an ideal self. This continuous effort to achieve myself is (...) marked by suffering, an indispensable part of Kierkegaard's project of identity formation. The imagined grasp of a possible ideal self is essential to this process but insufficient for it because the imagination can only ever glimpse a kind of static perfection, not the lived perfection that only results from willed actualization of an ideal self. The meaning of a human life, then, consists in the suffering that results from a struggle to actualize the ideal I aspire to become in the process of identity formation. I contrast this view with a tendency shared by many contemporary analytic philosophers of meaning in life, for whom meaning in life is constituted by achievement of valued goods, without much attention to one's relation to the process of achieving them. In that respect, I will focus on the position of Iddo Landau. After clearing a number of his misconceptions about Kierkegaard's philosophy, I claim that, for a life to be meaningful, valued goods in life must be complemented by a conscious enactment of the process of the formation of one's identity that includes striving to attain a kind of perfection. I conclude that Kierkegaard's paradoxical account of perfectionism makes him more of an ally to Landau than an opponent. (shrink)

There is, to all appearances, a philosophic hostility to fashionable dress. Studying this contempt, this paper examines likely sources in philosophy's suspicion of change; anxiety about surfaces and the inessential; failures in the face of death; and the philosophic disdain for, denial of, the human body and human passivity. If there are feminist concerns about fashion, they should be radically different from those of traditional philosophy. Whatever our ineluctable worries about desire and death, whatever our appropriate anger and impatience with (...) the merely superficial, whatever our genuine need to mark off the serious from the trivial, feminism may be a corrective therapy for philosophy's bad humor and self-deception, as these manifest themselves when the subject turns to beautiful clothes. (shrink)

A humanoid robot named ‘Sophia’ has sparked controversy since it has been given citizenship and has done media performances all over the world. The company that made the robot, Hanson Robotics, has touted Sophia as the future of artificial intelligence. Robot scientists and philosophers have been more pessimistic about its capabilities, describing Sophia as a sophisticated puppet or chatbot. Looking behind the rhetoric about Sophia’s citizenship and intelligence and going beyond recent discussions on the moral status or legal personhood (...) of AI robots, we analyse the performativity of Sophia from the perspective of what we call ‘political choreography’: drawing on phenomenological approaches to performance-oriented philosophy of technology. This paper proposes to interpret and discuss the world tour of Sophia as a political choreography that boosts the rise of the social robot market, rather than a statement about robot citizenship or artificial intelligence. We argue that the media performances of the Sophia robot were choreographed to advance specific political interests. We illustrate our philosophical discussion with media material of the Sophia performance, which helps us to explore the mechanisms through which the media spectacle functions hand in hand with advancing the economic interests of technology industries and their governmental promotors. Using a phenomenological approach and attending to the movement of robots, we also criticize the notion of ‘embodied intelligence’ used in the context of social robotics and AI. In this way, we put the discussions about the robot’s rights or citizenship in the context of AI politics and economics. (shrink)

Dieser Aufsatz analysiert Leibniz' Begriff der Expression. Er ist eine Vorstudie zu einer umfassenden Untersuchung der Lehre, daß jede einfache Substanz das ganze Weltall ausdrückt. Leibnizens Beispiele und Definitionen von Expression werden besprochen, und dann wird die Analyse des Begriffs in zwei Stufen entwickelt.

“Unconscionable.” “Outrageous.” “Indefensible.” These are just some of the tamer descriptions for the billing practices of most hospitals, and also many physicians, that have recently come to the public's attention. Earlier this year, Time magazine published an extraordinary 24,000‐word exposé—the longest article it has ever published—detailing how even charitable hospitals routinely price‐gouge their patients.1 With characteristic flare for telling details, journalist Steven Brill documented ten‐fold markups of charges over costs at some prominent hospitals for common services like X rays and (...) lab tests, and one‐hundred‐fold mark‐ups on mundane supplies such as gauze pads and generic aspirin. Just as the buzz from Brill's article was abating, the Centers for Medicare & Medicaid Services released a comprehensive data set in May that galvanized local and national media across the country. This news tsunami caught hospital managers flat‐footed and tongue‐tied. Typical responses conceded that hospitals’ pricing practices are based neither on actual cost structures nor rational marketplace dynamics. Instead, hospitals attempted to deflect blame by noting that hardly anyone actually pays list prices, and they characterized their indefensible pricing as a symptom of a broken system that is beyond them to fix. There are two glaring faults in these standard defenses. (shrink)

Thomas Kuhn has argued that scientists never reject a paradigm without simultaneously accepting a new paradigm. Coupled with Kuhn's claim that it is paradigms as a whole, and not individual theories, that are accepted or rejected, this thesis is seen as one of Kuhn's main challenges to the rationality of science. I argue that Kuhn is mistaken in this claim; at least in some instances, science rejects a paradigm despite the absence of a successor. In particular, such a description best (...) fits Kuhn's most discussed example, the Copernican Revolution. By differentiating scientific discoveries into three types, spontaneous, implicit, and directed, we see that Kuhn's thesis holds for spontaneous and implicit discoveries, but not directed discoveries. Directed discoveries must be understood by an alternative account of falsifiability, based on argument by reductio ad absurdum rather than argument by modus tollens as traditional accounts of falsifiability would have it. (shrink)

This chapter contains sections titled: Phenomenology Existentialism The Organization of the Book.

Therehasbeenevidencefortheverybrief,temporalquantizationofperceptualexperienceatregularintervalsbelo w100msforseveraldecades.Webrieflydescribehowearlierstudiesledtotheconceptof“psychologicalmoment”ofbe tween50and60msduration.Accordingtohistoricaltheories,withinthepsychologicalmomentalleventswouldbepro cessedasco-temporal.Morerecently,alinkwithphysiologicalmechanismshasbeenproposed,accordingtowhichthe 50–60mspsychologicalmomentwouldbedefinedbytheupperlimitrequiredbyneuralmechanismstosynchronizeandthe rebyrepresentasnapshotofcurrentperceptualeventstructure.However,ourownexperimentaldevelopmentsalsoid entifyamorefine-scaled,serializedprocessstructurewithinthepsychologicalmoment.Ourdatasuggeststhatnot alleventsareprocessedasco-temporalwithinthepsychologicalmomentandinstead,someareprocessedsuccessivel y.Thisevidencequestionstheanalogrelationshipbetweensynchronizedprocessandsimultaneousexperienceandop ensdebateontheontologyandfunctionof“moments”inpsychologicalexperience.

Abstract:Moral imagination is a reasoning process thought to counter the organizational factors that corrupt ethical judgment. We describe the psychology of moral imagination as composed of the four decision processes identified by Rest (1986), i.e., moral sensitivity, moral judgment, moral intention, and moral behavior. We examine each process in depth, distilling extant psychological research and indicating organizational implications. The conclusion offers suggestions for future research.The majority of men are subjective toward themselves and objective toward all others—terribly objective sometimes—but the real (...) task is in fact to be objective toward one’s self and subjective toward all others. (shrink)

Physicians' duties to their patients traditionally have been construed narrowly in time and scope to focus on the specific episode of care or clinical encounter. Physicians generally have had no ethical or legal duty to notify patients about new medical information discovered after a visit, notwithstanding the health care benefits to patients that might flow from receiving the information. The rule was based on the relatively high burdens that notification would impose on physicians compared with the likelihood of benefits to (...) patients. This established view, however, no longer may be appropriate in light of new physician-patient relationships and the reduced burden of patient notification using new types of health information technology. This article explores the duty to inform patients and former patients about relevant, medical developments subsequent to their episode of care. It concludes by recommending the recognition in ethics and law of a limited, ongoing duty to notify patients of significant information relevant to their health. (shrink)

Calling for an expanded framework of EuroAmerican science's methodology whose perspective acknowledges both quantitative/etic and qualitative/emic orientations is the broad focus of this article. More specifically this article argues that our understanding of shamanic and/or other related states of consciousness has been greatly enhanced through ethnographic methods, yet in their present form these methods fail to provide the means to fully comprehend these states. They fail, or are limited, because this approach is only a “cognitive interpretation” or “metanarrative” of the (...) actual experience and not the experience itself. Consequently this perspective is also limited because the researcher continues to assess his or her data through the lens of their symbolic constructs, thereby preventing them from truly experiencing shamanic and psi/spirit approaches to knowing since the data collection process does not “in and of itself” affect the observer. We, therefore, need expanded ethnographic methods that include within their approaches an understanding of methods and techniques to experientially encounter these states of consciousness—and become transformed by them. Our becoming transformed and then recollecting our ethnoautobiographical experiences is the means toward a new kind of science and its methods of inquiry that this article seeks to encourage. (shrink)

Many employers faced with rising health care costs have adopted “voluntary” wellness programs that urge employees to engage in various health-promotion activities, such as smoking cessation and weight reduction. In the proper setting, measures to promote a more healthful lifestyle are difficult to question, but there is little compelling evidence that workplace wellness programs have significant, sustained health benefits or substantially reduce health care costs other than through cost-shifting to unhealthy employees. Congressional support for workplace wellness programs has persisted on (...) a bipartisan basis for the last twenty years, and the incentives that current statutes allow employers to offer employees have become strong enough that the voluntariness of the programs has been called into question. In recent months, the battleground has shifted to the courts, where federal regulations and employer practices have been challenged. Three recent or pending cases raise questions about whether the incentives are coercing employees into the programs. (shrink)

National decline is typically blamed on special interests from the demand side of politics corrupting a country's institutions. The usual demand-side suspects include crony capitalists, consumer activists, economic elites, and labor unions. Less attention is given to government insiders on the supply side of politics - rulers, elected officials, bureaucrats, and public employees. In autocracies and democracies, government insiders have the motive, means, and opportunity to co-opt political power for their benefit and at the expense of national well-being. Many storied (...) empires have succumbed to such inside jobs. Today, they imperil countries as different as China and the United States. Democracy - government by the people - does not ensure government for the people. Understanding how government insiders use their power to subvert the public interest - and how these negative consequences can be mitigated - is the topic of this book by Mark A. Zupan. (shrink)

Beginning in the 20th century, scientific research came to be dominated by a growing class of credentialed, professional scientists who overwhelmingly displaced the learned amateurs of an earlier time. By the end of the century, however, the exclusive realm of professional scientists conducting research was joined, to a degree, by “citizen scientists.” The term originally encompassed non-professionals assisting professional scientists by contributing observations and measurements to ongoing research enterprises. These collaborations were especially common in the environmental sciences, where citizen scientists (...) participated in counting wildlife and measuring environmental conditions. Later, patient groups began to play a more active role in supporting clinical trials and collecting health records from affected individuals. (shrink)

Researchers increasingly rely on large data sets of health information, often linked with biological specimens. In recent years, the argument has been made that obtaining informed consent for conducting records-based research is unduly burdensome and results in ?consent bias.? As a type of selection bias, consent bias is said to exist when the group giving researchers access to their data differs from the group denying access. Therefore, to promote socially beneficial research, it is argued that consent should be unnecessary. After (...) analyzing the biostatistics evidence and bioethics arguments, the article concludes that (1) claims about the amount of consent bias are overstated; (2) commonly used statistical methods usually can account for consent bias; and (3) any residual effects of consent bias are below an acceptable level of imprecision and constitute a reasonable social cost for conducting ethically responsible research. (shrink)

This article is an extended commentary inspired by Alan Drengson's paper “Shifting Paradigms: From Technocrat to Planetary Person” (Drengson 2011). In this article Susan Greenwood and I echo Drengson's criticism that Euro-American science is incomplete, having committed what Thomas Roberts calls “The Singlestate Fallacy: the erroneous assumption that all worthwhile abilities reside in our normal, awake mindbody state” (Roberts 2006:105). This singlestate fallacy is vividly portrayed in Mary Shelley's novel Frankenstein, whose critique of Euro-American science is revisited in this article. (...) Alternatively, Greenwood and I suggest that what is needed is a multimodel framework “that allows for in-depth analysis of the different modes of consciousness.” Roberts refers to this alternative attitude toward science as the Multistate Paradigm. An awareness of the transformational character of shamanism is also explored in this article as a means to overcome the oppositions between the technocratic and person planetary perspective, and their related gender associations. (shrink)

Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine, 501 East Broadway # 310, Louisville, Kentucky 40202, USA. Tel.: 502 852 4980; Fax: 502 852 4963; Email: mark.rothstein{at}louisville.edu ' + u + '@' + d + ' '//--> Abstract In his article in this issue, Daniel Goldberg advocates a broad definition of public health and expressly rejects the narrow definition of public health I proposed in (...) a 2002 article. Goldberg asserts that public health should include all of the root causes of ill health in populations. Such a definition, however, would include within public health war, famine, crime, illiteracy and numerous other conditions on which public health professionals and agencies lack the resources, expertise and public support to act. The appropriate definition explicitly recognizes that public health is a legal term of art referring to specifically authorized activities by public officials to protect, promote and improve population health. CiteULike Connotea Del.icio.us What's this? (shrink)