Unnecessary health care is a tremendous problem that negatively impacts individuals and also increases health care costs across the system. While much scholarly attention has been paid to the role of patients and providers, payors' role in contributing to the problem is underexplored. The article recommends that payors should nudge providers away from unnecessary care by requiring electronic alerts intended to deter unnecessary care.

Patient or public involvement in health research is increasingly expected as a matter of policy. In theory, PPI can contribute both to the epistemic aims intrinsic to research, and to extrinsically valued features of research such as social inclusion and transparency. In practice, the aims of PPI have not always been clear, although there has been a tendency to encourage the involvement of so-called ordinary people who are regarded as representative of an assumed patient perspective. In this paper we focus (...) on the epistemic potential of PPI, using theoretical work in epistemology to develop a nuanced account of patients’ experiential knowledge and how this might contribute directly to conceptual development, hypothesis generation and data interpretation. We also consider how some features of health research pose barriers to this kind of epistemic contribution. Drawing on Miranda Fricker’s idea of testimonial injustice, we explore how disciplinary indicators of credibility in clinical and academic health research contexts might be wrongly applied to those involved in PPI, undermining their potential to contribute. Finally we argue for a range of strategies to maximize opportunities for patients to engage with research teams and make epistemologically significant contributions to research. (shrink)

We conducted a meta-analysis of 17 studies that tested for an association between grandparental survival and grandchild survival in patrilineal populations. Using two different methodologies, we found that the survival of the maternal grandmother and grandfather, but not the paternal grandmother and grandfather, was associated with decreased grandoffspring mortality. These results are consistent with the findings of psychological studies in developed countries (Coall and Hertwig Behavioral and Brain Sciences 33:1-59, 2010). When tested against the predictions of five hypotheses (confidence of (...) paternity; grandmothering, kin proximity, grandparental senescence, and local resource competition), our meta-analysis results are most in line with the local resource competition hypothesis. In patrilineal and predominantly patrilocal societies, the grandparents who are most likely to live with the grandchildren have a less beneficial association than those who do not. We consider the extent to which these results may be influenced by the methodological limitations of the source studies, including the use of retrospective designs and inadequate controls for confounding variables such as wealth. (shrink)

This paper raises questions about the epistemological foundations of evidence-based medicine . We argue that EBM is based upon reliabilist epistemological assumptions, and that this is appropriate - we should focus on identifying the most reliable processes for generating and collecting medical knowledge. However, we note that this should not be reduced to narrow questions about which research methodologies are the best for gathering evidence. Reliable processes for generating medical evidence might lie outside of formal research methods. We also question (...) the notion of the knower that is assumed by EBM. We argue that EBM assumes an enlightenment conception of knowers as autonomous, substitutable individuals. This conception is troubled by the way that clinicians learn the role of anecdote in health care and the role of patient choice, all of which bring into play features of clinicians and patients as situated individuals with particular backgrounds and experiences. EBM's enlightenment conception of the knower is also troubled by aspects of the way evidence is produced. Given these limitations, we argue that EBM should retain its reliabilist bent, but should look beyond formal research methodologies in identifying processes that yield reliable evidence for clinical practice. We suggest looking to feminist epistemology, with its focus on the standpoints of individual situated knowers, and the role of social context in determining what counts as knowledge. (shrink)

Evidence-based medicine has been rapidly and widely adopted because it claims to provide a method for determining the safety and efficacy of medical therapies and public health interventions more generally. However, as others have noted, EBM may be riven through with cultural bias, both in the generation of evidence and in its translation. We suggest that technological and scientific advances in medicine accentuate and entrench these cultural biases, to the extent that they may invalidate the evidence we have about disease (...) and its treatment. This creates a significant ethical, epistemological and ontological challenge for medicine. (shrink)

Since the 1990s, glycated haemoglobin (HbA1C) has been the gold standard for monitoring glycaemic control in people diagnosed as having either type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM). Discussions are underway about diagnosing diabetes mellitus on the basis of HbA1C titres and using HbA1C tests to screen for T2DM. These discussions have focused on the relative benefits for individual patients, with some attention directed towards reduced costs to healthcare systems and benefits to society. We argue that (...) there are strong ethical reasons for adopting HbA1C-based diagnosis and T2DM screening that have not yet been articulated. The rationale includes the differential impact of HbA1C-based diabetic testing on disadvantaged groups, and what we are beginning to learn about HbA1C vis-à-vis population health. Although it is arguable that screening must primarily benefit the individual, using HbA1C to diagnose and screen for T2DM may promote a more just distribution of health resources and lead to advances in investigating, monitoring and tackling the social determinants of health. (shrink)

The American Journal of Bioethics, Volume 11, Issue 9, Page 18-20, September 2011.

According to Buddhist philosophies, recognizing the self as impermanent, changing, and interdependent is at the root of virtue. With this realization, desires shift away from inward self-cherishing and toward outward self-transcending. This altruistic outlook underlies virtuous action and flourishing. Our primary research question asks: 1) to what extent do people experience self-transcending and self-cherishing desires in everyday life, and 2) to what extent do these different desires predict behaviors and body physiology that underlie virtue and well-being. As highlighted by the (...) SMV project, one challenge involves measuring both intention and action. To overcome this challenge, we propose a multi­methodological study that will integrate first­person experiences of desires, second­person reports from close others, and third­person laboratory measures of prosocial behavior and body physiology that underlie virtue and flourishing in the context of social relationships. We will use an “experience sampling” method delivered via a smartphone app to capture psychological desires in daily life. In the laboratory, we will examine if desires in daily life are related to prosocial behavior and physiological synchrony during face-to-face social interactions with a romantic partner. Theoretically, we anticipate that integration of Buddhist philosophy into Western psychology research will encourage more emphasis on the deep psychological desires that appear to continually drive behavior. Empirically, we predict that frequent self-transcending desires in daily life will be related to prosocial behavior and physiological synchrony during interactions with romantic partners. Going forward, this project will provide the foundation for future work examining how the moral self can be shaped through contemplative practice in everyday life. (shrink)

Lloyd (2009) contends that climate models are confirmed by various instances of fit between their output and observational data. The present paper argues that what these instances of fit might confirm are not climate models themselves, but rather hypotheses about the adequacy of climate models for particular purposes. This required shift in thinking—from confirming climate models to confirming their adequacy-for-purpose—may sound trivial, but it is shown to complicate the evaluation of climate models considerably, both in principle and in practice.

Whether in characterizing Catharine MacKinnon's theory of gender as itself pornographic or in identifying liberalism as unable to make good on its promises, Wendy Brown pursues a central question: how does a sense of woundedness become the basis for a sense of identity? Brown argues that efforts to outlaw hate speech and pornography powerfully legitimize the state: such apparently well-intentioned attempts harm victims further by portraying them as so helpless as to be in continuing need of governmental protection. "Whether (...) one is dealing with the state, the Mafia, parents, pimps, police, or husbands," writes Brown, "the heavy price of institutionalized protection is always a measure of dependence and agreement to abide by the protector's rules." True democracy, she insists, requires sharing power, not regulation by it; freedom, not protection.Refusing any facile identification with one political position or another, Brown applies her argument to a panoply of topics, from the basis of litigiousness in political life to the appearance on the academic Left of themes of revenge and a thwarted will to power. These and other provocations in contemporary political thought and political life provide an occasion for rethinking the value of several of the last two centuries' most compelling theoretical critiques of modern political life, including the positions of Nietzsche, Marx, Weber, and Foucault. (shrink)

First published in 1982. Routledge is an imprint of Taylor & Francis, an informa company.

This article summarizes the April 5–6, 2002 conference on Conflict of Interest and Its Significance in Science and Medicine. Several themes are identified and addressed, including the globalization of science, the widespread presence of conflicts, the increased interest and involvement in conflict of interest by a number of organizations, the difference between academic research and research conducted by industry, and the tension between science and medicine. At the heart of the matter lies objectivity in research and the need for transparency (...) to ensure objectivity. Several future activities were discussed, including the need to share specific examples of how conflict has been managed, and the need for behavioral research to provide a sound empirical understanding of the best ways to provide informed consent for research subjects. (shrink)

After a short introduction, this article contains the text of a previously unpublished interview with Raymond Aron in which he discusses what he takes to be the significance and continuing importance, if any, of the French Revolution. In the course of the interview Aron discusses different interpretations of the Revolution. The interview took place in February 1983.

Informal political representation can be a political lifeline, particularly for oppressed and marginalized groups. Such representation can give these groups some say, however mediate, partial, and imperfect, in how things go for them. Coeval with the political goods such representation offers these groups are its particular dangers to them. Mindful of these dangers, skeptics challenge the practice for being, inter alia, unaccountable, unauthorized, inegalitarian, and oppressive. These challenges provide strong pro tanto reasons to think the practice morally impermissible. This paper (...) considers the question: On what conditions is the informal political representation of oppressed and marginalized groups permissible? By responding to skeptics’ challenges, I develop a systematic account of moral constraints that, if adopted, would make such representation permissible. The account that emerges shows that informal political representatives (IPRs) must aim to fulfill two sets of sometimes conflicting duties to the represented: democracy within duties, which concern how the representative treats and relates to the represented, and justice without duties, which concern how the representative’s actions advance the aims of the representation. (shrink)

This article reviews empirical and conceptual material from two distinct research traditions: on the science-technology relation and on industrial innovation. It aims both to shed new light on an old debate—the distinction between scientific and technological knowledge—and to refine our conceptualizations of the knowledge used by companies in the course of research and development leading to innovation. On the basis of three empirical studies, a composite categorization of different types of knowledge used in innovation is proposed, as part of a (...) broader framework encompassing two further taxonomic dimensions. It is hoped that this typology and framework might provide useful research tools in furthering our understanding of the knowledge transfers and transformations that occur in the course of innovation. It could also prove useful for organizations and groups facing difficult strategic choices about technology. (shrink)

Data from further human experiments touch four open questions in the target article. (1) Extinction of reward acquisition postulated by Depue & Collins's model could not be confirmed if correlating craving for, liking of, and satisfaction from smoking. (2) Intraindividual correspondence between responsivity to dopamine agonists and antagonists could likewise not be confirmed. (3) Nicotine craving and drug-induced hormone responses were not substantially correlated. (4) Low serotonin can be the cause and not just the moderator of dopaminergic sensitivity, and personality (...) correlates of low dopamine/low MAO (aggressive impulsive traits) can hardly be related to the positive emotion associated with dopaminergic activity. (shrink)

According to an adequacy-for-purpose view, models should be assessed with respect to their adequacy or fitness for particular purposes. Such a view has been advocated by scientists and philosophers...

In 1946, after an eight-year debate with the New Critics, Charles Morris doggedly maintained that "an education which gave due place to semiotic would destroy at its foundations the cleavage and opposition of science and the humanities."1 This insistence on the unity of disciplines—the hallmark of the logical empiricist movement and its brainchild, The International Encyclopedia of Unified Science —effectively silenced semiotics as a force in American literary studies. For the New Critics' point of departure—and one of the few tenets (...) that they held in common—was the belief that art creates a mode of knowledge different in kind from that of practical or scientific discourse and that a criticism modeled on the latter would miss the essence of its subject matter. The quarrel, which continued unresolved during the polemics of the war years, now fuels the controversy between structuralism and post-structuralism. It lies at the very heart of the question of the relevance of semiotics to the humanities. · 1. Charles Morris, Signs, Language, and Behavior, in Writings on the General Theory of Signs , p. 327. Wendy Steiner, assistant professor of English at the University of Pennsylvania, is the author of Exact Resemblance to Exact Resemblance: The Literary Portraiture of Gertrude Stein. She has written a book on the relations between modern painting and literature and edited the proceedings of the 1978 Ann Arbor Conference on the Semiotics of Art. (shrink)

Bioethics is a practically oriented discipline that developed to address pressing ethical issues arising from developments in the life sciences. Given this inherent practical bent, some form of advocacy or activism seems inherent to the nature of bioethics. However, there are potential tensions between being a bioethics activist, and academic ideals. In academic bioethics, scholarship involves reflection, rigour and the embrace of complexity and uncertainty. These values of scholarship seem to be in tension with being an activist, which requires pragmatism, (...) simplicity, certainty and, above all, action. In this paper I explore this apparent dichotomy, using the case example of my own involvement in international efforts to end forced organ harvesting from prisoners of conscience in China. I conclude that these tensions can be managed and that academic bioethics requires a willingness to be activist. (shrink)

Wendy Rogers ist Professorin für klinische Ethik und Catriona Mackenzie ist Professorin für Philosophie. Beide lehren an der Macquarie University in Sydney, Australien. Susan Dodds ist Professorin für Philosophie an der La Trobe University in Melbourne, Australien. Alle drei befassen sich seit Jahren intensiv mit feministischer Theorie, angewandter und biomedizinischer Ethik sowie mit Moralphilosophie.

Across the Euro-Atlantic world, political leaders have been mobilizing their bases with nativism, racism, xenophobia, and paeans to “traditional values,” in brazen bids for electoral support. How are we to understand this move to the mainstream of political policies and platforms that lurked only on the far fringes through most of the postwar era? Does it herald a new wave of authoritarianism? Is liberal democracy itself in crisis? In this volume, three distinguished scholars draw on critical theory to address our (...) current predicament. Wendy Brown, Peter E. Gordon, and Max Pensky share a conviction that critical theory retains the power to illuminate the forces producing the current political constellation as well as possible paths away from it. Brown explains how “freedom” has become a rallying cry for manifestly un-emancipatory movements; Gordon dismantles the idea that fascism is rooted in the susceptible psychology of individual citizens and reflects instead on the broader cultural and historical circumstances that lend it force; and Pensky brings together the unlikely pair of Tocqueville and Adorno to explore how democracies can buckle under internal pressure. These incisive essays do not seek to smooth over the irrationality of the contemporary world, and they do not offer the false comforts of an easy return to liberal democratic values. Rather, the three authors draw on their deep engagements with nineteenth–and twentieth–century thought to investigate the historical and political contradictions that have brought about this moment, offering fiery and urgent responses to the demands of the day. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Duality and Non-Duality in Christian Practice:Reflections on the Benefits of Buddhist-Christian Dialogue for Constructive TheologyWendy FarleyThe question before us is the desirability of Buddhist-Christian dialogue in the work of (what Christians call) constructive theology. As a feminist theologian whose work is ever more deeply shaped by such a dialogue, my immediate answer is an unequivocal yes.1 This dialogue fits a general pattern over two thousand years in which theologians (...) have drawn from the wisdom of other traditions or cultures to better understand the mysteries of human experience. Without neo-Platonism and Aristotle there could hardly have been anything we recognize as Christian theology. Without pre-Christian Irish religion, there would be no Saint Brigit or Celtic Christianity. Without phenomenology, process, and Marxist philosophy the greatest works of twentieth-century Christian thought would not exist. Christianity, like all religions, is a moving river changed by time and culture and nearly as interiorly diverse as its members. The dialogue with Buddhism might be seen as a contemporary example of Christianity's openness to exchange with other ways of thinking that broadens and deepens its best insights. It is perhaps analogous to Origen's reliance on neo-Platonism or Thomas Aquinas's inspiration by the rediscovery of Aristotle.2The porous boundaries between Christianity and its culture open it to wisdom beyond itself but they also open it to cruelty and ignorance. Nothing protects religions from participating in the human condition and thus the prejudices and power structures that mutilate human society. Consumer culture and oppressions by class, ethnicity, and gender are seamlessly incorporated into Christian identity. The tacit synthesis of a culture's values with those of a religion neutralizes possible critique and can elevate a society's oppressions to a sacred duty. For this reason, too, dialogue with Buddhism is important to call Christianity back to its ethical moorings in the ideal of universal love and compassion.Religions are porous to the world around them, but they tend to conceal this from themselves and often imagine themselves to be not only untainted but also uniquely [End Page 135] qualified to mediate salvation. Religions provide human beings with language and practice through which dimensions of reality that cannot simply be read off of nature or experience are (in some sense) encountered. This is their great gift. The difficulty of religions is that tradition can become an end in itself. Because a tradition really does offer meaning and tools for transformation it is easy to slip into the existential posture of so idealizing a tradition that it seems in some direct and exclusive way to correlate to ultimate truth. The curvature of the ego onto itself, so attached to its own pain and pleasure that everything else seems a mere shadow, moves from the microcosm of the self to the macrocosm of religious tradition. The particular religion—or that element within it with which I identify—becomes identical with sacred reality. In the hostility to other religions characteristic of many Christians we see the illusion of egocentrism in its religious form. Paul Tillich described this tendency to absolutize itself as the demonic distortion of religion.3 Religious dialogue is a potent medicine against this overattachment to one's own tradition.These different senses in which a religion integrates into itself the wisdom and illusions of its time and place create enormous diversity within a religious tradition. Root concepts within Christianity concerning soteriology, divinity, and suffering do not have any agreed upon meaning. That is, there is no "Christian" view of salvation. Gregory of Nyssa's ideal of theosis, Luther's emphasis on salvation by grace through faith, an evangelical's experience of being born again, a liberal Protestant's commitment to social justice are so diverse that they seem to represent almost different religions.In light of the malleability and interior diversity of traditions, dialogue may not be between two self-sufficient religions but between participants who inhabit their tradition in a variety of ways.4 With this in mind, I would like to experiment with practice as a basis for some kinds of dialogue. Practice is concretely located in a religious tradition and yet reflects... (shrink)

T. G. Masaryk’s thought is famous for his concept of the Czech nation as well as his ideals of humanity. As a philosopher, sociologist, and politician, he was confronted with Czech anti-Semitism, and after Czechoslovakia was founded, with issues of the Jewish national minority. He tried to solve all the questions with respect to his ethical conviction and the ideals of democracy and equality. The most difficult personal situation for Masaryk emerged with the ‘Hilsner affair’, when his brave stance against (...) anti-Semitism caused animosity and even hatred from the public. As a consequence of that Masaryk had to abandon his public activities including lecturing at university for some time. The philosopher Jan Patočka analysed Masaryk’s involvement in this case and the following events in his study Masaryk’s struggle against anti-Semitism. Patočka pointed out that there is an interconnection between Masaryk’s involvement in this affair and his engagement in the question of Czech nationality, as Masaryk intended to improve the ethical level of the nation by disposing of bias and namely the ritual murder myth. The second part of the present contribution is focused on Masaryk’s views on Zionism and the assimilation movement and his ambiguity in relation to the issue. It seems that Masaryk’s concept of the Czech nation, formed for the struggle against the Habsburg monarchy, became inadequate in the new republic, as it was not inclusive of the many minorities, the Jewish one included. On the other hand, Masaryk’s ideals of humanity provide a certain solution on the level of ethics. (shrink)

Taking its cue from sign languages, this paper pulls together a range of studies to support the proposal that the recruitment and composition of body actions counts as evidence for linguistic properties. Adopting the view that compositionality is the foundational organizing property of language, we find first that actions of the hands, face, head, and torso in sign languages directly reflect linguistic components, as well as certain aspects of compositional organization among them that are common to all languages, signed and (...) spoken. Work on emerging sign languages strengthens the approach by showing that the gradual recruitment of bodily articulators for linguistic functions directly maps the way in which a new language increases in complexity over time. While compositional communication is almost exclusively restricted to humans, it is not restricted to language. In the spontaneous, intense emotional displays of athletes, different emotional states are correlated with actions of particular face and body features and feature groupings, indicating a much more ancient compositional foundation for language. (shrink)

While the economic and environmental dimensions of the triple bottom line have been covered extensively by management theory and practice, the social dimension remains largely underrepresented. The resource-based view of the firm and the natural resource-based view of the firm are revisited to lay the theoretical foundation for exploring how the social dimension might be addressed. Social capabilities are then explored by looking at the social entrepreneurship literature and illustrative cases with the purpose of elaborating RBV toward a social resource-based (...) view of the firm. Three illustrative cases, which represent social businesses located in catastrophe-ridden Haiti, show how capabilities are used to overcome challenging constraints. The goal for the social entrepreneur is to employ the appropriate capabilities to ensure economic success, a positive environmental impact, and social benefits that leave the local community in a better position than without the business. Just as NRBV is a previous elaboration of RBV, so can SRBV be an elaborated theoretical foundation for future research. The components of a theory are systematically addressed by extending the range of variables, extending the domain, and offering propositions on variable relationships and outcome predictions. By highlighting the social capabilities of social entrepreneurs, this research illuminates the micro-foundations of corporate social responsibility, emphasizing the value of individual level analyses. (shrink)

This article explores some of the roles of computer simulation in measurement. A model-based view of measurement is adopted and three types of measurement—direct, derived, and complex—are distinguished. It is argued that while computer simulations on their own are not measurement processes, in principle they can be embedded in direct, derived, and complex measurement practices in such a way that simulation results constitute measurement outcomes. Atmospheric data assimilation is then considered as a case study. This practice, which involves combining information (...) from conventional observations and simulation-based forecasts, is characterized as a complex measuring practice that is still under development. The case study reveals challenges that are likely to resurface in other measuring practices that embed computer simulation. It is also noted that some practices that embed simulation are difficult to classify; they suggest a fuzzy boundary between measurement and non-measurement. 1 Introduction2 A Contemporary View of Measurement3 Three Types of Measurement4 Can Computer Simulations Measure Real-World Target Systems?5 Case Study: Atmospheric Data Assimilation5.1 Why data assimilation?5.2 A complex measuring practice under development5.3 Epistemic iteration6 The Boundaries of Measurement7 Epistemology, Not Terminology. (shrink)

Concern for human vulnerability seems to be at the heart of bioethical inquiry, but the concept of vulnerability is under-theorized in the bioethical literature. The aim of this article is to show why bioethics needs an adequately theorized and nuanced conception of vulnerability. We first review approaches to vulnerability in research ethics and public health ethics, and show that the bioethical literature associates vulnerability with risk of harm and exploitation, and limited capacity for autonomy. We identify some of the challenges (...) emerging from this literature: in particular, how to reconcile universal human vulnerability with a context-sensitive analysis of specific kinds and sources of vulnerability; and how to reconcile obligations to protect vulnerable persons with obligations to respect autonomy. We then briefly survey some of the theoretical resources available within the philosophical literature to address these challenges, and to assist in understanding the conceptual connections between vulnerability and related concepts such as harm, exploitation, needs, and autonomy. We also sketch out a taxonomy of sources and kinds of vulnerability. Finally, we consider the implications for policy evaluation of making vulnerability an explicit and central focus of bioethics. Our investigation is in the form of a broad survey motivating a research agenda rather than a detailed analysis. (shrink)

I would describe myself as an accidental humanist, if not atheist. That was very much how I felt when I found myself on June 4, 2010, standing at the podium of the sixty-ninth annual conference of the American Humanist Association. I was receiving the Humanist Pioneer Award. But what did I do to deserve the honor? The golden letters on the beautifully crafted award said: “To Wendy Liu for her pioneering work that advances Humanist values and critical thought through (...) cross cultural perspectives on American Society.” The “pioneering work” presumably meant my writings on US-China relatedtopics, especially the collection of essays on my understanding of America from a Chinese and non-religious angle. As an aspiring writer, I was happy to be recognized for anything, not to say that particular angle. But that angle, with which I stumbled my way to the San Jose conference, was not an accident. It had come a long way with me on a journey starting in Xian, China, my hometown. Talking about Xian, the terracotta warriors of Qin Shihuang, the first Emperor of China, would probably come to one’s mind. Visitors have marveled at the work of ancient artisans, especially the rendering of individual facial features of the clay soldiers in eternity. In contrast to that humanistic touch was the cruelty of Emperor Qin, who ordered that upon his death the entrance to the underground mausoleum be sealed on completion, entombing the laborers inside to keep it secret.1 This is a brief but telling picture of humanism vs. tyranny in China–the once-upon-a time China. (shrink)