Non-pharmaceutical interventions, including social distancing, quarantine, and isolation, are a potentially attractive means to limit the transmission of a pandemic virus. Many of these interventions are directed at children given children’s disproportionate role in amplifying epidemics. The ethics of non-pharmaceutical interventions can be analyzed using Nancy Kass’ ethics framework for public health. Such an analysis highlights the limited data supporting these interventions’ effectiveness. It also suggests the framework itself needs to be expanded to consider (...) harms other than constraints on liberty and to consider affirmative programs to mitigate these broader harms. (shrink)

The paper discusses non-pharmaceutical interventions (NPIs) as a collective form of protection that, in terms of health justice, benefits groups at risk, allowing them to engage in social life and activities during health crises. More specifically, the paper asserts that NPIs that realize social distancing are justifiable insofar as they are constitutive of a type of social protection that allows everyone, especially social disadvantaged agents, to access the public health sphere and other fundamental social spheres, such as the (...) family and civil society. (shrink)

A wide range of non-pharmaceutical interventions (NPIs) have been introduced to stop or slow down the COVID-19 pandemic. Examples include school closures, environmental cleaning and disinfection, mask mandates, restrictions on freedom of assembly and lockdowns. These NPIs depend on coercion for their effectiveness, either directly or indirectly. A widely held view is that coercive policies need to be publicly justified—justified to each citizen—to be legitimate. Standardly, this is thought to entail that there is a scientific consensus on the (...) factual propositions that are used to support the policies. In this paper, we argue that such a consensus has been lacking on the factual propositions justifying most NPIs. Consequently, they would on the standard view be illegitimate. This is regrettable since there are good reasons for granting the state the legitimate authority to enact NPIs under conditions of uncertainty. The upshot of our argument is that it is impossible to have both the standard interpretation of the permissibility of empirical claims in public justification and an effective pandemic response. We provide an alternative view that allows the state sufficient room for action while precluding the possibility of it acting without empirical support. (shrink)

This paper discusses the issue of overriding the right of individual consent to participation in cluster randomised trials (CRTs). We focus on CRTs testing the efficacy of non-pharmaceutical interventions. As an example, we consider school closures during the COVID-19 pandemic. In Norway, a CRT was promoted as necessary for providing the best evidence to inform pandemic management policy. However, the proposal was rejected by the Norwegian Research Ethics Committee since it would violate the requirement for individual informed consent. (...) This sparked debate about whether ethics stand in the way of evidence-based health policy, since the Norwegian Research Ethics law’s strict requirements for individual consent make it practically impossible to carry out CRTs of public health interventions. We argue that, in the case of the school closure trial, the suggested CRT would not have eliminated an epistemic gap and thus would not have justified the violation of consent rights. First, we focus on the methodological challenges to estimating quantifiable effects of school closures in the specific case of an airborne infectious disease. Second, in line with Evidential Pluralism, we highlight the value of alternative lines of evidence for informing school closure policy in a pandemic. In general, we propose that a trial requiring the waiver of participants’ consent rights must be highly likely to eliminate an epistemic gap. We elaborate on the practical aspects of this criterion and discuss the potential advantages of adding it to the Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials. (shrink)

Measured against the gloomy pre-COVID-19 predictions, Africa has fared far better than most regions in managing the pandemic. This much, however, has received less attention. This paper answers the question: how have the new rituals of self determination in public health affected the successful management of COVID-19 in Africa, and how can the continent and the rest of the world build on such models/lessons in the post-pandemic era? I employ emancipatory theorising in reviewing literature on approaches to governance of COVID-19. (...) The rationale is to empower the grassroots and to accentuate the urgency for a decolonized local ownership of the governance of all public health crises. I argue that while traditional international cooperation is necessary for additional resource and expertise from the global North for sustainable health, the political will of Southern governments remains fundamental for any extraordinary success due to its grassroots/community orientation towards non-pharmaceutical interventions and initial pre-emptive rituals. The novelty in this paper is that it lays bare the ignored African responses and lessons and reveals how to harness protective communitarian ethos in solving future crises. The paper further provides population health as an ‘immune system’ policy framework for explaining and predicting how a scientific and human-centrered grassroots leadership can yield optimal outcomes in any future crisis. (shrink)

In February 2020, as covid-19 infections spread to more than fifty countries, public health officials needed to recommend how the public could protect themselves, balancing safety and urgency. But there was very little data since this novel virus had only been identified three months prior. How could public health officials decide with insufficient data? The multi-armed bandit problem of computer science offers adaptive decision-making procedures that can achieve both safety and urgency. These adaptive methods balance learning information (exploring) with using (...) information (exploiting), adjusting the balance toward learning when uncertainty is high (March 1991; Kaelbling et al. 1996). Related methods are already used in adaptive clinical trials for pharmaceuticals (Pallmann et al. 2018). But we still need to develop these methods for non-pharmaceutical interventions, as I will illustrate with a case study of public mask-wearing to reduce the spread of covid-19. Public health pronouncements impact future learning. (shrink)

The recent rise of injectable ‘wonder drugs’ for weight loss has been rapid and unregulated (so rapid that it has resulted in a worldwide shortage of Ozempic). We analyse the commercialisation of these drugs, and the political manoeuvres companies engage in to leverage and manufacture the gendered capitalism of ‘care’. Marketing relies heavily on situating ‘obesity’ as a chronic disease influenced by genes or other aspects of biology, working therefore to supposedly mitigate the blame and shame of the taken-for-granted aetiology (...) of ‘obesity’, overwhelmingly understood as excess food intake and insufficient activity. Armed with this evidence, women are told to ‘stand up against weight care judgement’ and to engage in ‘shame free’ care. Pharmaceutical interventions are at the ready to inject this weekly dose of care, producing freedom through neoliberal pleasure but, ironically, in doing so, sacrificing the pleasure of food and non-conditional self-acceptance as vital forms of self-care. (shrink)

An abundance of data unequivocally shows that exercise can be an effective tool in the fight against obesity and its associated co-morbidities. Indeed, physical activity can be more effective than widely-used pharmaceutical interventions. Whilst metformin reduces the incidence of diabetes by 31% (as compared with a placebo) in both men and women across different racial and ethnic groups, lifestyle intervention (including exercise) reduces the incidence by 58%. In this context, it is notable that a group of prominent medics (...) and exercise scientists recently sent a well-publicised letter to the General Medical Council and Medical Schools Council calling for the introduction of evidence-based lifestyle education into all medical curricula. The letter warns that there is a lack of understanding of the impact that exercise and nutrition can have on physical health amongst doctors. In the absence of an educational overhaul, the signatories warn that the government is likely to fail to reach its goal of preventing tens of thousands of premature deaths from heart disease and cancer by 2020. Whilst we agree with the need to address this apparent lack of understanding, we argue that the ethical justification of doing so is not limited to this broadly beneficence-based justification. There is also a justification grounded in the duty of non-maleficence, that is, the duty to avoid unreasonably harming patients. This duty requires that doctors refrain from (i) preventing patients from undergoing beneficial treatment without good reason, (ii) exposing patients to unreasonable risks and (iii) reducing the therapeutic effect of an effective medical intervention. This requires an understanding of the physical impact of exercise. (shrink)

Healthcare delivery and access, both in the United States and globally, were negatively affected during the entirety of the COVID-19 pandemic. This was particularly true during the first year when countries grappled with high rates of illness and implemented non-pharmaceutical interventions such as stay-at-home orders. Among children with special healthcare needs, research from the United Kingdom (U.K.) has shown that the pandemic response uniquely impacted various aspects of their care, including decreased access to care, delays in diagnosis, and (...) poorer chronic disease control. In response to these findings, and to begin to comprehend whether the concerning findings from the nationalized system of healthcare in the U.K. extend to the highly dissimilar United States (U.S.) healthcare context, we reviewed the literature on alterations in access to and delivery of care during the early stages of the COVID-19 pandemic for children with special healthcare needs in the U.S. We then utilize these findings to consider the ethical and policy considerations of alterations in healthcare provision during pandemics and crisis events in the U.K. and U.S. and make recommendations regarding how the needs of CSHCN should be considered during future responses. (shrink)

‘Moral bioenhancement’ refers to the use of pharmaceuticals and other direct brain interventions to enhance ‘moral’ traits such as ‘empathy,’ and alter any ‘morally problematic’ dispositions, such as ‘aggression.’ This is believed to result in improved moral responses. In a recent paper, Tom Douglas considers whether medical interventions of this sort could be “provided as part of the criminal justice system’s response to the commission of crime, and for the purposes of facilitating rehabilitation : 101–122, 2014).” He suggests (...) that they could “at least in some cases, permissibly be provided without valid consent : 101–122, 2014)” as a form of rehabilitative punishment. He argues for this conclusion by ‘parity of reasoning,’ starting from the currently accepted practice of non-consensual incarceration. His argument appears to be dependent on the successful defence of the following two claims: that non-consensual incarceration is a morally justifiable practice, and that there is no meaningful distinction between the forcible imposition of this practice, and the forcible imposition of medical interventions on prisoners. From both claims, he deduces : if non-consensual incarceration is morally justifiable, so is the non-consensual imposition of medical correctives, in some cases. In this paper, I begin by suggesting that the basic argument behind the Parity Claim results in a reductio ad absurdum, whereby any practice that is sufficiently similar to incarceration in the ways Douglas presents, would also be considered permissible. This appears to be an unpalatable conclusion, casting doubt on the soundness of a key premise. Douglas appears to offer no means of deciding which practices are sufficiently similar to incarceration in terms of harm and threat to agency, and of the practices that I will present, which do seem to be, it does not seem that he could rule them out in any principled way. Next I turn to dispute claim relating to the purported justifiability of incarceration on rehabilitative grounds. If successful, this attack causes a break in reasoning from the justifiability of incarceration, to the justifiability of medical interventions. Medical interventions would then require an alternative, independent justification, through outlining the ways in which they are conducive to a particular aim of punishment, without relying on the justifiability of incarceration. This argument has not been provided, and I suggest that attempts to do so may run into difficulty. I untangle and make explicit the various assumptions made in Douglas’ contention that medical interventions “might be thought conducive to rehabilitation in some offenders,” locating my critique in the wider debate on the causes of crime. Finally, I seek to challenge the normative weight of the Parity Claim, arguing that to show that two practices are comparable in some sense is not sufficient to show that both are equally as permissible. Other social purposes must be considered, leading me to suggest that the forcible imposition medical correctives falls beyond the appropriate remit of the criminal justice system. (shrink)

This book isolates three moments within the epidemic—‘the Science,’ non-pharmaceutical intervention, and pharmaceutic remedies—and shows how each of these unities came to immunise itself against alternative proposals. Michael Lewis demonstrates the auto-immune and counter-productive effects of this approach.

Lockdowns, or modern quarantines, involve the use of novel restrictive non-pharmaceutical interventions (NPIs) to suppress the transmission of COVID-19. In this paper, I aim to critically analyze the emerging history and philosophy of lockdowns, with an emphasis on the communication of health evidence and risk for informing policy decisions. I draw a distinction between evidence-based and modeling-based decision-making. I argue that using the normative framework of evidence-based medicine would have recommended against the use of lockdowns. I first review (...) the World Health Organization’s evidence-based pandemic preparedness plans for respiratory viruses. I then provide a very brief history of COVID-19 modeling, which was cited as justification for the use of lockdowns in the U.K., the U.S., and much of the world. I focus on the so-called Imperial College model designed by Neil Ferguson et al. as well as the so-called Oxford model designed by José Lourenço et al. I analyze the evidence-based pandemic response known as ‘mitigation’, and I compare it with Ferguson et al.’s experimental strategy known as ‘suppression’. I summarize the strengths and weaknesses of these strategies based on their diametric aims and each model’s parametric assumptions. Based on my critical analysis of the suppression strategy, I attempt to expose what has been called the ‘logic of lockdowns’, which Sunetra Gupta of the Oxford model group has suggested is flawed. Finally, I consider Trisha Greenhalgh’s objection to evidence-based policy based on the precautionary principle, and I attempt to offer a response. I conclude with a brief narrative review of the emerging randomized evidence on restrictive NPIs, which seems to support my claim that mitigation was the strategy that would have been recommended by evidence-based medicine. If this is true, then COVID-19 modeling may serve as an important reminder of the enduring lesson of evidence-based medicine: that one should always ‘Trust the Evidence!’ for better health policy. (shrink)

In times of crises, public health leaders may claim that trials of public health interventions are unethical. One reason for this claim can be that equipoise—i.e. a situation of uncertainty and/or disagreement among experts about the evidence regarding an intervention—has been disturbed by a change of collective expert views. Some might claim that equipoise is disturbed if the majority of experts believe that emergency public health interventions are likely to be more beneficial than harmful. However, such beliefs are (...) not always justified: where high quality research has not been conducted, there is often considerable residual uncertainty about whether interventions offer net benefits. In this essay we argue that high-quality research, namely by means of well-designed randomized trials, is ethically obligatory before, during, and after implementing policies in public health emergencies (PHEs). We contend that this standard applies to both pharmaceutical and non-pharmaceutical interventions, and we elaborate an account of equipoise that captures key features of debates in the recent pandemic. We build our case by analyzing research strategies employed during the COVID-19 pandemic regarding drugs, vaccines, and non-pharmaceutical interventions; and by providing responses to possible objections. Finally, we propose a public health policy reform: whenever a policy implemented during a PHE is not grounded in high-quality evidence that expected benefits outweigh harms, there should be a planned approach to generate high-quality evidence, with review of emerging data at preset time points. These preset timepoints guarantee that policymakers pause to review emerging evidence and consider ceasing ineffective or even harmful policies, thereby improving transparency and accountability, as well as permitting the redirection of resources to more effective or beneficial interventions. (shrink)

While there has been a significant amount of scholarship done on health and risk in relation to public health and disease prevention, relatively little attention has been paid to therapeutic interventions which seek to manage risks as bodily, and biological, matters. This article elucidates the distinct qualities and logics of these two different approaches to risk management, in relation to Michel Foucault’s conception of the two poles of biopower, that is, a biopolitics of the population and an anatomo-politics of (...) the human body. Using a case study of contemporary addiction biomedicine, the article examines the development and deployment of treatments for addiction that seek to reduce the risks of relapse to drug use, and relates this case to other risk-reducing (but non-curative) medications, particularly cholesterol-reducing medications. The notion of a ‘disease of risk’ is developed in order to identify a range of medical conditions that bear a family resemblance, insofar as they are pharmaceutically managed with risk-reducing medications, and bound up within what is described as a contemporary ‘risk anatomo-politics’. (shrink)

Should research projects involving epidemiological modelling be subject to ethical scrutiny and peer review prior to publication? Mathematical modelling had considerable impacts during the COVID-19 pandemic, leading to social distancing and lockdowns. Imperial College conducted research leading to the website publication of a paper, Report 9, on non-pharmaceutical interventions (NPIs) and COVID-19 mortality demand dated 16th March 2020, arguing for a Government policy of non-pharmaceutical interventions (e.g. lockdowns, social distancing, mask wearing, working from home, furlough, school (...) closures, reduced family interaction etc.) to counter COVID 19. Enquiries and Freedom of Information requests to the institution indicate that there was no formal ethical committee review of this specific research, nor was there any peer review prior to their online publication of Report 9. This paper considers the duties placed upon researchers, institutions and research funders under the UK ‘Concordat to Support Research Integrity’ (CSRI), across various bioethical domains, and whether ethical committee scrutiny should be required for this research. (shrink)

In the following paper I develop an account of Gilles Deleuze’s ethics through his work on Spinoza, which he contrasts with morality, to argue that an ethical response to the COVID-19 pandemic should resist the moralizing of the New Normal and instead have an immanent focus on what is happening to us. In the first part of the paper I detail the novel approach to ethics as ethology that Deleuze works out most explicitly in Spinoza: Practical Philosophy. In the second (...) part I show exactly how Deleuze contrasts ethics from morality and moral thinking before showing the relation of ethics to morality in relation to the New Normal and contrast the Deleuzian ethical perspective from other ethical philosophical accounts that I claim are indicative a moral approach to the New Normal. I conclude by arguing that the prevalence of the New Normal amidst COVID-19 represents a triumph of what Spinoza calls the sad passions and suggest Deleuze’s ethics might be a way to reject those sad passions. (shrink)

Phosphotyrosine phosphatases (PTPases) are the enzymes which remove phosphate groups from protein tyrosine residues. An enormous number of phosphatases have been cloned and sequenced during the past decade, many of which are expressed in haematopoietic cells. This review focuses on the biochemistry and cell biology of three phosphatases, the transmembrane CD45 and the cytosolic SH2‐domain‐containing PTPases SHP‐1 and SHP‐2, to illustrate the diverse ways in which PTPases regulate receptor signal transduction. The involvement of these and other PTPases has been demonstrated (...) in haematopoietic cell development, apoptosis, activation and non‐responsiveness. A common theme in the actions of many haematopoietic cell PTPases is the way in which they modulate the thresholds for receptor signalling, thereby regulating critical events in the positive and negative selection of lymphocytes. There is growing interest in haematopoietic PTPases and their associated regulatory proteins as targets for pharmaceutical intervention and in the involvement of these enzymes in human disease. (shrink)

When experienced in-person, engagement with art has been associated—in a growing body of evidence—with positive outcomes in wellbeing and mental health. This represents an exciting new field for psychology, curation, and health interventions, suggesting a widely-accessible, cost-effective, and non-pharmaceutical means of regulating factors such as mood or anxiety. However, can similar impacts be found with online presentations? If so, this would open up positive outcomes to an even-wider population—a trend accelerating due to the current COVID-19 pandemic. Despite its (...) promise, this question, and the underlying mechanisms of art interventions and impacts, has largely not been explored. Participants were asked to engage with one of two online exhibitions from Google Arts and Culture. With just 1–2 min exposure, both improved negative mood, state-anxiety, loneliness, and wellbeing. Stepdown analysis suggested the changes can be explained primarily via negative mood, while improvements in mood correlated with aesthetic appraisals and cognitive-emotional experience of the exhibition. However, no difference was found between exhibitions. We discuss the findings in terms of applications and targets for future research. (shrink)

In 2014, John O’Keefe was awarded the Nobel Prize in Physiology or Medicine for his work on the hippocampus and its role in encoding map-like representations. His contributions were significantly influenced by Morris water maze studies. O’Keefe himself acknowledged the pivotal role of the Morris water maze, stating that it remains the preeminent behavioral assay for assessing hippocampal function. Indeed, thousands of researchers have turned to the Morris water maze for evidence about navigation abilities and the effects that stress, lesions, (...) pharmaceutical interventions, and more can have on them. This body of studies constitutes an important scientific enterprise. -/- This dissertation is about some of the philosophical dimensions of Morris water maze studies. Chapter 1 is about the different types of information states (including representational states) found across hypotheses about Morris water maze performance. Chapter 2 is about systematic task failures reported in Morris water maze studies. I argue these impose a constraint on what can count as an explanation (a good hypothesis) of task success. While this has the air of a chopping block for scientific hypotheses, I see things a little differently. In Chapter 3, I argue that satisfying the constraint is a formidable challenge for any hypothesis. One that should make researchers second-guess the concepts and strategies employed to explain the roles information states play in the maze task. Chapter 4 focuses on two spatial concepts. I argue that researchers working definitions for the spatial concepts of distal (far) and proximal (near) in maze studies are problematic. They are not ecologically valid, and so claims about them do not generalize to real-life navigation behaviors like migration or scavenging behaviors. Following this, I present alternative definitions in terms of neural information about visual cues. The neural information relevant to this account is non-conceptual, and so it provides a sketch of the ways in which information states can fruitfully contribute to explanations of rat success and failure while maintaining ecological validity. -/- To sum, this dissertation navigates important philosophical dimensions of Morris water maze studies, illustrating the challenges and opportunities involved in using information states to explain and understand animal navigation. (shrink)

This paper attempts a critical discussion of the possibilities for mental health nurses to claim a particular right of conscientious objection to their involvement in enforced pharmaceutical interventions. We nest this within a more general critique of perceived shortcomings of psychiatric services, and injustices therein. Our intention is to consider the philosophical and practical complexities of making demands for this conscientious objection before arriving at a speculative appraisal of the potential this may hold for broader aspirations for a (...) transformed or alternative mental health care system, more grounded in consent than coercion. We consider a range of ethical and practical dimensions of how to realize this right to conscientious objection. We also rely upon an abolition democracy lens to move beyond individual ethical frameworks to consider a broader politics for framing these arguments. (shrink)

While “Love Drugs” may look today like science fiction, psychopharmacology has already a long history of influencing humans’ thoughts, emotions and behavior (Lehmann 1993). Thus, if Love Drugs mate...

The world's political and military leaders are under increasing pressure to intervene in the affairs of sovereign nations. Although the sovereignty of states and the corollary principle of nonintervention have been part of the foundation of international law, there is some latitude for states, as well as collective security organizations, to intervene in another state's domestic and foreign affairs, thus making sovereignty and the principle less than absolute. In this paper I first sketch a reasonable foundation for sovereignty of states (...) and the principle of nonintervention. Second, I offer a decision-making procedure for justified intervention. Finally, I argue that there is an important difference between the strategic argument and the humanitarian argument, a difference that may have profound implications for the future use of the latter argument by our political leaders. (shrink)

Current developments in the area of neuroenhancement pose multiple ethical and societal questions. Improvements in general cognitive capacities can have important positive effects. With the use of several interventions, ranging from pharmaceutics through microsurgery to non-invasive and invasive methods, new possibilities of enhancing human abilities can be achieved. Yet, they have to be critically evaluated from the point of view of both individual and societal consequences that are involved. The aim of this paper is to address societal benefits and (...) challenges that are related to these interventions. These new developments, especially in the specific area of their military application, pose important questions with regard to safety of their use, long-term results, coercion to use them, and issues of inequality. Often, these consequences are unforeseeable at the present moment and can greatly interfere with development of both individuals and societies. Therefore, as in both areas – civilian and military – the long-term consequences are still difficult to predict, prudency is prescribed. Consequently, any use of the methods of enhancement should be under exceptional scrutiny from the ethical as well as legal and social point of view. (shrink)

Alzheimer’s disease is emerging into public view in unprecedented ways. Foremost among these is the embodied form of elderly men and women appearing in commercial imagery for patient advocacy groups or pharmaceutical advertisements, but scientific imagery also seeps into the visual media cultures that surround us. The recent reconfiguration of Alzheimer’s disease is due to expanding ageing populations, an aggressive biopharmaceutical industry becoming a fast-growing material-semiotic realm that is providing powerful images of both gendered and racialized embodiment. Such a (...) visual, and yet highly material, realm is in need of feminist interventions, engaging with the images and ideas that circulate around ageing, medicine, human and non-human embodiment. From a non-representationalist and posthumanist perspective identified as feminist visual studies of technoscience, the authors seek to further the discussion in the direction of understanding the ‘scattered ontologies’ of Alzheimer’s — in laboratory practice, the realm of medical media and in commercial appeals to coherent individuality and human cognition — as gendered domains of figural reality and performative matter. (shrink)

In ‘Moral Enhancement, Freedom, and the God Machine’, Savulescu and Persson argue that recent scientific findings suggest that there is a realistic prospect of achieving ‘moral enhancement’ and respond to Harris's criticism that this would threaten individual freedom and autonomy. I argue that although some pharmaceutical and neuro‐scientific interventions may influence behaviour and emotions in ways that we may be inclined to evaluate positively, describing this as ‘moral enhancement’ presupposes a particular, contested account, of what it is to (...) act morally and implies that entirely familiar drugs such as alcohol, ecstasy, and marijuana are also capable of making people ‘more moral’. Moreover, while Savulescu and Persson establish the theoretical possibility of using drugs to promote autonomy, the real threat posed to freedom by ‘moral bioenhancement’ is that the ‘enhancers’ will be wielding power over the ‘enhanced’. Drawing on Pettit's notion of ‘freedom as non‐domination’, I argue that individuals may be rendered unfree even by a hypothetical technology such as Savulescu and Persson's ‘God machine’, which would only intervene if they chose to act immorally. While it is impossible to rule out the theoretical possibility that moral enhancement might be all‐things‐considered justified even where it did threaten freedom and autonomy, I argue that any technology for biomedical shaping of behaviour and dispositions is much more likely to be used for ill rather than good. (shrink)

The persistent educational challenges that fractions pose call for developing novel instructional methods to better prepare students for fraction learning. Here, we examined the effects of a 24-session, Cuisenaire rod intervention on a building block for symbolic fraction knowledge, continuous and discrete non-symbolic proportional reasoning, in children who have yet to receive fraction instruction. Participants were 34 second-graders who attended the intervention (intervention group) and 15 children who did not participate in any sessions (control group). As attendance at the intervention (...) sessions was irregular (median = 15.6 sessions, range = 1–24), we specifically examined the effect of the number of sessions completed on their non-symbolic proportional reasoning. Our results showed that children who attended a larger number of sessions increased their ability to compare non-symbolic continuous proportions. However, contrary to our expectations, they also decreased their ability to compare misleading discretized proportions. In contrast, children in the Control group did not show any change in their performance. These results provide further evidence on the malleability of non-symbolic continuous proportional reasoning and highlight the rigidity of counting knowledge interference on discrete proportional reasoning. (shrink)

During an emergency, laws serve crucial functions, including clarifying responsibilities, authorizing critical interventions, and protecting vulnerable populations. However, provisions of existing laws designed for normal, non-emergency circumstances may sometimes hinder emergency response efforts, thereby potentially endangering the public's health rather than protecting it. Pursuant to declared states of emergency, disaster, or public health emergency, however, the legal landscape changes in several important ways. Interventions not legally permissible under non-emergency circumstances become available. One key example is authority to temporarily (...) waive legal provisions that may impede emergency response efforts, such as professional licensing requirements, facility capacity limitations, pharmaceutical pedigree obligations, and state contract restrictions, among other laws spanning a host of legal spheres.This article examines the structure and use of waiver authority in emergencies. It provides recent examples of waivers and analyzes potential application to a hypothetical emergency scenario. (shrink)

The present study seeks to expand on research concerning the benefits of organizational citizenship behaviors (OCB) to work-family facilitation (WFF) by integrating the theoretical framework of the attachment personality perspective (Bowlby, 1982). We hypothesized that OCB would enhance WFF for employees having lower levels of avoidance and anxious orientations but reduce WFF for employees with higher levels of avoidance and anxiety orientations. Two studies were conducted to test these hypotheses. Study 1 adopted a cross-sectional design, and Study 2 implemented a (...) diary procedure. In Study 1, employees from a pharmaceutical company completed attachment orientations and WFF questionnaires, whereas their direct supervisors assessed the participants’ OCB. In Study 2, attachment orientations of 108 participants were assessed, with OCB and WFF measures collected over 10 days. Findings from both studies supported our hypotheses relating to avoidance orientations. Performing OCB can enhance WFF, with the effect stronger for employees having lower avoidance orientations. However, findings regarding anxiety orientations were non-significant. A better understanding of the role that attachment orientations play in the OCB - WFF association may facilitate implementing possible interventions that could benefit both the organization and the family. (shrink)

Drug regulation is fraught with inductive risk. Regulators must make a prediction about whether or not an experimental pharmaceutical will be effective and relatively safe when used by typical patients, and such predictions are based on a complex, indeterminate, and incomplete evidential basis. Such inductive risk has important practical consequences. If regulators reject an experimental drug when it in fact has a favourable benefit/harm profile, then a valuable intervention is denied to the public and a company’s material interests are (...) needlessly thwarted. Conversely, if regulators approve an experimental drug when it in fact has an unfavourable benefit/harm profile, then resources are wasted, people are needlessly harmed, and other potentially more effective treatments are underutilized. Given that such regulatory decisions have these practical consequences, non-epistemic values about the relative importance of these consequences impact the way such regulatory decisions are made (similar to the analysis of laboratory studies on the toxic effects of dioxins presented in Douglas [2000]). To balance the competing demands of the pertinent non-epistemic values, regulators must perform what I call an “inductive risk calculus.” At least in the American context this inductive risk calculus is not well-managed. (shrink)

Until the recent spread of public-private partnerships, pharmaceutical firms had avoided research and development into neglected tropical diseases (NTDs). Because these are diseases that affect the poorest populations in developing regions, research and development initiatives have for the most part depended on the resources and expertise drawn from academia, international organizations, and intermittent state interventions in disease-endemic countries. Over the last few decades, however, public-private product development partnerships (PDPs) have been introducing new collaborative agreements in which the existing (...) resources and expertise combine with the those traditionally withheld by the pharmaceutical industry and global health NGOs. This paper explores recent transformations in the representation of NTDs by examining the shifting logic and spaces of knowledge production which the advent of PDPs has enabled. An analysis of two case studies focused on Chagas disease-related initiatives addresses recurring preoccupations in Science, Technology and Society studies as well as in critical analyses of PDPs: that is, the back-and-forth movement of the disease from being an object of scientific inquiry to a public health concern, and the legitimacy risks and material asymmetries entailed in global health PDPs. Both cases show that it is major global health stakeholders and experts in non-endemic countries, rather than transnational pharmaceutical firms, that exert the greatest influence upon these changing representations: PDPs attempt to expand the preexisting biomedical focus on NTDs by means of incorporating “real world” drug development preoccupations (which I term epistemic shifts), but they also combine their stated global humanitarian aim with security concerns about the diseases spreading to non-endemic, industrialized countries (which I term geographical shifts). (shrink)

Philosophical discussions of the morality of suicide have tended to focus on its justifiability from an agent’s point of view rather than on the justifiability of attempts by others to intervene so as to prevent it. This paper addresses questions of suicide intervention within a broadly Kantian perspective. In such a perspective, a chief task is to determine the motives underlying most suicidal behaviour. Kant wrongly characterizes this motive as one of self-love or the pursuit of happiness. Psychiatric and scientific (...) evidence suggests that suicide is instead motivated by a nihilistic disenchantment with the possibility of happiness which, at its apex, results in the loss of the individual’s conception of her practical identity. Because of this, methods of intervention that appeal to agents’ happiness, while morally benign, will prove ineffective in forestalling suicide. At the same time, more aggressive methods violate the Kantian concern for autonomy. This apparent dilemma can be resolved by seeing suicide intervention as an action undertaken in non-ideal circumstances, where otherwise unjustified manipulation, coercion, or paternalism are morally permitted. (shrink)

Background In modern Russia, any clinical investigation of a pharmaceutical for use in humans is subject to prior evaluation and approval by the Ministry of Health and its Central Ethics Committee. Despite this, some researchers and trial sponsors fail to comply, this is particularly true in case of the studies initiated by domestic sponsors or sponsor-investigators and published in Russian language medical journals. This exploratory research aims to discover whether it is a sporadic non-compliance with regulations or a common (...) practice. Methods We searched the Russian language database eLIBRARY for the phrase ‘results of a randomised trial’. We selected publications reporting clinical trials and conducted in Russia. For each of the selected studies, we searched the state register of the approved clinical trials. We assessed whether the investigational medicinal product was approved for marketing in Russia; the therapeutic indications, posology, and administration method in the clinical trial were consistent with the approved labelling; the issue of the journal included an advertisement of the medicinal product in question; and the full description of the methodology corroborated that the clinical trial was randomised, as was stated in the title or abstract. Results Of the 26 selected articles, 22 reported the results of unauthorised clinical trials. Three of those trials were conducted in children. Twenty-one studies reported on data from unauthorised trials for investigational products approved for marketing in Russia. However, in nine cases, the therapeutic indications, posology, or administration method did not match the conditions indicated in the labelling. Moreover, in one case, the unauthorised trial included a drug therapy intervention where the active substance was not approved for use in any medicinal product marketed in Russia. In 14 of the 26 articles, the issue of the journal or the article itself contained an advertisement for the same medicinal product or, in one case, its manufacturer. All publications accompanied by advertisements claimed that the medicinal product in question was efficacious. Conclusions A substantial fraction of the clinical trials initiated by domestic sponsors and reported in Russian medical journals failed to obtain the mandatory prior evaluation and approval from the regulator. This can affect the rights and well-being of the study participants and the scientific validity of the studies. (shrink)

In chapter 3 of Wild Animal Ethics Johannsen argues for a collective obligation based on beneficence to intervene in nature in order to reduce the suffering of wild animals. In the same chapter he claims that the non-identity problem is merely a “theoretical puzzle” which doesn’t affect our reasons for intervention. In this paper I argue that the non-identity problem affects both the strength and the nature of our reasons to intervene. By intervening in nature on a large scale we (...) change which animals come into existence. In doing so, we enable harmful animals to inflict harms on other animals, and we put other animals in harm’s way. The harms that these animals will inflict and endure are foreseeable. Furthermore, since non-human animals aren’t moral agents, harmful animals cannot be morally responsible for their harmful actions. I argue therefore that by causing animals to exist, knowing that they will inflict and suffer harms, we become morally responsible for those harms. By engaging in identity-affecting actions then we take on secondary moral duties towards the animals we have thereby caused to exist, and these secondary moral duties may be extremely demanding, even more so than the initial costs of intervention. Finally, these duties are duties of justice rather than duties of beneficence, and as such are more stringent than purely beneficence-based moral reasons. Furthermore, this conclusion flows naturally from several plausible principles which Johannsen explicitly endorses. (shrink)

Neuroenhancement offers the prospect of improving the cognitive, emotional and motivational functions of healthy individuals. Of all the conceivable interventions, psychopharmacology provides the most readily available ones, such as antidepressants which are thought to make people “better than well”. However, up until now, whether they possess such an enhancing ability remains controversial and therefore in this systematic review we will evaluate the effect and safety of modern antidepressants in healthy individuals. A search of MEDLINE and EMBASE databases and cross-references (...) was carried out and the pharmaceutical industry was contacted for suitable data. Trials published in any language through the third week of July 2007 were regarded. Included were single or double blind randomised or quasi-randomised controlled trials that compared a placebo to one or more of the following antidepressants: bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, moclobemide, paroxetine, reboxetine, sertraline or venlafaxine in any dose or dosing schedule. Eligible studies were those involving healthy people of any age and either sex who showed no evidence of a psychiatric disorder, cognitive decline or other disease. One hundred thirty-five articles met our inclusion criteria reporting single dose trials and trials with repeated drug administration. Sixty-five of these articles were eligible for a statistical analysis. Based on a linear mixed model, a meta-analysis and a fixed effects meta-regression were performed. Pooling of results by meta-analysis was stratified by the outcome measures mood, emotional processing, wakefulness, attention, memory, and executive functions. On a significance level of p < 0.05 the following significant results emerged: After a single dose of an antidepressant, a significant effect was shown in two of the analysed outcomes. Firstly, there was a small yet significant negative effect on wakefulness. On memory, a positive effect after several measurements was found, but this result could be traced to the results of the one study out of all included studies, which had that many assessment points. The analysis of trials with repeated drug administration yielded the following effects: on mood, a non-significant positive effect was detected that was continuously increasing and reached significance at the last assessment point. Regarding attention, a fluctuating effect was found, while for memory, the fact that the two groups started with a group difference confounded the results. For wakefulness there was no significant effect in any particular assessment point, while for emotional processing and executive functions, the small number of studies did not allow for any effect to emerge. In summary, no consistent evidence for enhancing effects of antidepressants could be found. There is little evidence so far to support the popular opinion that antidepressants have a positive effect on the mood of healthy individuals after repeated administration. No evidence of a significant adverse event profile could be found. The studies included in this systematic review not only provide insufficient evidence for or against any effect in healthy people, but they are inapt to be used for answering this question. This may be explained by the fact that most of them were not designed to examine neuroenhancement effects. The growing public interest in neuroenhancement stands in stark contrast to the paucity of data on enhancement effects of available psychopharmacological agents. (shrink)

A central tenet of medical ethics holds that it is permissible to perform a medical intervention on a competent individual only if that individual has given informed consent to the intervention. However, in some circumstances it is tempting to say that the moral reason to obtain informed consent prior to administering a medical intervention is outweighed. For example, if an individual’s refusal to undergo a medical intervention would lead to the transmission of a dangerous infectious disease to other members of (...) the community, one might claim that it would be morally permissible to administer the intervention even in the absence of consent. Indeed, as we shall discuss below, there are a number of examples of public health authorities implementing compulsory or coercive measures for the purposes of infectious disease control (IDC). The plausibility of the thought that non-consensual medical interventions might be justified when performed for the purpose of IDC raises the question of whether such interventions might permissibly be used to realize other public goods. In this article we focus on one possibility: whether it could be permissible to non-consensually impose certain interventions that alter brain states or processes through chemical or physical means on serious criminal offenders. We shall suggest that some such interventions might be permissible if they safely and effectively serve to facilitate the offender’s rehabilitation and thereby prevent criminal recidivism. (shrink)

In this chapter we outline the need to develop ethical frameworks to guide research on the role of animal-orientated health, therapeutic, and service interventions. We discuss findings from our research on uses of animals in therapeutic settings and benefits of human–canine interactions for human health. These stories from the field reveal that current ethics review processes do not recognise the animal as an equal partner in the potential reciprocal benefits and risks of therapeutic human–animal relationships. We explore how these (...) review processes frame research on the relationships between humans and non-human animals and use the ethical review system of Aotearoa/New Zealand as an example. We propose an ethical framework that goes beyond animal welfare legislation and recognises a range of non-human animal capacities. (shrink)

This paper argues that doctors ought to make all things considered value judgments about what is best for their patients. It illustrates some of the shortcomings of the model of doctor as 'fact-provider'. The 'fact-provider' model fails to take account of the fact that practising medicine necessarily involves making value judgments; that medical practice is a moral practice and requires that doctors reflect on what ought to be done, and that patients can make choices which fail to express their autonomy (...) and which are based on mistaken judgments of value. If doctors are properly to respect patient autonomy and to function as moral agents, they must make evaluations of what their patients ought to do, all things considered. This paper argues for 'rational, non-interventional paternalism'. This is a practice in which doctors form conceptions of what is best for their patients and argue rationally with them. It differs from old-style paternalism in that it is not committed to doing what is best. (shrink)

In this article, 41 models of covariation detection from 2 × 2 contingency tables were evaluated against past data in the literature and against data from new experiments. A new model was also included based on a limiting case of the normative phi‐coefficient under an extreme rarity assumption, which has been shown to be an important factor in covariation detection (McKenzie & Mikkelsen, 2007) and data selection (Hattori, 2002; Oaksford & Chater, 1994, 2003). The results were supportive of the new (...) model. To investigate its explanatory adequacy, a rational analysis using two computer simulations was conducted. These simulations revealed the environmental conditions and the memory restrictions under which the new model best approximates the normative model of covariation detection in these tasks. They thus demonstrated the adaptive rationality of the new model. (shrink)

The number of family members caring and caregiving for a loved one undergoing physical and mental changes continues to increase dramatically. For many, this ongoing experience not only involves the “burden of caregiving” but also the “burden of grief” as their loved-one’s newfound medical condition can result in the loss of the person they previously knew. Dramatic cognitive, behavioral, and personality changes, often leave caregivers bereft of the significant relationship they shared with the affected person prior to the illness or (...) injury. This results in what we term conditions of acquired “non-death interpersonal loss”. Current approaches to these losses use an amalgam of models drawn from both death and non-death loss. Despite their utility, these frameworks have not adequately addressed the unique processes occurring in the interpersonal sphere where the grieving caregiver needs to reach some modus vivendi regarding the triad of “who the person was,” “who they are now,” and “who they will yet become.” In this paper we propose a process-based model which addresses cognitive-emotional-behavioral challenges caregivers meet in the face of their new reality. These require a revision of the interpersonal schemas and the relationships that takes into account the ongoing interactions with the affected family member. The model and its utility to identify adaptive and maladaptive responses to NoDIL is elaborated upon with clinical material obtained from caregivers of people diagnosed with major neuro-cognitive disorder and pediatric traumatic brain injury. The article concludes with implications for theory, research and clinical intervention. (shrink)

Volume 20, Issue 8, August 2020, Page 23-25.

Research on animal-assisted interventions has increased massively in the last few years. But it is still not clear how AAIs work and how important the animal is in such interventions. The aim of this systematic review was to compile the existing state of knowledge about the working mechanisms of AAIs. We searched 12 major electronic databases for previous AAI studies with active control groups. Of 2001 records identified, we included 172 studies in the systematic review. We extracted previously (...) published hypotheses about working mechanisms and factors that have been implicitly considered specific or non-specific in AAI research by categorizing control conditions using content analysis. We analyzed the categories using descriptive statistics. We found that 84% of the included studies mentioned a hypothesis of working mechanisms, but 16% did not define specific hypotheses. By analyzing their control conditions, we found that in most controlled studies, the animal or the interaction with the animal was implicitly considered as a specific factor for the effects of the AAI. Non-specific factors such as therapeutic aspects, social interactions, or novelty have also been controlled for. We conclude that AAI research still cannot answer the question of how and why AAIs work. To address this important research gap, we suggest using component studies with innovative control conditions and results from placebo research to address both the specific and non-specific, contextual factors of AAIs to disentangle its mechanisms.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=158103, identifier: CRD42020158103. (shrink)

BackgroundDiagnosis and treatment of differentiated thyroid carcinomas cause anxiety and depression. Additionally, these patients suffer hormonal alterations that are associated with psychological symptoms. This study aims to evaluate the effectiveness of a psycho-oncological intervention based on counseling to reduce anxiety and depression related to the treatment in patients with DTC.MethodsA non-randomized controlled study, with two groups [experimental group, n = 37, and control group, n = 38] and baseline and posttreatment measures, was designed. Patients in the EG received a psycho-oncological (...) intervention based on counseling in addition to the standard treatment. The independent variable was the assigned group and the dependent one was the evolution of anxiety and depression, which were analyzed separately, and both were evaluated using the Hospital Anxiety and Depression Scale. Other relevant covariables related to the quality of life were also analyzed using Short Form-36 Health Survey and Psychological General Wellbeing Index scales.ResultsThe difference of the posttreatment-baseline variation showed a statistically significant reduction in anxiety and depression in the EG in relation to the CG. The mean of the Psychological General Wellbeing Index scales score increased significantly in the EG and decreased significantly in the CG. All the baseline and the posttreatment scores of the variables evaluated showed a statistically significant improvement in the EG vs. the CG.ConclusionThis study demonstrates significant benefits of psycho-oncological intervention based on counseling in anxiety, depression, QoL, and wellbeing of the patient with differentiated thyroid carcinomas. (shrink)

Michael Walzer argues that except in cases involving genocide or mass slaughter, humanitarian intervention is unjustifiable because “citizens get the government they deserve, or, at least, the government for which they are ‘fit.’”Yet, if people are autonomous and deserve the government that rules over them, then it would seem that they are responsible for the government’s actions, including their nation’s wars of aggression.That line of thought undermines the doctrine of noncombatant immunity, which is perhaps the most important of Walzer’s jus (...) in bello principles. In this way, the concept of self-determination frustrates Walzer’s attempts to keep jus ad bellum and jus in bello considerations separate. (shrink)