BiDil, a heart failure drug for African Americans, emerged five years ago as the first FDA approved drug targeted at a specific racial group. While critical scholarship and the popular media have meticulously detailed the history of BiDil from its inauspicious beginnings as a generic combination drug for the general population to its dramatic resuscitation as a racial medicine, the enthusiastic support shown by some African American interest groups has been too little understood, as has their argument that BiDil was (...) an important response to race-based health disparities. In this essay, we show how the drugmaker, NitroMed, used the support it had solicited from black advocacy groups and community members to market BiDil as a unique “grassroots” pharmaceutical to the African American community. We go on to situate BiDil, which relied on a domestic, U.S.-centered conception of race, within the context of the global nature of both race and health disparities. Ironically, the grassroots angle of the BiDil case ultimately obscured the global crisis in health disparities. Furthermore, we argue that the grassroots model initiated by NitroMed should be taken note of, as it marks a potential avenue for the marketing of other drugs in the future. (shrink)

Since the first phase of the formal effort to sequence the human genome, geneticists, social scientists and other scholars of race and ethnicity have warned that new genetic technologies and knowledge could have negative social effects, from biologizing racial and ethnic categories to the emergence of dangerous forms of genetic discrimination. Early on in the Human Genome Project, population geneticists like Luigi Luca Cavalli-Sforza enthusiastically advocated for the collection of DNA samples from global indigenous populations in order to track the (...) history of human ancestry, migration, and languages, while social scientists like Troy Duster insisted that the new genetics was in danger of ushering in insidious practices of eugenics. The Human Genome Diversity Project's 1991 proposal to archive human genetic variation around the world quickly came under intense scrutiny by indigenous peoples and advocacy groups who worried that such measures could exploit indigenous groups as research populations and even resurrect racist taxonomies from the nineteenth century. (shrink)

Hastings Center Report, Volume 52, Issue S1, Page S83-S88, March‐April 2022.

In June 2002, the University of Minnesota hosted a conference to explore the implications of using genetic technologies and genealog.

The enrolment of children and adolescents in health research requires that attention to be paid to specific assent and consent requirements such as the age range for seeking assent; conditions for parental consent (and waivers); the age group required to provide written assent; content of assent forms; if separate assent and parental consent forms should be used, consent from emancipated young adults; reconsent at the age of adulthood when a waiver of assent requirements may be appropriate and the conditions for (...) waiving assent requirements. There is however very little available information for researchers and ethics committees on how to navigate these different issues. To provide guidance to research initiatives, the SickleInAfrica consortium conducted a thematic analysis of a sample of research ethics guidelines and procedures in African countries, to identify guidance for assent requirements in health research. The thematic analysis revealed that 12 of 24 African countries specified the age group for which assent is required. The minimum age for written assent varied across the countries. Five countries, Algeria, Botswana, Cameroon, Nigeria and The Democratic Republic of Congo require consent from both parents/family council in certain circumstances. Botswana, Nigeria, South Africa and Uganda have specific assent/consent requirements for research with emancipated minors. South Africa and Algeria requires re-consent at onset of adulthood. Five countries (Botswana, Cameroon, Nigeria, South Africa and Tanzania) specified conditions for waiving assent requirements. The CIOMS and the ICH-GCP guidelines had the most comprehensive information on assent requirements compared to other international guidelines. An interactive map with assent requirements for different African countries is provided. The results show a major gap in national regulations for the inclusion of minors in health research. The SickleInAfrica experience in setting up a multi-country SCD registry in Africa highlights the need for developing and harmonising national and international guidelines on assent and consent requirements for research involving minors. Harmonisation of assent requirements will help facilitate collaborative research across countries. (shrink)

Sickle cell disease is a debilitating illness that affects quality of life and life expectancy for patients. In Cameroon, it is now possible to opt for termination of an affected pregnancy where the fetus is found to be affected by SCD. Our earlier studies found that, contrary to the views of Cameroonian physicians, a majority of parents with their children suffering from SCD would choose to abort if the fetuses were found to be affected. What have not yet been investigated (...) are the views of people suffering from/living with SCD. We used a quantitative sociological method, with administered structured questionnaires, to study the attitudes of adult patients suffering from SCD on prenatal genetic diagnosis and possible TAP. The majority of the 89 participants were urban dwellers , women , Christian and single , with a secondary/tertiary education . The majority would consider PND for SCD; almost half would reject TAP while 40.9% would consider it. Respondents who rejected TAP claimed mostly ethical reasons while those who found TAP acceptable cited fear of having an affected child and the poor quality of the affected child's health . Cameroonian patients with SCD are generally supportive of PND and a remarkably high number of patients living with SCD reported that they would consider terminating a pregnancy based on their assessment of the future well-being of the child. Research is required to investigate the burden of SCD on families and their quality of life. (shrink)

Among bioethicists and members of the public, genetics is often regarded as unique in its ethical challenges. As medical researchers and clinicians increasingly combine genetic information with a range of non-genetic information in the study and clinical management of patients with common diseases, the unique ethical challenges attributed to genetics must be re-examined. A process of genetic routinisation that will have implications for research and clinical ethics, as well as for public conceptions of genetic information, is constituted by the emergence (...) of new forms of genetic medicine, in which genetic information is interpreted in a multifactorial frame of reference. Although the integration of genetics in medical research and treatment may be a helpful corrective to the mistaken assumptions of genetic essentialism or determinism, the routinisation of genetics may have unintended consequences for the protection of genetic information, perceptions of non-genetic information and the loss of genetic research as a laboratory for exploring issues in research and clinical ethics. Consequently, new ethical challenges are presented by the increasing routinisation of genetic information in both biomedical and public spheres. (shrink)

The letter sent by the Royal Society to the London optician, John Marshall, in 1694, commending his new method of grinding, has been reprinted, and referred to, in recent years. However, there has been no comprehensive analysis of the method itself, the letter and the circumstances in which it was written, nor the consequences for trade practices. The significance of the approval by the Royal Society of this innovation and the use of that approbation by John Marshall and (...) other practitioners are examined. Gaps in existing accounts of Marshall's method are partly remedied by supplementing surviving written materials with accounts of contemporary, and present-day, trade practices based on his method. The reasons why Marshall and his contemporaries failed to record his method and specify his improvements are discussed. The reactions of the Spectacle Makers' Company and its more prominent members, both to the innovation itself and to the Royal Society's letter, are analysed. The impact of the new technique on contemporary and later opticians is described. (shrink)

The papers collected in this volume are the proceedings of the 1999 Royal Institute of Philosophy conference: the theme of the conference, the same as the title of this collection, Naturalism, Evolution and Mind. The essays collected here cover a wide array of disparate themes in philosophy, psychology, evolutionary biology and the philosophy of science. They range in subject matter from the mind/body problem and the nature of philosophical naturalism, to the naturalization of psychological norms to the naturalization of (...) phenomenal and intentional content, from the methodology cognitive ethology to issues in evolutionary psychology. They are united by the simple thought that the great promise of current naturalism in philosophy of mind resides in its potential to reveal mental phenomena as continuous with other phenomena of the natural world, particularly with other biological phenomena. (shrink)

In a recent article in this journal our unit was accused of a number of errors of judgment in applying covert video surveillance (CVS) to infants and children suspected of life-threatening abuse. The article implied, that on moving from the Royal Brompton Hospital in London to North Staffordshire Hospital, we failed to present our work to the Research Ethics Committee (REC). We did send our protocol to the REC though we did not consider that, after a total of 16 (...) patients had been documented as being the subject of life-threatening abuse, this was research. The REC in Staffordshire agreed with us. We were also accused of undertaking work that should be pursued by the Police. We agree with this. However, unlike the Metropolitan Police the Staffordshire Police would not undertake CVS. We fail to agree that 'working together' with parents is necessarily practical or safe when trying to protect children from life-threatening abuse of this kind. (shrink)

Entities of many kinds, not just material things, have been credited with parts. Armstrong , for example, has taken propositions and properties to be parts of their conjunctions, sets to be parts of sets that include them, and geographical regions and events to be parts of regions and events that contain them. The justification for bringing all these diverse relations under a single ‘part–whole’ concept is that they share all or most of the formal features articulated in mereology . But (...) the concept has also prompted an ontological thesis that has been expressed in various ways: that wholes are ‘no ontological addition’ to their parts ; that to list both a whole and its parts is ‘double counting’; and that there is ‘no more’ to a whole than its parts: for example, that there is no more to a conjunction than the conjuncts that are its parts, and whose truth or falsity determines whether it is true or false. For brevity, I shall express the thesis in the last of these ways, as the claim that entities with parts are ‘nothing but’ those parts. (shrink)

Sentimentalist theories in ethics treat evaluative judgments as somehow dependent on human emotional capacities. While the precise nature of this dependence varies, the general idea is that evaluative concepts are to be understood by way of more basic emotional reactions. Part of the task of distinguishing between the concepts that sentimentalism proposes to explicate, then, is to identify a suitably wide range of associated emotions. In this paper, we attempt to deal with an important obstacle to such views, which arises (...) from the dominant tradition in the philosophy of emotion. We will be attempting to steer a middle course between the traditional view and some recent, empirically-minded criticism. (shrink)

Entities of many kinds, not just material things, have been credited with parts. Armstrong, for example, has taken propositions and properties to be parts of their conjunctions, sets to be parts of sets that include them, and geographical regions and events to be parts of regions and events that contain them. The justification for bringing all these diverse relations under a single ‘part–whole’ concept is that they share all or most of the formal features articulated in mereology. But the concept (...) has also prompted an ontological thesis that has been expressed in various ways: that wholes are ‘no ontological addition’ to their parts ; that to list both a whole and its parts is ‘double counting’; and that there is ‘no more’ to a whole than its parts: for example, that there is no more to a conjunction than the conjuncts that are its parts, and whose truth or falsity determines whether it is true or false. For brevity, I shall express the thesis in the last of these ways, as the claim that entities with parts are ‘nothing but’ those parts. (shrink)

What darkness was the ‘Enlightenment’ supposed to have removed? The answer is irrational forms of religion. Most of the ‘enlightened’ took the view that revealed religion was irrational and that natural religion could be rational; but some were sceptical about natural religion too. Hume was the most honest and the most penetrating thinker of the latter group. His biographer, Professor E. C. Mossner, is not alone in believing that the Dialogues concerning Natural Religion is ‘his philosophical testament’.

What darkness was the ‘Enlightenment’ supposed to have removed? The answer is irrational forms of religion. Most of the ‘enlightened’ took the view that revealed religion was irrational and that natural religion could be rational; but some were sceptical about natural religion too. Hume was the most honest and the most penetrating thinker of the latter group. His biographer, Professor E. C. Mossner, is not alone in believing that the Dialogues concerning Natural Religion is ‘his philosophical testament’.

What could an empirical theory of the Mind be? Surely one which demonstrated that questions about the existence of minds were empirical questions – to be decided by observation, by the senses. This in turn would require an explanation of the meaning of statements about minds or mental states in terms referring to observable events, states and objects.

What could an empirical theory of the Mind be? Surely one which demonstrated that questions about the existence of minds were empirical questions – to be decided by observation, by the senses. This in turn would require an explanation of the meaning of statements about minds or mental states in terms referring to observable events, states and objects.

This article reports of the activities of the working group, Ethics & Engineers, of the Royal Flemish Society of Engineers. More particularly, the ethical problems that engineers face in the preparation of an environmental report are illuminated. Irrespective to which party the engineer belongs, he or she is confronted with the difficult weighting of his or her personal interest, the interests of private companies and last but not least the common good. It is argued that the implementation of a (...) code of ethics and the introduction of courses on engineering ethics into the education of engineers would strengthen the engineer in the fulfilment of his vocation. (shrink)

There are certain metaphysical theories which present a view of the world and of the position of human-beings within it which have seemed attractive or at least impressive to many irrespective of the arguments that are marshalled in their favour. That is certainly true of Schopenhauer. His identification of the inner nature of reality with the will, and the conclusions which he drew from this as regards the nature of human-beings and their place in the world, have seemed striking and (...) perhaps even illuminating to many thinkers, not all of whom have been philosophers in the most obvious sense and not all of whom have had much concern for the underlying argument that led Schopenhauer to his conclusions. It is in this way too, perhaps, that certain of Schopenhauer's ideas have become well known—his emphasis on the will to live, his pessimism and his views on suicide, and his thoughts about human nature and about sex that have been seen as something of an anticipation of Freud. In recent times attention has also been directed to his influence on Wittgenstein. In all these respects, however, it is Schopenhauer's ideas that have been influential, rather than the argument that underlies them. Indeed it is sometimes said that Schopenhauer was not a very systematic thinker at all. If that seems true it is so in the sense that Kant too has seemed to some unsystematic in the details of his argument. That does not mean that the main structure of the argument is not clear. So it is with Schopenhauer. (shrink)

In September 1998 the Dutch Ministry of Health together with the Dutch Society of General Practitioners , the Royal Dutch Society of Pharmacists , and the Dutch Patient and Consumer Federation published a pamphlet entitled: The same medicine in a different coat. Drugs without a trademark, equally effective, but cheaper. Patients could obtain a copy at the local pharmacy or in the waiting room of their general practitioner. It deals with the question whether the name of the patent drug (...) should be written on the prescription or only the active component. This is important because, according to the authors, the costs of health care can be reduced without reducing the quality of the care if the doctor prescribes the generic form. It is also mentioned that another advantage of prescribing the generic form is that, contrary to the …. (shrink)

Our knowledge of the world comes to us, one way or another, through our senses. I know there's a table here, because I see it, and that there's traffic outside, because I hear it. And similarly for our other senses. I know when it's cold, because I feel it; when there's sugar in my tea, because I taste it; smoke in the air, because I smell it; and so on.

Between 1234 and 1258 King Henry III, having emerged from the tutelage of ministers inherited from his father, controlled the government of England himself. Looking at this period of personal rule, it would be easy to gain the impression that Henry's kingship, in its theory, and also to some extent its practice, challenged the position of the magnates. M. T. Clanchy, for example, in a justly famous article has suggested that in the 1240s and 1250s Henry III evolved a theory (...) of royal absolutism, a theory which had threatening implications for the magnates. He has also stressed the extent to which Henry was “the initiator both of the methods and of the theory” behind Edward I's quo warranto campaign, which questioned the liberties possessed by the magnates in the field of local government. As for Henry's court, the impression has been given by R. F. Treharne that few English barons were present there, and that the king was largely surrounded by officials and foreign relatives — the latter being his wife's Savoyard uncles and his own Poitevin half-brothers of the house of Lusignan. G. W. S. Barrow has written that Henry “appeared to be excluding the barons as a class from membership of his royal council.” The question whether Henry, like his father John, was pressing magnates to pay their debts has never been investigated; but Matthew Paris's picture of the king as a “vigilant and indefatigable searcher after money” might indicate that the revolution of 1258, like that of 1215, was a “rebellion of the king's debtors.”. (shrink)

There are certain metaphysical theories which present a view of the world and of the position of human-beings within it which have seemed attractive or at least impressive to many irrespective of the arguments that are marshalled in their favour. That is certainly true of Schopenhauer. His identification of the inner nature of reality with the will, and the conclusions which he drew from this as regards the nature of human-beings and their place in the world, have seemed striking and (...) perhaps even illuminating to many thinkers, not all of whom have been philosophers in the most obvious sense and not all of whom have had much concern for the underlying argument that led Schopenhauer to his conclusions. It is in this way too, perhaps, that certain of Schopenhauer's ideas have become well known—his emphasis on the will to live, his pessimism and his views on suicide, and his thoughts about human nature and about sex that have been seen as something of an anticipation of Freud. In recent times attention has also been directed to his influence on Wittgenstein. In all these respects, however, it is Schopenhauer's ideas that have been influential, rather than the argument that underlies them. Indeed it is sometimes said that Schopenhauer was not a very systematic thinker at all. If that seems true it is so in the sense that Kant too has seemed to some unsystematic in the details of his argument. That does not mean that the main structure of the argument is not clear. So it is with Schopenhauer. (shrink)

‘The Principle of Sufficient Reason in all its forms is the sole principle and the sole support of all necessity. For necessity has no other true and distinct meaning than that of the infallibility of the consequence when the reason is posited. Accordingly every necessity is conditioned; absolute, i.e. unconditioned, necessity therefore is a contradicto in adjecto. For to be necessary can never mean anything but to result from a given reason.’ These words are taken from the beginning of section (...) 49 of Schopenhauer's The Fourfold Root of the Principle of Sufficient Reason. They express sentiments with which I am to some extent in agreement, and it therefore seemed to me worth while to explore in some kind of detail Schopenhauer's treatment of the issues. It might, however, be asked why the view expressed by Schopenhauer should be of philosophical interest, what, if anything, turns on the rejection of the notion of absolute necessity. To this I can reply by saying only that apart from the intrinsic interest of the notion of necessity itself, an issue on which a philosopher ought to make himself clear, Schopenhauer himself points to some of the consequences of his doctrine - the impossiblity, for example, of an absolutely necessary being, and the similar impossibility of ontological or cosmological arguments. (shrink)

‘The Principle of Sufficient Reason in all its forms is the sole principle and the sole support of all necessity. For necessity has no other true and distinct meaning than that of the infallibility of the consequence when the reason is posited. Accordingly every necessity is conditioned ; absolute, i.e. unconditioned, necessity therefore is a contradicto in adjecto . For to be necessary can never mean anything but to result from a given reason.’ These words are taken from the beginning (...) of section 49 of Schopenhauer's The Fourfold Root of the Principle of Sufficient Reason . They express sentiments with which I am to some extent in agreement, and it therefore seemed to me worth while to explore in some kind of detail Schopenhauer's treatment of the issues. It might, however, be asked why the view expressed by Schopenhauer should be of philosophical interest, what, if anything, turns on the rejection of the notion of absolute necessity. To this I can reply by saying only that apart from the intrinsic interest of the notion of necessity itself, an issue on which a philosopher ought to make himself clear, Schopenhauer himself points to some of the consequences of his doctrine - the impossiblity, for example, of an absolutely necessary being, and the similar impossibility of ontological or cosmological arguments. (shrink)

The paper investigates the senses in which the world may be thought external, and argues that none of them supports doubt about the possibility of knowledge of the world. Scepticism sometimes depends on certain erroneous conceptions of perception, especially those which lead to belief in 'inner, representational states'. How we perceive things depends on the satisfaction of certain general conditions--on what concepts we have, on the kind of senses we have, and so on a kind of anthropocentricity; but this does (...) not prevent objectivity, even in the case of secondary qualities. (shrink)

Heidegger says concerning the question of the possibility of a proof of the existence of an external world that ‘the “scandal of philosophy” is not that this proof has yet to be given, but that such proofs are expected and attempted again and again’. Heidegger thinks this because our being is in the world, and this is something which Descartes for one failed to appreciate. I am not concerned here to answer the question whether Heidegger's own views on these matters (...) will do, though I think that they will not. Indeed they might well be said to beg the question at issue, in that Heidegger starts from the presumption that we are actually in the world, even if we are not in it in the way in which the tree in the garden is. Another way of reacting to Heidegger would be to say that he does not treat the fact and force of scepticism seriously enough when he makes that presumption. After all, it is possible for us to raise sceptical doubts about the existence of a world apart from ourselves, while it is not possible for the tree in the garden to act similarly. Hence, even if we make the presumption that we are in the world, as Heidegger insists, we are in it in a way that leaves untouched the possibility of sceptical doubts about what that world and our being in it are like. It might, logically, be the case, for example, that the world consists of just me and that my being in the world is no more than for me just to exist. In other words, my being in the world does not directly entail that there exists a world apart from me. (shrink)

Mill says that the object of his essay On Liberty is to defend a certain principle, which I will call the ‘liberty principle’, and will take to say the following: ‘It is permissible, in principle, for the state or society to control the actions of individuals “only in respect to those actions of each, which concern the interest of other people”’. The liberty principle is a prescription of intermediate generality. Mill intends it to support more specific political prescriptions, such as (...) liberty of conscience, of expressing and publishing opinions, of framing a plan of life to suit our own character, and of combination for any purpose not involving harm to others . The liberty principle is more general than these prescriptions but less general than its possible moral foundations, such as utilitarianism. My concern will be with attempts to defend the liberty principle by showing it to be supported by an acceptable moral position. (shrink)

Mill says that the object of his essay On Liberty is to defend a certain principle, which I will call the ‘liberty principle’, and will take to say the following: ‘It is permissible, in principle, for the state or society to control the actions of individuals “only in respect to those actions of each, which concern the interest of other people”’. The liberty principle is a prescription of intermediate generality. Mill intends it to support more specific political prescriptions, such as (...) liberty of conscience, of expressing and publishing opinions, of framing a plan of life to suit our own character, and of combination for any purpose not involving harm to others. The liberty principle is more general than these prescriptions but less general than its possible moral foundations, such as utilitarianism. My concern will be with attempts to defend the liberty principle by showing it to be supported by an acceptable moral position. (shrink)

In an article contributed to Mind in 1934, the young A. J. Ayer declared war on metaphysics, claiming that his destruction of the metaphysicians' arguments rested on the establishment of the sheerly non-sensical character of their statements. Their errors were syntactical; the combination of symbols in the sentences with which they expressed their propositions violated fundamental principles of significance.

Everybody supports freedom—even authoritarians, though what they call freedom looks suspiciously like bondage. Rousseau begins The Social Contract with a flourish: ‘Man is born free, and everywhere he is in chains.’ He ends up by trying to persuade us that the chains, the restraints of law and organized society, are necessary for true freedom. He wants us to believe that true freedom, the freedom essential for human existence, is not the happy-go-lucky freedom of Liberty Hall, do as you like, but (...) the straight and narrow path of duty, of conformity to law. The universal popularity of the idea of freedom does not mean that everybody is really agreed about it. Plato, Rousseau, Hegel and his followers—they all talk of a true or genuine freedom, but they oppose this to Liberty Hall, to doing as you please. (shrink)

We hear nowadays in literary criticism of a type of novel that is an ‘anti-novel’ and of a type of hero who is an ‘anti-hero’. I recently read an article which argued, rather well in my opinion, that the later philosophy of Wittgenstein is an anti-philosophy. One could say the same of the philosophie positive of Auguste Comte, who is often called the father of sociology. The principle with which Comte starts off his philosophy, ‘the fundamental law of mental development’, (...) would put an end to philosophy as traditionally conceived, and would replace it by science. According to Comte, human inquiry goes through three stages. In the first stage, the theological or fictive, men try to give explanations in terms of supernatural beings. At the second stage, the metaphysical or abstract, theological explanation has given way to explanation in terms of abstract entities such as Absolute Motion or Absolute Justice. In the third stage, the scientific or positive, metaphysical explanations have given way to scientific explanations, that is to explanations which do not refer to any unobservable entities but instead simply correlate observable phenomena with each other. This is a picture of intellectual history in which philosophy takes the place of theology and then science takes the place of philosophy. (shrink)