The Problem of Doxastic Shift may be stated as a dilemma: on the one hand, the distribution of nominal complements of the form `the ψ that p’ strongly suggests that `that’-clauses cannot be univocally assigned propositionaldenotations; on the other hand, facts about quantification strongly suggest that `that’-clauses must be assigned univocal denotations. I argue that the Problem may be solved by defining the extension of a proposition to be a set of facts or, more generally, conditions. Given this, the logical (...) operation of descriptive predication can be introduced in a way that resolves the dilemma withoutsacrificing the singular term analysis of `that’-clauses. (shrink)

It has been claimed that the attempt to analyze know-how in terms of propositional knowledge over-intellectualizes the mind. Exploiting the methods of so-called “experimental philosophy”, we show that the charge of over-intellectualization is baseless. Contra neo-Ryleans, who analyze know-how in terms of ability, the concrete-case judgments of ordinary folk are most consistent with the view that there exists a set of correct necessary and sufficient conditions for know-how that does not invoke ability, but rather a certain sort of propositional knowledge. (...) To the extent that one’s considered judgments agree with those of the folk (or to the extent that one is unwilling to contravene widespread judgments), this constitutes a strong prima facie case against neo-Ryleanism. (shrink)

Knowledge how to do things is a pervasive and central element of everyday life. Yet it raises many difficult questions that must be answered by philosophers and cognitive scientists aspiring to understand human cognition and agency. What is the connection between knowing how and knowing that? Is knowledge how simply a type of ability or disposition to act? Is there an irreducibly practical form of knowledge? What is the role of the intellect in intelligent action? This volume contains fifteen state (...) of the art essays by leading figures in philosophy and linguistics that amplify and sharpen the debate between "intellectualists" and "anti-intellectualists" about mind and action, highlighting the conceptual, empirical, and linguistic issues that motivate and sustain the conflict. The essays also explore various ways in which this debate informs central areas of ethics, philosophy of action, epistemology, philosophy of language, and philosophy of mind and cognitive science. Knowing How covers a broad range of topics dealing with tacit and procedural knowledge, the psychology of skill, expertise, intelligence and intelligent action, the nature of ability, the syntax and semantics of embedded questions, the mind-body problem, phenomenal character, epistemic injustice, moral knowledge, the epistemology of logic, linguistic competence, the connection between knowledge and understanding, and the relation between theory and practice. This is the book on knowing how--an invaluable resource for philosophers, linguists, psychologists, and others concerned with knowledge, mind, and action. (shrink)

Perhaps it is a pity that the Theory of Knowledge and the Theory of Conduct have fallen into separate compartments. (It certainly was not so in Socrates’ time, as his interest in the relation between eidos and technê bears witness.) If we studied them together, perhaps we might have a better understanding of both. H.H. Price, Thinking and Representation..

This compilation of references includes all references for the knowledge-how chapters included in Bengson & Moffett's edited volume. The volume and the compilation of references may serve as a good starting point for people who are unfamiliar with the philosophical literature on knowledge-how.

The singular term theory maintains that that-clauses are complex singular terms which designate propositions. Though extremely well-supported, the theory is endangered by the existence of oblique that-clauses; that is, that-clauses occurring in what appear to be nonargument positions (e.g., ‘Lola was upset that Slick Willy had all the fun’). In this paper I argue that the best solution to the problem consistent with the singular term theory, invokes a construction-based grammatical theory. Such an approach challenges traditional views of semantic compositionality (...) by rejecting a central dogma of semantics, namely, that linguistic constructions contribute only trivial logical or quasi-logical information to semantic interpretation (e.g., function-application relations). (shrink)

There are two constraints on any functionalist solution to the Mind-Body Problem construed as an answer to the question, “What is the relationship between the mental properties and relations (hereafter, simply the mental properties) and physical properties and relations?” The first constraint is that it must actually address the Mind-Body Problem and not simply redefine the debate in terms of other, more tractable, properties (e.g., the species-specific property of having human-pain). Such moves can be seen to be spurious by the (...) very multiple-realizability intuitions that motivate functionalism in the first place. For, according to those intuitions, it is possible for a being to experience pain, have beliefs, etcetera, and yet not only to be of a different species, but to have an entirely different material constitution from human beings. (shrink)

According to one widely held view, a belief is fully justified only if it holds up against the strongest available counterarguments, and we can be appropriately confident that it does hold up only if there is free and open critical discussion of those beliefs between us and our epistemic peers. In this paper I argue that this common picture of ideal rational group inquiry interacts with epistemic problems concerning reasonable disagreement in a way that makes those problems particularly difficult to (...) resolve. By focusing on this idealized context, we get a clearer picture of the epistemic principles at issue. In the end, I argue that the best way to resolve the resulting epistemic conflicts is by appeal to the underdetermination of theory by evidence together with a principle of epistemic conservatism. (shrink)

“Well, in our country,” said Alice, still panting a little, “you’d generally get to somewhere else—if you run very fast for a long time, as we’ve been doing.”.

On the face of it, Plato’s dialogue the Cratylus has a clear and narrowly linguistic subject matter, specifically, the debate between conventionalism and naturalism in the theory of meaning. But why should this topic be of sufficient interest to Plato to warrant an entire dialogue? What philosophically was at stake for him in these seemingly recherché questions about language? I argue that at least one major motivation is a defense of Platonistic epistemology and, in particular, Plato’s Theory of Recollection. Specifically, (...) I argue that conventionalism and naturalism pose alternative responses to a certain version of the paradox of analysis. If either is correct, Plato’s own solution to the paradox – the Theory of Recollection – will not be adequately motivated. If, however, neither conventionalism nor naturalism can plausibly avoid the paradox, the Theory of Recollection will still be needed. (shrink)

We begin with a puzzle: why do some know-how attributions entail ability attributions while others do not? After rejecting the tempting response that know-how attributions are ambiguous, we argue that a satisfactory answer to the puzzle must acknowledge the connection between know-how and concept possession (specifically, reasonable conceptual mastery, or understanding). This connection appears at first to be grounded solely in the cognitive nature of certain activities. However, we show that, contra anti-intellectualists, the connection between know-how and concept possession can (...) be generalized via reflection on the cognitive nature of intentional action and the potential of certain misunderstandings to undermine know-how even when the corresponding abilities and associated propositional knowledge are in place. Such considerations make explicit the intimate relation between know-how and understanding, motivating a general intellectualist analysis of the former in terms of the latter. (shrink)

Conflicts of interest are rampant in the American medical community. Today it is not uncommon for doctors to refer patients to clinics or labs in which they have a financial interest (40% of physicians in Florida invest in medical centers); for hospitals to offer incentives to physicians who refer patients (a practice that can lead to unnecessary hospitalization); or for drug companies to provide lucrative give-aways to entice doctors to use their "brand name" drugs (which are much more expensive than (...) generic drugs). In Medicine, Money and Morals, Marc A. Rodwin draws on his own experience as a health lawyer--and his research in health ethics, law, and policy--to reveal how financial conflicts of interest can and do negatively affect the quality of patient care. He shows that the problem has become worse over the last century and provides many actual examples of how doctors' decisions are influenced by financial considerations. We learn how two California physicians, for example, resumed referrals to Pasadena General Hospital only after the hospital started paying $70 per patient (their referrals grew from 14 in one month to 82 in the next). As Rodwin writes, incentives such as this can inhibit a doctor from taking action when a hospital fails to provide proper service, and may also lead to the unnecessary hospitalization of patients. We also learn of a Wyeth-Ayerst Labs promotion in which physicians who started patients on INDERAL (a drug for high blood pressure, angina, and migraines) received 1000 mileage points on American Airlines for each patient (studies show that promotions such as this have a direct effect on a doctor's choice of drug). Rodwin reveals why the medical community has failed to regulate conflicts of interest: peer review has little authority, state licensing boards are usually ignorant of abuses, and the AMA code of ethics has historically been recommended rather than required. He examines what can be learned from the way society has coped with the conflicts of interest of other professionals --lawyers, government officials, and businessmen--all of which are held to higher standards of accountability than doctors. And he recommends that efforts be made to prohibit and regulate certain kinds of activity (such as kickbacks and self-referrals), to monitor and regulate conduct, and to provide penalties for improper conduct. Our failure to face physicians' conflicts of interest has distorted the way medicine is practiced, compromised the loyalty of doctors to patients, and harmed society, the integrity of the medical profession, and patients. For those concerned with the quality of health care or medical ethics, Medicine, Money and Morals is a provocative look into the current health care crisis and a powerful prescription for change. (shrink)

Joseph Heath defends competitive markets and conceptualizes business ethics with reference to Pareto efficiency, which he takes to be the “implicit morality of the market.” His justification for markets is that they generate Pareto efficient outcomes, meaning that markets optimally satisfy consumer preferences. And, for Heath, business ethics is the set of normative constraints—regulation and beyond-compliance norms—needed to preserve that outcome. The present paper accepts Heath’s claim that the economic justification for markets is ethical, in that satisfying consumer preferences is (...) a good. But, contra Heath, the ethical consideration at work is a consequentialist one; and acknowledging this consequentialism exposes limitations of Heath’s “market failures” approach to business ethics. We suggest two limitations, and we expect many will accept our argument that Heath’s conception of business ethics is too narrow. The present paper outlines two broader implications. First, acknowledging that the justification for markets is ethical eliminates the apparent—and false—conflict between purportedly amoral economic activity on one hand and ethical considerations on the other; instead, business ethics is a matter of weighing the consequentialist ethical benefit of economic activity and markets against other moral arguments/other ethical considerations. Second, Heath restricts business ethics to the constraints needed to protect the market’s ability to efficiently satisfy consumer preferences, constraints he calls “efficiency imperatives”; this restriction supports the widespread tendency to think that all social problems are economic; and, a business ethics so-conceived diminishes the perceived importance of noneconomic values—this attitude is dangerous. (shrink)

Across the management, social science, and business ethics literatures, and in much of the philosophy literature, trust is characterized as a disposition to act given epistemic states—beliefs and/or expectations about others and about the risks involved. This characterization of trust is best thought of as epistemological because epistemic states distinguish trust from other dispositions. The epistemological characterization of trust is the amoral one referred to in the title of this paper, and we argue that this characterization is conceptually inadequate. We (...) outline and defend an alternative conception of trust as a moral phenomenon: when A trusts B to do something, A invites B to acknowledge and accept an obligation; when B accepts the invitation, B takes on an obligation; in that way trust creates an obligation. We conclude with an application, drawing out the difference between the epistemological conception of trust and our own in the context of Ghoshal et al.'s (Sloan Management Review 40:9—20, 1995, Academy of Management Learning & Education 4:75—91, 2005) critique of transaction cost theories of the firm. (shrink)

The most recent restatements of stakeholder theory formulate that approach in terms of the distribution of value: “A stakeholder approach to business is about creating as much value as possible for stakeholders, without resorting to tradeoffs” (Freeman et al. 2010: 28). This formulation marks a shift from earlier work, which included a procedural dimension—a requirement that stakeholders participate in organization decision making. The present paper pushes back against this shift: it argues that orienting the stakeholder approach around the participation requirement (...) provides for a different moral logic, one not available to (now) conventional stakeholder theorizing (without that requirement), and one that may be more compelling to many. This argument requires critical re-examination of the moral arguments offered in the most recent restatements of the stakeholder approach. (shrink)

This paper argues that Rawls’ principles of justice provide a normative foundation for stakeholder theory. The principles articulate (at an abstract level) citizens’ rights; these rights create interests across all aspects of society, including in the space of economic activity; and therefore, stakeholders – as citizens – have legitimate interests in the space of economic activity. This approach to stakeholder theory suggests a political interpretation of Boatright’s Moral Market approach, one that emphasizes the rights/place of citizens. And this approach to (...) stakeholder theory – in terms of citizens – raises a further question, what rights and obligations do economic agents have, beyond those attached to their roles as citizens? Rawls would reject additional rights and obligations of this sort for two reasons, one tied to freedom and one tied to pluralism. Rawls’ work therefore presses us to re-conceptualize the place of ethical claims in the economic context. (shrink)

According to recent literature in philosophy and psychology, there is a set of basic emotions that were preserved over the course of evolution because they serve adaptive functions. However, the empirical evidence fails to support the claim that there are basic emotions because it fails to show that emotions can be identified with specific functions. Moreover, work on basic emotions lacks the conceptual space to take emotional experience into account and so fails to amount to an adequate theory of emotion: (...) in the literature basic emotions are identified with emotional responses, but these responses — even if they did exist as characterized — are not emotions or emotional. That said, recent empirical discoveries about the brain structures responsible for emotional responses, discoveries that are often cited in the basic emotions literature, nevertheless form the foundation for a comprehensive theory of emotion — a theory that is broadly Jamesian in that an emotion is the experience and interpretation of a prior, physiological response. (shrink)

Bernard Williams briefly discusses agent regret in his broader account of moral luck. The present paper first outlines one way to develop Williams’s notion with reference to the unintended harm; it then suggests that agent regret can be counteracted by externalizing the action that caused unintended harm, in Harry Frankfurt’s sense of externalization; and then the present paper argues that apology is a mechanism by which a person can externalize an offending action/effect—in that way counteracting agent regret. This function for (...) apology—self-repair—is different from others described in the literature, which address the role of apology in repairing relationships. The present paper describes a nonfictional example, that of a veteran of the U.S. war in Iraq who contacts a family gravely injured by him and his combat unit; the veteran is motivated to contact the family to apologize. The example serves as a prototypical case of agent regret. The example is taken from a recent literature on the clinical psychology of self-inflicted “moral injury”; categorizing this example of moral injury as agent regret also helps broaden our understanding of moral injury as a philosophical category and as a psychological phenomenon. (shrink)

This short paper defends Oliver Williamson’s (1993) claim that talk of trust is ‘redundant at best and can be misleading’ when trust is defined as a form of calculated risk (p. 463). And this paper accepts Williamson’s claim that ‘Calculative trust is a contradiction in terms’ (p. 463). But the present paper defends a conception of genuine, non-calculative trust that is compatible with calculative considerations and calculative antecedents. This conception of trust creates space for genuine (non-calculative) trust relationships in the (...) economic order—in which calculative considerations and antecedents (most often) play an essential role. (shrink)

George Berkeley, Bishop of Cloyne, was an Irish philosopher and divine who pursued a number of grand causes, contributing to the fields of economics, mathematics, political theory and theology. He pioneered the theory of 'immaterialism', and his work ranges over many philosophical issues that remain of interest today. This volume offers a complete and accurate edition of Berkeley's extant correspondence, including letters written both by him and to him, supplemented by extensive explanatory and critical notes. Alexander Pope famously said 'To (...) Berkeley every virtue under heaven', and a careful reading of the letters reveals a figure worthy of admiration, sheds new light on his personal and intellectual life, and provides insight into the broad historical and philosophical currents of his time. The volume will be an invaluable resource for philosophers, modern historians and those interested in Anglo-Irish culture. (shrink)

Joseph A. Bracken, S.J,. is one of the more significant North American theologians of the past 40 years. With 12 monographs, two edited or co-edited volumes, over 150 articles, numerous professional and popular conference presentations and media appearances, he is one of the foremost interlocutors in contemporary theological discourse. Having developed and consistently defended a comprehensive and intellectually rigorous worldview that combines the modern and classical Christian worldviews, Bracken has accomplished an invaluable service to the academy, the church, and the (...) world. He has not favored a particular theological or philosophical system, past or present. Instead, he culls what he judges to be true and good in a myriad of seemingly prima facie noncompossible thinkers and systems with divergent programs. Synthesizing the Catholic intellectual tradition and process-relational metaphysics, Bracken also incorporates aspects of German and Anglo-American Idealism, Pragmatism, recent philosophy of science, and a litany of past and present theologians and philosophers. The present volume is a Festschrift to honor Bracken’s career and accomplishments. It differs from the standard Festschrift genre in that the contributors, while certainly explicating and reflecting upon various aspects of his comprehensive worldview, offer their original contributions n a variety of topics. They do in dialogue with Bracken’s positions, simply as starting points, not as end points. The common theme of the Festschrift, then, is serious reflection on and in some cases critique of Bracken’s comprehensive process-relational, Catholic, and Trinitarian worldview and its pertinence for work in contemporary theology from a given perspective. Yet there is a certain richness coming from the diverse perspectives of the contributors whose work intersects with Bracken’s, and not always in terms of process thought per se. The contributors come from diverse backgrounds, not only in process and Roman Catholic theology but also including even other academic disciplines. They represent a balance of senior and junior scholars, and of genders. (shrink)

Empirical evidence shows that non-conscious appraisal processes generate bodily responses to the environment. This finding is consistent with William James’s account of emotion, and it suggests that a general theory of emotion should follow James: a general theory should begin with the observation that physiological and behavioral responses precede our emotional experience. But I advance three arguments (empirical and conceptual arguments) showing that James’s further account of emotion as the experience of bodily responses is inadequate. I offer an alternative model, (...) according to which responses (physical states) are perceived and interpreted by a separate cognitive process, one that assigns meaning to those responses. The non-conscious appraisal process and the interpretive process are distinct, hence a two-stage model of emotion. This model is related to Schachter and Singer’s two-factor theory. Their often-discussed experiment showed that interpretation can play a role in producing emotions. But they do not show that interpretation is necessary for producing emotions in general, outside of the experimental conditions that generated unexplained arousal in subjects. My two-stage model supports this stronger claim by situating the interpretive process in a comprehensive model of emotion. (shrink)

Why do physicians have financial conflicts of interest? They arise because society expects physicians to act in their patients’ interest, while simultaneously, financial incentives encourage physicians to practice medicine in ways that promote their own interests or those of third parties. Because physicians’ clinical choices, referrals, and prescriptions affect the fortune of third parties, these third parties may offer physicians financial incentives to make income-driven clinical choices. In the past, physicians and scholars typically conceived of conflicts of interest as an (...) ethical issue to be resolved according to individual judgment or professional and organizational norms. However, society can mitigate or eliminate conflicts of interest by changing financial and organizational arrangements in medicine. Conflicts of interest, therefore, are as much matters of public policy and management as individual choices or social norms. (shrink)

This chapter argues that trust is an intrinsic good (that is, a good to be pursued apart from material or instrumental beneft), and so we have moral reason to trust.

Social scientists widely believe that trust begets trustworthiness, meaning that persons reward actions that they view as expressing trust. But evidence from the trust game (also known as the investment game)—introduced by Berg, Dickhaut, and McCabe and frequently used to test this relationship—is surprisingly inconclusive. The present article therefore reexamines this hypothesis (Experiment 1), using the trust game but incorporating mediation analysis and distinguishing between trust and distrust effects. The trust game has been used to study the effects of trust (...) within a relationship: when A trusts B, does this affect B’s behavior toward A? This research (in Experiment 2) extends the question: when A trusts B, is B more likely to trust another player C in a second (unrelated) game? If so, then trust relationships have a transitive structure. Taken together, findings from these experiments show that trust begets trustworthiness and also trust in others. (shrink)

Joseph Heath states that our paper “misinterpret[s]” and so misrepresents his account. The present Commentary corrects the record. Our paper (Cohen and Peterson 2019) outlined Heath’s account on his own terms; it explained that Heath distances himself from consequentialism. But then we argued that Heath is mistaken and so offered a repaired version of the market failures approach. Our central concern, in the original paper and in this short Commentary, is showing that the economic argument for markets is at the (...) same time ethical, and then being more precise about the ethical consideration that does the work. (shrink)

Across the social sciences and even in philosophy, trust is most often characterized in terms of expectations and probabilities. This book defends an alternative conception of trust as a moral phenomenon. -/- When one person trusts another to do something, the first relies on the second’s commitment(s). So, trust reflects—and is a product of—agreement about the commitments and obligations that bind persons who live and work together. These commitments and obligations can be implicit, but building (or rebuilding) trust often requires (...) making these commitments and obligations explicit, defining the terms of cooperation. Part 1 argues that this account of trust better captures our actual trust practices, and it draws out connections with both the philosophy and the social science literatures. It also describes the process of creating trust relationships with reference to trust invitations. Part 2 addresses practical applications of the account defended here, in the context of social relationships, economic systems, and within business organizations. These applications emphasize the material benefits of trust but, separate from those, Part 2 argues that trust is an intrinsic good—so we have moral reason to trust. -/- The Nature and Practice of Trust will appeal to scholars and advanced students working in ethics, social and political philosophy, and the social sciences. -/- Chapter 6 of this book is available for free in PDF format as Open Access from the individual product page at the Routledge web site. It has been made available under a Creative Commons Attribution-Non Commercial-No Derivatives 4.0 license. (shrink)

Jared D. Harris, Brian T. Moriarty, and Andrew C. Wicks’ recent book collects eleven chapters by well-known scholars on the question of public trust in business, published along with an introduction and conclusion by the editors. But the collection doesn’t make progress on what this reviewer takes to be the two essential questions. This review outlines those questions and then addresses a further, more technical difficulty with the conceptualizations of trust at work across the chapters. The central theme here is (...) that business as an institution has obligations to society; we—the public—trust business to act on those obligations; and when business violates those obligations our trust is betrayed. The essays collected in this volume do not directly address the question of what those obligations are, but this should be the starting point for an investigation of public trust in business. (shrink)

We examined the relationship between sleep and the affective components of subjective well-being as well as psychological well-being, and between sleep and academic performance, of full-time undergraduate students in a residential college at the National University of Singapore. The aspects of sleep considered were self-reported sleep duration, sleep efficiency, frequency of sleep disturbances, daytime dysfunction, sleep latency and overall sleep quality, as measured by the Pittsburgh Sleep Quality Index. Academic performance was measured using self-reported cumulative average point scores, typically known (...) as grade point average in other institutions. Psychological well-being and the affective components of subjective well-being were assessed using the Flourishing Scale and the Scale of Positive and Negative Experience, respectively. With the exception of sleep latency, our univariate analysis revealed significant associations between the abovementioned facets of sleep, and the affective components of subjective well-being. The analysis also revealed significant associations between the above sleep variables and psychological well-being, except sleep latency and frequency of sleep disturbances. Only daytime dysfunction was found to be significantly correlated with academic performance in our univariate analysis. In addition, our multivariate analysis shows that psychological well-being, affect balance and academic performance each has a direct effect on overall sleep quality. The relationship between overall sleep quality and psychological well-being is U-shaped, while that between overall sleep quality and affect balance is linear and moderated by psychological well-being. The relationship between overall sleep quality and academic performance is either U-shaped or an inverted-U, depending on the level of psychological well-being, which moderates the relationship. These nonlinear relationships indicate that individuals with the highest levels of psychological well-being are not the best sleepers, neither are the highest academic achievers necessarily the best sleepers. (shrink)

Donald Davidson's work has been of seminal importance in the development of analytic philosophy and his views on the nature of language, mind and action remain the starting point for many of the central debates in the analytic tradition. His ideas, however, are complex, often technical, and interconnected in ways that can make them difficult to understand. This introduction to Davidson's philosophy examines the full range of his writings to provide a clear succinct overview of his ideas. This book begins (...) with an account of the assumptions and structure of Davidson's philosophy of language, introducing his compositionalism, extensionalism and commitment to a Tarski-style theory of truth as the model for theories of meaning. It goes on to show how that philosophical framework is to be applied and how it challenges the traditional picture. Marc Joseph examines Davidson's influential work on action theory and events and discusses the commonly made charge that his theory of action and mind leaves the mental as a mere 'epiphenomenon' of the physical. The final section explores Davidson's philosophy of mind, some of its consequences for traditional views of subjectivity and objectivity and, more generally, the relation between minded beings and the physical and mental world they occupy. (shrink)

My original paper (Cohen 2012) argued that business ethics education should focus on cultivating empathetic concern. This response clarifies terminology used in that paper and responds to criticisms presented by David Ohreen (2013).

Generalized trust is widely said to be essential for social and economic cooperation, but—despite the large empirical literature—there is disagreement and confusion over how to understand generalized trust. This paper develops the conceptual options that can be drawn from the social science literature—with attention to the moral dimension in each, and with some attention to the different ways that generalized trust can serve as a foundation for the social order.

The federal government indirectly subsidizes the pharmaceutical industry by funding basic research, various tax credits and deductions, patent rules, grants of market exclusivity, and other means, in order to spur drug development, promote public health, and improve medical care. But today, the pharmaceutical industry often neglects these goals and sometimes even undermines them, due to what Lawrence Lessig refers to as institutional corruption — that is, widespread or systemic practices, usually legal, that undermine an institution’s objectives or integrity. A key (...) source of institutional corruption is improper dependence by the institution or its key actors on the actions of third parties that have fundamentally different interests. It is the health care system’s improper dependency on pharmaceutical firms that allows them to displace some public policy goals and to compromise the attainment of others. (shrink)

Data from the World Values Survey shows that generalized trust in Mainland China—trust in out-group members—is very low, but generalized trust in Taiwan is much higher. The present article argues that positive interactions with out-group members in the context of Taiwan’s export-oriented economy fostered generalized trust—and so explains this difference. This line of argument provides evidence for Albert O. Hirschman’s doux commerce thesis, that market interaction can improve persons and even stabilize the social order. The present article defends this point (...) by separating two theses that Hirschman combines under that label, a countervailing forces thesis and a doux commerce thesis narrowly understood. These theses offer different explanations (or mechanisms) for how commerce could have those positive effects. The data about Taiwanese trust practices provides evidence for the latter. (shrink)

Improper dependencies slant policy over a drug's life span, biasing the development of new drugs, the testing and marketing approval for new drugs, and the monitoring of patient safety after drugs are marketed. This article examines five ways in which the public improperly depends on pharmaceutical firms that compromise the integrity of pharmaceutical policy. Today the public relies on pharmaceutical firms: (1) to set priorities on drug research and development; (2) to conduct clinical trials to test whether drugs are safe (...) and effective; (3) to decide what clinical trial data to disclose to the public; (4) to monitor post marketing drug safety; (5) to supply product information to physicians and to finance continuing medical education and other professional activities. The article suggests options to overcome each of these dependencies. (shrink)

Through the 1960s, many people claimed that drug advertising was educational and physicians often relied on it. Continuing Medical Education (CME) was developed to provide an alternative. However, because CME relied on grants, industry funders chose the subjects offered. Now policymakers worry that drug firms support CME to promote sales and that commercial support biases prescribing and fosters inappropriate drug use. A historical review reveals parallel problems between advertising and industry-funded CME. To preclude industry influence and improve CME, we should (...) ensure independent funding by taxing medical industries, facilities and physicians. Independent public and professional authorities should create CME curricula. An independent agency should allocate all funds to educational institutions for approved curricula. (shrink)

Public policy tries to promote appropriate drug use by allowing firms to market drugs in interstate commerce only for uses that the Food and Drug Administration has found to be safe and effective. Because of their medical knowledge, physicians are authorized to prescribe drugs even for uses unapproved by the FDA. Nevertheless, physicians have relied on drug firms for information on appropriate prescribing despite the inherent tension between drug firm dissemination of information to promote sales and rational prescribing. In the (...) past, physicians often relied particularly on drug firm advertising for information on drug use. Today, physicians rely on drug firms to finance continuing medical education. A historical review reveals connections between these two different ways commercial interests have influenced the information that physicians receive and points the way to needed reforms. (shrink)

The Food and Drug Administration authorizes the marketing of a drug only for uses that the manufacturer has demonstrated to be safe and effective, based on evidence from at least two clinical trials. However, the FDA does not regulate the practice of medicine, so physicians may prescribe drugs in any manner they choose. Prescribing drugs in ways that deviate from the uses specified in the FDA-approved drug label, package insert, and marketing authorization is referred to as off-label prescribing. This occurs (...) when physicians prescribe a drug for a therapeutic purpose other than the one approved by the FDA; treat patients in a different age cohort or gender than the population on which it was tested; or prescribe a different dose, for a different duration of use, or a different mode of administration than indicated on the label. (shrink)

"A wide-ranging study of the 'way of ideas' and its metaphysics, culminating in a bold reinterpretation of Berkeley.".

Prescribing drugs for uses that the FDA has not approved — off-label drug use — can sometimes be justified but is typically not supported by substantial evidence of effectiveness. At the root of inappropriate off-label drug use lie perverse incentives for pharmaceutical firms and flawed oversight of prescribing physicians. Typical reform proposals such as increased sanctions for manufacturers might reduce the incidence of unjustified off-label use, but they do not remove the source of the problem. Public policy should address the (...) cause and control the practice. To manage inappropriate off-label drug use, off-label prescriptions must be tracked in order to monitor the risks and benefits and the manufacturers’ conduct. Even more important, reimbursement rules should be changed so that manufacturers cannot profit from off-label sales. When off-label sales pass a critical threshold, manufacturers should also be required to pay for independent testing of the safety and effectiveness of off-label drug uses and for the FDA to review the evidence. Manufacturers should also finance, under FDA supervision, programs designed to warn physicians and the public about the risks of off-label drug use. (shrink)