The use of a placebo arm in clinical trials is unethical if there is an active comparator that is acceptably safe and effective. We argue that reasonable evidence of effectiveness and safety of an inexpensive alternative to an expensive therapy is sufficient to require that the inexpensive therapy be included as a comparator when the expensive therapy is tested, and that use of an inactive placebo comparator only is not ethical. For example, studies of the expensive drug eplerenone for congestive (...) heart failure have not included a spironolactone arm, although there is reasonable evidence that spironolactone would be safe and effective, and spironolactone is inexpensive. The requirement to study inexpensive therapies is based on avoidance of unnecessary cost in medical care as an example of non-maleficence. Several ethical actors in the design, conduct, and publication of clinical trials and their results bear responsibility for the appropriate conduct of clinical trials. That responsibility includes protecting study subjects from being asked to participate in clinical trials that serve primarily to promote the use of new and expensive therapies. (shrink)

It is easier to resist at the beginning than at the end.– Leonardo da VinciPhysicians often believe that a conscious commitment to ethical behavior and professionalism will protect them from industry influence. Despite increasing concern over the extent of physician-industry relationships, physicians usually fail to recognize the nature and impact of subconscious and unintentional biases on therapeutic decision-making. Pharmaceutical and medical device companies, however, routinely demonstrate their knowledge of social psychology processes on behavior and apply these principles to their marketing. (...) To illustrate how pharmaceutical marketing strategies use psychological techniques to promote targeted therapies, we draw on the relevant social psychology literature on conflicts of interest and on the six principles of influence articulated by the eminent social psychologist Robert Cialdini. Hospitals, professional organizations, medical educators, and other stakeholders must also draw on social psychology to respond effectively to commercial activities that compromise good medical practice. (shrink)

Pharmaceutical and medical device companies apply social psychology to influence physicians' prescribing behavior and decision making. Physicians fail to recognize their vulnerability to commercial influences due to self-serving bias, rationalization, and cognitive dissonance. Professionalism offers little protection; even the most conscious and genuine commitment to ethical behavior cannot eliminate unintentional, subconscious bias. Six principles of influence — reciprocation, commitment, social proof, liking, authority, and scarcity — are key to the industry's routine marketing strategies, which rely on the illusion that the (...) industry is a generous avuncular partner to physicians. In order to resist industry influence, physicians must accept that they are vulnerable to subconscious bias and have both the motivation and means to resist industry influence. A culture in which accepting industry gifts engenders shame rather than gratitude will reduce conflicts of interest. If greater academic prestige accrues to distant rather than close relationships with industry, then a new social norm may emerge that promotes patient care and scientific integrity. In addition to educating faculty and students about the social psychology underlying sophisticated but potentially manipulative marketing and about how to resist it, academic medical institutions should develop strong organizational policies to counteract the medical profession's improper dependence on industry. (shrink)

Women’s health activists laid the groundwork for passage of the law that created the U.S. Food and Drug Administration in 1906. The pharmaceutical and food industries fought regulatory reforms then and continue to do so now. We examine public health activism in the Progressive Era, the postwar era and the present day. The women’s health movement began in the 1960s, and criticized both the pharmaceutical industry and the medical establishment. In the 1990s, patient advocacy groups began accepting industry funds; thousands (...) of commercially-funded groups now dominate the advocacy landscape. As pharma funding became normalized, concerns arose regarding a) the lack of transparency and public accountability regarding funding, b) the distortion of groups’ agendas, and c) the ability of pharma-funded groups to dominate the discourse and override less well-resourced patient and health advocacy groups. Although industry-funded groups argue that funding allows them to provide useful services, the trade-off in health risks, exorbitant prices and distorted information is far too high. Sincerity is beside the point; patients and the industry have differing interests when it comes to drug safety and efficacy, drug information and drug prices. A growing resistance movement is asserting the values of its activist predecessors and opposing the prevailing culture of pharma-funded advocacy. (shrink)

This chapter offers an indirect defence of the Evansian conception of egocentric space, by showing how it resolves a puzzle concerning the unity of egocentric spatial perception. The chapter outlines several common assumptions about egocentric perspectival structure and argues that a subject’s experience, both within and across her sensory modalities, may involve multiple structures of this kind. This raises the question of how perspectival unity is achieved, such that these perspectival structures form a complex whole, rather than merely disunified set (...) of individually, distinctively structured experiences. The shortcomings of variety of accounts are considered: switch accounts ; sensory accounts; transformation accounts; and ultimate accounts. These shortcomings are addressed by a further kind of account provided by the Evansian conception – an agentive account – according to which egocentrically structured experiences present the world in relation to parts of a single thing, the body as a dynamic unity. (shrink)

This paper is concerned with representational explanations of how one experiences and acts with one’s body as an integrated whole. On the standard view, accounts of bodily experience and action must posit a corresponding representational structure: a representation of the body as an integrated whole. The aim of this paper is to show why we should instead favour the minimal view: given the nature of the body, and representation of its parts, accounts of the structure of bodily experience and action (...) need not appeal to a representation of the body as an integrated whole. The argument proceeds by distinguishing two kinds of explanatory roles for representations: standing-in for absent targets and structuring ambiguous sensory information concerning a target. Representations of body-parts are suited to fulfil both kinds of explanatory role, whereas a representation of the body as an integrated whole is only suited to fulfil the latter, as a means of coordinating representations of body-parts. It is then argued that the structure of the body can itself serve as a means of coordinating body-part representations, rendering representation of the body as an integrated whole explanatorily superfluous. (shrink)

Combining sociological evidence with the analytical tools of philosophy, Ethics, Money and Sport articulates and explores the main concerns about the way money has changed our experience of sports. Clearly written and illustrated by examples from major sports around the world, Ethics, Money and Sport enables students, researchers and policymakers - as well as anyone with an interest in the future of sport - to engage with this crucial debate.

The complexities of bodily experience are outlined; its spatial phenomenology is specified as the explanatory target. The mereological structure of body representation is discussed; it is claimed that global spatial representations of the body are not necessary, as structural features of the actual body can be exploited in partial internal representation. The spatial structure of bodily experience is discussed; a structural affordance theory is introduced; it is claimed that bodily experience and subpersonal representation have action-orientated content; and that egocentric terms (...) continue to make sense in application to bodily experience. (shrink)

Commentary on: Olaf Blanke, Thomas Metzinger, Full-body illusions and minimal phenomenal selfhood, Trends in Cognitive Sciences, Volume 13, Issue 1, January 2009, Pages 7-13, ISSN 1364-6613, DOI: 10.1016/j.tics.2008.10.003.

This article proposes an ecophilosophy of the cinema. It builds on Martin Heidegger’s articulation of art as ‘world-disclosing,’ and on a Whiteheadian and Deleuzian understanding of the universe as a lively and eventful place in which subjects and objects are persistently coming into being, jointly constituted in the process of their becoming. Accordingly, it proposes that cinema be considered a machine that produces or discloses worlds. These worlds are, at once, anthropomorphic, geomorphic, and biomorphic, with each of these registers mapping (...) onto the ‘three ecologies,’ in Felix Guattari’s terms, that make up the relational ontology of the world: the social, the material, and the mental or perceptual. Through an analysis of Andrei Tarkovsky’s Stalker (1979), I suggest that cinema ‘stalks’ the world, and that our appreciation of its potentials should similarly involve a kind of ‘stalking’ of its effects in the material, social, and perceptual dimensions of the world from which cinema emerges and to which it returns. (shrink)

The information contained within the linear sequence of bases (the genome) must be faithfully replicated in each cell cycle, with a balance of constancy and variation taking place over the course of evolution. Recently, it has become clear that additional information important for genetic regulation is contained within the chromatin proteins associated with DNA (the epigenome). Epigenetic information also must be faithfully duplicated in each cell cycle, with a balance of constancy and variation taking place during the course of development (...) to achieve differentiation while maintaining identity within cell lineages. Both the genome and the epigenome are synthesized at the replication fork, so the events occurring during S‐phase provide a critical window of opportunity for eliciting change or maintaining existing genetic states. Cells discriminate between different states of chromatin through the activities of proteins that selectively modify the structure of chromatin. Several recent studies report the localization of certain chromatin modifying proteins to replication forks at specific times during S‐phase. Since transcriptionally active and inactive chromosome domains generally replicate at different times during S‐phase, this spatiotemporal regulation of chromatin assembly proteins may be an integral part of epigenetic inheritance. BioEssays 25:647–656, 2003. © 2003 Wiley Periodicals, Inc. (shrink)

Entre las diferentes apariciones del arte en la obra cervantina, se cuentan dos poemas con elementos pictóricos de interés: el temprano soneto “A san Francisco” presenta una écfrasis en la que el alarde de conocimientos artísticos muestra un uso social y cortesano de la poesía, mientras el romance a Altisidora aprovecha una serie de tecnicismos pictóricos de manera burlesca.

This book was born out of two interdisciplinary seminars held in 2014. The first one was the Climate Ethics and Climate Economics workshop in April adjoined as part of the European Consortium for Political Research Joint Sessions 2014 in Salamanca. Spurred on by the invigorating discussions, the participants decided to put together more workshops, with Ethical Underpinnings of Climate Economics following in Helsinki in November that same year. Without the organisers of these workshops the collaborators of this book would not (...) have come together: Matthew Rendall, Dominic Roser, Sade Hormio, Simo Kyllonen, Aaron Maltais and Joanna Burch-Brown. We would also like to thank all the participants at the workshops for making them so enjoyable and worthwhile. The Helsinki workshop that this book was named after was organized as part of the Climate Ethics and Economics project, led by Aki Lehtinen and funded by the University of Helsinki. The three-year project is based at the Social and Moral Philosophy discipline in the Department of Political and Economic Studies. The workshop itself was made possible by funding from the Academy of Finland Centre of Excellence in the Philosophy of the Social Sciences, which also helped to host the event. (shrink)

An original account of social justice using Neo-Aristotelian value theory to fully explore the concept of human good. The book concentrates on developing a pluralist egalitarian theory of social justice in conjunction with a distinctive account of human good.

Lea & Webley (L&W) provide two alternative biological accounts of human monetary motivations, the Tool Theory and the Drug Theory. They argue that both are required for an adequate explanation. I explore the applicability of these models to philosophical discussions of how we might justify such motivations. I argue their approach is not entirely satisfactory for normative questions, since it precludes the possibility of rational non-instrumental attitudes towards money. (Published Online April 5 2006).

The body may be the object we know the best. It is the only object from which we constantly receive a flow of information through sight and touch; and it is the only object we can experience from the inside, through our proprioceptive, vestibular, and visceral senses. Yet there have been very few books that have attempted to consolidate our understanding of the body as it figures in our experience and self-awareness. This volume offers an interdisciplinary and comprehensive treatment of (...) bodily self-awareness, the first book to do so since the landmark 1995 collection The Body and the Self, edited by José Bermúdez, Naomi Eilan, and Anthony Marcel. Since 1995, the study of the body in such psychological disciplines as cognitive psychology, cognitive neuroscience, psychiatry, and neuropsychology has advanced dramatically, accompanied by a resurgence of philosophical interest in the significance of the body in our mental life. The sixteen specially commissioned essays in this book reflect the advances in these fields. The book is divided into three parts, each part covering a topic central to an explanation of bodily self-awareness: representation of the body; the sense of bodily ownership; and representation of the self. ContributorsAdrian Alsmith, Brianna Beck, José Luis Bermúdez, Anna Berti, Alexandre Billon, Andrew J. Bremner, Lucilla Cardinali, Tony Cheng, Frédérique de Vignemont, Francesca Fardo, Alessandro Farnè, Carlotta Fossataro, Shaun Gallagher, Francesca Garbarini, Patrick Haggard, Jakob Hohwy, Matthew R. Longo, Tamar Makin, Marie Martel, Melvin Mezue, John Michael, Christopher Peacocke, Lorenzo Pia, Louise Richardson, Alice C. Roy, Manos Tsakiris, Hong Yu Wong. (shrink)

Background: The research community has a mandate to discover effective treatments for neurodegenerative disorders. The ethics landscape surrounding this mandate is in a constant state of flux, and ongoing challenges place ever greater demands on investigators to be accountable to the public and to answer questions about the implications of their work for health care, society, and policy. Methods: We surveyed US-based investigators involved in neurodegenerative diseases research about how they value ethics-related issues, what motivates them to give consideration to (...) those issues, and the barriers to doing so. Using the NIH CRISP database we identified 1,034 researchers with relevant, active grants and invited them to complete an online questionnaire. We received 193 responses. We used exploratory factor analysis to transform individual survey questions into a smaller set of factors, and linear regression to understand the effect of key variables of interest on the factor scores. Results: Ethics-related issues clustered into two groups: research ethics and external influences. Heads of research groups viewed issues of research ethics to be more important than the other respondents. Concern about external influences was related to overall interest in ethics. Motivators clustered into five groups: ensuring public understanding, external forces, requirements, values, and press and public. Heads of research groups were more motivated to ensure public understanding of research than the other respondents. Barriers clustered into four groups: lack of resources, administrative burden, relevance to the research, and lack of interest. Perceived lack of ethics resources was a particular barrier for investigators working in drug discovery. Conclusions: The data suggest that senior level neuroscientists working in the field of neurodegeneration (ND), and drug discovery specifically, are motivated to consider ethics issues related to their work, but the perceived lack of ethics resources thwarts their efforts. With bioethics centres at more than 50% of the institutions at which these respondents reside, the neuroscience and bioethics communities appear to be disconnected. Dedicated ethical, legal and social implications (ELSI) programs, such as those fully integrated into genetics and regenerative medicine, provide models for achieving meaningful partnerships not yet adequately realized for scholars and trainees interested in drug discovery for ND. (shrink)

The function of groups as information processors is increasingly being recognised in a number of theories of group cognition. A theme of many of these is an emphasis on sharing cognition. This paper extends current conceptualisations of groups by critiquing the focus on shared cognition and emphasising the distribution of cognition in groups. In particular, it develops an account of the distribution of one cognitive construct, mental models. Mental models have been chosen as a focus because they are used in (...) a number of theories of high level cognition from different areas of research such as cognitive science and human factors and so the implication of this development is wide reaching. This paper reviews the unconnected literatures on distributed cognition and mental models and integrates them in order to extend the theory of mental models to distributed cognitive systems such as groups. The distributed cognition literature is reviewed and the importance of considering the group as single cognitive system is adopted. A range of mental model theories are reviewed leading to the conclusion that they all have, in some form, the central feature of a mapping onto the cognitive system. Combining these two ideas, it is proposed that the model can be a mapping onto the whole group, if the information is distributed appropriately and the connections between parts of the model maintained through communication. This cognitive construct is referred to as a distributed mental model. Implications and applications of this theory are discussed. (shrink)