Across a wide range of legal contexts, E. Thomas Sullivan and Richard S. Frase identify three basic ways that government measures and private remedies have been ...
Background: Omalizumab, an anti-immunoglobulin E antibody, reduces exacerbations and symptoms in uncontrolled allergic asthma. The study objective was to estimate the costs and consequences of omalizumab compared to usual care from a US payer perspective. Methods: We estimated payer costs, quality-adjusted survival (QALYs), and the incremental cost-effectiveness ratio (ICER) of omalizumab compared to usual care using a state-transition simulation model that included sensitivity analyses. Every 2 weeks, patients could transition between chronic asthma and exacerbation health states. The best available evidence (...) informed the clinical and cost input estimates. Five years of omalizumab treatment followed by usual care was assumed to estimate a lifetime horizon. Omalizumab responders (60.5% of treated) were modeled as a separate scenario where nonresponders reverted back to usual care after 16 weeks of active treatment. Results: The mean lifetime discounted costs and QALYs were $83 400 and 13.87 for usual care and $174 500 and 14.19 for omalizumab plus usual care resulting in $287 200/QALY (95% interval: $219 300, $557 900). The ICER was $172 300/QALY when comparing omalizumab to usual care in the responder scenario. One-way sensitivity analyses indicated that the results were sensitive to the difference in treatment-specific utilities for the chronic state, exacerbation-associated mortality, omalizumab price, exacerbation rates, and response definition. Conclusions: The results suggest that adding omalizumab to usual care improves QALYs at an increase in direct medical costs. The cost-effectiveness of omalizumab is similar to other chronic disease biologics. The value increases when omalizumab response is used to guide long-term treatment. (shrink)
The aim of this systematic review was to summarize and assess the quality of asthma intervention health economic studies from 2002 to 2007, compare the study findings with clinical management guidelines, and suggest avenues for future improvement of asthma health economic studies. Forty of the 177 studies met our inclusion criteria. We assessed the quality of studies using The Quality of Health Economic Studies validated instrument (total score range: 0-100). Six studies (15%) had quality category 2, 26 studies (65%) achieved (...) quality category 3, and the remaining eight (20%) studies were scored as the highest quality level, category 4. Overall, the findings from this review are in line with the Global Initiative for Asthma clinical guidelines. Many asthma health economic studies lacked appropriate long term time horizons to match the chronic nature of the disease and suffered from using effectiveness measures that did not capture all disease related risks and benefits. We recommend that new asthma simulation models: be flexible to allow for long term time horizons, focus on using levels of asthma control in their structure, and estimate both long term asthma specific outcomes like well-controlled time as well as generic outcomes such as quality adjusted survival. (shrink)
Given that university faculty members and supervisors practicing in the community have been involved in at least one research supervisor-graduate student relationship, it is surprising that so little attention has been paid to the ethical issues involved in such relationships. Indeed, as a student and her or his graduate research supervisor may be involved in a close working relationship for many years, it is understandable that several opportunities can arise that could be considered dual or multiple relationships. Examples of such (...) relationship issues discussed in this article include authorship matters, favoritism or inequitable treatment of students, and sexual relationships. Depending on the nature of the relationship, the impact on students can be quite severe; although, the effects on students have not been adequately studied. Existing ethical guidelines do not provide enough guidance in this area where students are in a position of diminished power with respect to the supervisor. Following the discussion of relationship issues, we suggest extensions of current guidelines to deal with these issues. (shrink)
Descriptive accounts of the nature of explanation in neuroscience and the global goals of such explanation have recently proliferated in the philosophy of neuroscience (e.g., Bechtel, Mental mechanisms: Philosophical perspectives on cognitive neuroscience. New York: Lawrence Erlbaum, 2007; Bickle, Philosophy and neuroscience: A ruthlessly reductive account. Dordrecht: Kluwer Academic Publishing, 2003; Bickle, Synthese, 151, 411–434, 2006; Craver, Explaining the brain: Mechanisms and the mosaic unity of neuroscience. Oxford: Oxford University Press, 2007) and with them new understandings of the <span class='Hi'>experimental</span> (...) practices of neuroscientists have emerged. In this paper, I consider two models of such practices; one that takes them to be reductive; another that takes them to be integrative. I investigate those areas of the neuroscience of learning and memory from which the examples used to substantiate these models are culled, and argue that the multiplicity of <span class='Hi'>experimental</span> protocols used in these research areas presents specific challenges for both models. In my view, these challenges have been overlooked largely because philosophers have hitherto failed to pay sufficient attention to fundamental features of <span class='Hi'>experimental</span> practice. I demonstrate that when we do pay attention to such features, evidence for reduction and integrative unity in neuroscience is simply not borne out. I end by suggesting some new directions for the philosophy of neuroscience that pertain to taking a closer look at the nature of neuroscientific experiments. (shrink)
The Morris water maze has been put forward in the philosophy of neuroscience as an example of an experimental arrangement that may be used to delineate the cognitive faculty of spatial memory (e.g., Craver and Darden, Theory and method in the neurosciences, University of Pittsburgh Press, Pittsburgh, 2001; Craver, Explaining the brain: Mechanisms and the mosaic unity of neuroscience, Oxford University Press, Oxford, 2007). However, in the experimental and review literature on the water maze throughout the history of its use, (...) we encounter numerous responses to the question of “what” phenomenon it circumscribes ranging from cognitive functions (e.g., “spatial learning”, “spatial navigation”), to representational changes (e.g., “cognitive map formation”) to terms that appear to refer exclusively to observable changes in behavior (e.g., “water maze performance”). To date philosophical analyses of the water maze have not been directed at sorting out what phenomenon the device delineates nor the sources of the different answers to the question of what. I undertake both of these tasks in this paper. I begin with an analysis of Morris’s first published research study using the water maze and demonstrate that he emerged from it with an experimental learning paradigm that at best circumscribed a discrete set of observable changes in behavior. However, it delineated neither a discrete set of representational changes nor a discrete cognitive function. I cite this in combination with a reductionist-oriented research agenda in cellular and molecular neurobiology dating back to the 1980s as two sources of the lack of consistency across the history of the experimental and review literature as to what is under study in the water maze. (shrink)
But logic as it stands, e.g. in Principia Mathematica, can quite well be applied to our ordinary propositions; e.g. from ‘All men are mortal’ and ‘Socrates is a man’ there follows according to this logic ‘Socrates is mortal’, which is obviously correct, even though I equally obviously do not know what structure is possessed by the thing Socrates or the property of mortality. Here they just function as simple objects.
In this paper, Wittgenstein's philosophical approach and remarks are used to highlight features of pride that are not represented in contemporary psychological theories. Wittgenstein's scattered philosophical and autobiographical remarks on pride are arranged in order to engage with aspects of pride (e.g., as a self-conscious emotion) that can appear to have only empirical answers. Important themes to emerge in the resulting surview include the temptation to talk of pride as having or being a structure, the role of personal context in (...) understanding intense emotions, the difficulty of finding a referent for proud feelings, choices of words to convey or capture feelings, the possibility of further descriptions of one's inner experiences, bodily and immediate features of the experience of pride, and the need to reconcile occasional immediate bodily and behavioural manifestations of pride with the popular view of pride as a “thoughtful” emotion. The results suggest that new perspectives can emerge through assembling reminders of the everyday use of a concept and engaging with existing research. (shrink)
Vacillating and mixed emotional experiences are often difficult to explore and understand because they confront the limits of our language's ability to capture private experiences in extreme or abnormal circumstances. In this paper, we build upon remarks by Wittgenstein (1953) to present a conceptual-discursive perspective based on naturalistic examples of individuals vacillating between pride and other emotions. This perspective is used to show how relevant emotion theories contain conceptual errors of the sort identified by Wittgenstein. The “assembled reminders” of shifts (...) between pride and other emotions are presented in contrast to analyses that focus on people's identification of causes of emotions, an approach which leads to theoretical speculation about underlying appraisal set changes or discussion of the empirical justification of cognitive ontology. We bypass a direct confrontation on these issues by examining how people's talk about the content of vacillating and mixed emotional experiences (i.e., aspect shifts) augments a shared “emotionology” with creative expressions and poetic comparisons. This last point is illustrated by the emotional instability experienced by individuals with Borderline Personality Disorder (BPD). Support for the conceptual-discursive perspective is provided by the success of a particular therapeutic approach, the Conversational Model, in ameliorating the developmental disruption of BPD by encouraging participation in empathic conversations. We conclude that a conceptual-discursive perspective undermines the cognitive appraisal “picture” of vacillating emotions and adds to our understanding. (shrink)
For the most of us, work is an entirely non-discretionary activity, an inescapable and irreducible fact of existence. According to E. F. Schumacher one of the darkest aspects of contemporary work life is the existence of an appalling number of men and women condemned to work which has no connection with their inner lives, no meaning for them whatever. Work for too many people is perceived as down-time, something that has to be done, but seldom adding to who they are. (...) And yet recent surveys indicate that 74% of the work force would chose to work even if they were not financially required to do so. Why?This paper contends that people want to work because they are intuitively aware that work, be it bad or good, helps to shape them. It gives them a sense of direction and allows them the opportunity for personal creativity and fulfillment. Work is the axis of human self-making. Work molds the person and work is the mark of a person. Satisfaction with life seems to be related to satisfaction with our work and the quality of our lives seems dependent on the quality of work that we do. (shrink)
In several works, Frege argues that content is objective (i.e., thethoughts we entertain and communicate, and the senses of which theyare composed, are public, not private, property). There are, however,some remarks in the Fregean corpus that are in tension with this view.This paper is centered on an investigation of the most notorious andextreme such passage: the `Dr. Lauben example, from Frege (1918). Aprincipal aim is to attain more clarity on the evident tension withinFreges views on content, between this dominant objectivism (...) and someelements that seem to run counter to it, via developing an understandingof the `Dr. Lauben example. Then I will argue that this interpretation goes some way toward undermining some prevalent contemporary viewsabout language. Based on the advice of Dr. Lauben, I will argue againsta certain understanding of the causal-historical theory of reference –more specifically, of the phenomenon of deferential uses of linguisticexpressions – upon which these views are premised, and I will drawout some morals that pertain to individualism and competence. (shrink)
School psychologists often break confidentiality if confronted with risky adolescent behavior. Members of the National Association of School Psychologists ( N = 78) responded to a survey containing a vignette describing an adolescent engaging in risky behaviors and rated the degree to which it is ethical to break confidentiality for behaviors of varying frequency, intensity, and duration. Respondents generally found it ethical to break confidentiality when risky adolescent behaviors became more dangerous or potentially harmful, although there was considerable variability between (...) respondents. Significant gender effects were found between male and female respondents for alcohol use, and a significant Form Type (i.e., male or female vignette) Frequency/Duration interaction was observed for antisocial behaviors. School psychologists could benefit from further training in ethical decision making because these ethical dilemmas are not always clear-cut. (shrink)
American orthodox medicine consolidated its professional authority in the early 20th Century on the basis of its unbiased scientific method. The centerpiece of such a method is a strategy for identifying truly effective new therapies, i.e., the randomized clinical trial (RCT). A crucial component of the RCT in illnesses without established treatment is the placebo control. Placebo effects must be identified and distinguished from pharmacological effects because placebos produce actual but unexplained therapeutic successes. The blinding necessary for a proper placebo-controlled (...) RCT therefore introduces an epistemic bias into orthodox medicine: therapeutic successes that rely upon a direct link between knowing and healing, such as placebo effects, are discarded in favor of therapeutic successes that rely upon an indirect link between knowing and healing, such as pharmacological interventions. Where the capacity to produce therapeutic results once validated the method of clinical medical science, now method validates results. The clinical consequences of this method of testing therapies include a diminished vision of the therapeutic potential of the doctor-patient relationship and of the potential human resources available for healing. Keywords: doctor-patient relationship, epistemology, placebo effect, professionalization, randomized clinical trials CiteULike Connotea Del.icio.us What's this? (shrink)
Is inheritable genetic modification the new dividing line in gene therapy? The editors of this searching investigation, representing clinical medicine, public health and biomedical ethics, have established a distinguished team of scientists and scholars to address the issues from the perspectives of biological and social science, law and ethics, including an intriguing Foreword from Peter Singer. Their purpose is to consider how society might deal with the ethical concerns raised by inheritable genetic modification, and to re-examine prevailing views about whether (...) these procedures will ever be ethically and socially justifiable. The book also provides background to define the field, and discusses the biological and technological potential for inheritable genetic modification, its limitations, and its connection with gene therapy, cloning, and other reproductive interventions. For scientists, bioethicists, clinicians, counsellors and public commentators, this is an essential contribution to one of the critical debates in current genetics. (shrink)
The economic and socio-political impact of multinational corporations (MNCs) on third world countries has been the subject of intense debate and controversy leading to charges of exploitation and colonization on the one hand, and demands for codes of conduct on the other. This article examines the working of one of the most comprehensive of such codes under the most reprehensible political conditions, i.e., the operations of U.S.—based multinational corporations in South Africa under the acgis of the Sullivan Principles. It (...) is argued that despite the best intentions, and considerable social goodwill, the Sullivan Principles were seriously flawed both as to goals and as to means of achieving them. Finally, it suggests a new approach to developing standards of MNC behavior in third world countries which emphasizes those areas of activities that are directly under the control of MNCs, and offers targets of achievement to which MNCs can and should be held accountable.The paper is a revised and expanded version of a keynote speech delivered by the author at the First Biannual Conference on Advances in Management, Orlando, Florida March 25–28, 1992. (shrink)
S. Adams, W. Ambrose, A. Andretta, H. Becker, R. Camerlo, C. Champetier, J.P.R. Christensen, D.E. Cohen, A. Connes. C. Dellacherie, R. Dougherty, R.H. Farrell, F. Feldman, A. Furman, D. Gaboriau, S. Gao, V. Ya. Golodets, P. Hahn, P. de la Harpe, G. Hjorth, S. Jackson, S. Kahane, A.S. Kechris, A. Louveau,, R. Lyons, P.-A. Meyer, C.C. Moore, M.G. Nadkarni, C. Nebbia, A.L.T. Patterson, U. Krengel, A.J. Kuntz, J.-P. Serre, S.D. Sinel'shchikov, T. Slaman, Solecki, R. Spatzier, J. Steel, D. Sullivan, (...) S. Thomas, A. Valette, V.S. Varadarajan, B. Velickovic, B. Weiss, J.D.M. Wright, R.J. Zimmer. (shrink)
It is widely thought that functionalism and the qualia theory are better positioned to accommodate the ‘affective’ aspect (i.e., the hurtfulness) of pain phenomenology than representationalism. In this paper, we attempt to overturn this opinion by raising problems for both functionalism and the qualia theory on this score. With regard to functionalism, we argue that it gets the order of explanation wrong: pain experience gives rise to the effects it does because it hurts, and not the other way around. With (...) regard to the qualia theory, we argue that it fails to capture the sense in which pain's affective phenomenology rationalises various bodily-directed beliefs, desires, and behaviours. Representationalism, in contrast, escapes both of these problems: it gets the order of explanation right and it explains how pain's affective phenomenology can rationalise bodily-directed beliefs, desires, and behaviours. For this reason, we argue that representationalism has a significant advantage in the debates about pain's affective phenomenology. We end the paper by examining objections, including the question of what representationalists should say about so-called ‘disassociation cases’, such as pain asymbolia. (shrink)
Collectively, institutions own an increasing proportion of outstanding corporate equities. As an emergent force in shaping corporate America, the linkages between institutional ownership and corporate social performance (CSP) require empirical examination. Not only do corporate policy makers need to know those areas where social performance may lure or inhibit capital infusions, lawmakers also need a better understanding of the social forces guiding corporate policy. As anticipated, this study found a positive relationship between the amount of institutional ownership of corporate stock (...) and a company's social responsiveness as measured by the representation of women on its board of directors; however, no statistically significant relationship with social responsibility as measured by charitable giving was found. The exemplar of social issues management — compliance with the Sullivan principles — showed an unexpected, negative relationship with the level of institutional ownership. (shrink)
