Infectious and parasitic diseases cause enormous health problems in the developing world whereas they leave the developed one relatively unscathed. Research and development (R&D) of drugs for diseases that mainly affect people in developing countries is limited. The problem that relatively few drugs are available for diseases that cause an enormous burden of disease in the developing world is called the 'availability problem'. In recent years, the availability problem has received quite a bit of attention. A number of proposals have (...) been fielded as to how this problem might be minimized. Wild-card patent extensions, advance market commitments, cash prizes and the Health Impact Fund are prominent examples of such proposals. These proposals can be thought of as pull-mechanisms for R&D of drugs for neglected diseases. What has been coined a 'priority review voucher' is another pull-mechanism. This paper is a critical discussion of this pull-mechanism. First, the original priority review voucher scheme, as proposed by Ridley et al. (2006), is described. A number of objections to this scheme are thereafter presented. A few amendments to the original scheme are then suggested, and it is argued that with these amendments in place, the priority review voucher scheme constitutes an attractive way of stimulating R&D of drugs for neglected diseases. (shrink)

"The largest Ebola outbreak to date—first detected in December 2013 and still ongoing as of April 2015—has cast new light on the shortfalls of international public health systems.1 As in previous health crises, scrutiny has reemerged over the pharmaceutical industry’s ability and willingness to innovate new medicines for underserved disease areas. The public debate has intensified following revelations that promising drug candidates to treat Ebola had gone undeveloped despite compelling preclinical results.2 This lack of development is especially troubling because it (...) occurred after a recently implemented U.S. incentive scheme—the Food and Drug Administration’s (FDA) tropical disease priority review voucher program—designed to counteract exactly this problem. Taking Ebola as a case in point, it is useful to examine the short history and ongoing refinement of this voucher program, since it represents one of the most significant legislative efforts to systematically address the relative absence of com- mercial rewards for drugs targeting tropical diseases. This analysis evaluates the voucher program’s effectiveness for both stimulating private sector innovation and achieving positive health impacts among populations most severely burdened by tropical diseases. It then proposes specific recommendations for how law- makers can improve the program’s legislation to better achieve these objectives. ". (shrink)

Michael Ravvin, Department of Political Science, Columbia University, 420 W. 118th Street, New York, NY 10027 Email: mer2133{at}columbia.edu ' + u + '@' + d + ' '//--> Abstract The existing intellectual property regime discourages the innovation of, and access to, essential medicines for the poor in developing countries. A successful proposal to reform the existing system must address these challenges of access and innovation. This essay will survey the problems in the existing pharmaceutical patent system and offer critical analysis (...) of some reform proposals. I will argue that existing mechanisms that are intended to mitigate the harms of the current pharmaceutical patent system, such as bulk buying, differential pricing and compulsory licenses, are inadequate and perhaps even counter-productive over the long-term. Other incentive mechanisms based on push funding, such as government research grants, are inefficient and limited in scope. Pull mechanisms, which offer some reward for successful pharmaceutical innovations, offer a more promising incentive mechanism. I will evaluate three pull mechanisms -- Priority Review Vouchers, Advance Market Commitment (AMC) and the Health Impact Fund -- on the basis of their capacity to incentivize access and innovation, as well as their efficiency and political feasibility. Though the Health Impact Fund appears to be the most promising proposal, more work must be done to overcome challenges of its implementation. CiteULike Connotea Del.icio.us What's this? (shrink)

In this article, readers are presented with an analysis of some of the problems that became the center of discussion at the XXI International Likhachev Scientific Readings held in May 2023 at the St. Petersburg Humanitarian University of Trade Unions. The readings were held under the general title "Dialogues and conflicts of cultures in a changing world", combining the traditional theme of dialogue with the problems of conflict that have arisen in recent years. This review focuses on two significant (...) issues, one of which determined the course of the plenary discussion, and the other became the main one for the breakout session devoted to the values and trends of the modern world. The main issue of the plenary session was the consideration of the conflict between the unipolar and multipolar world. Both domestic and foreign participants actively spoke out on this issue. The speakers who spoke at the Readings adhered to the idea of prioritizing the values of a multipolar world, pointing to the undemocratic nature of unipolarity. Analyzing this aspect of the discussion, the author of the review notes that in modern society the same value attitudes develop to the limits where they lead to opposite conclusions. The idea of unipolarity implies the uniqueness of the democratic model. From the idea of multipolarity, there are many different development scenarios, which looks like a more democratic position. It can be concluded that the value attitude coincides, but the basis of the ideological conflict is a political conflict. Nevertheless, the final value discrepancy is very acute. The philosophical and cultural section of the conference was devoted to this. Noting the sharpness of the criticism expressed by the speakers to the "new ethics" and the "culture of cancellation", the author of the review points out that in this criticism there is a desire to "cancel" the criticized, which again unites both positions, but does not provide grounds for a constructive dialogue. To overcome the contradiction, a rational analysis of the ideological and historical foundations, as well as the dynamics of the development of opposing value positions, is necessary. (shrink)

Most public and non-profit organisations that fund health research provide the majority of their funding in the form of grants. The calls for grant applications are often untargeted, such that a wide variety of applications may compete for the same funding. The grant review process therefore plays a critical role in determining how limited research resources are allocated. Despite this, little attention has been paid to whether grant review criteria align with widely endorsed ethical criteria for allocating health (...) research resources. Here, we analyse the criteria and processes that ten of the largest public and non-profit research funders use to choose between competing grant applications. Our data suggest that research funders rarely instruct reviewers to consider disease burden or to prioritise research for sicker or more disadvantaged populations, and typically only include scientists in the review processes. This is liable to undermine efforts to link research funding to health needs. (shrink)

The present work is a review of Imaguire's book 'Priority Nominalism'. In the first part I present the fundamental idea of the book along general lines; successively, I report a resume of each chapter and I present in more details the view of the author and the dialectic of his arguments. In the final part, I highlight some strong points of the book and I attempt a formulation of a possible difficulty arising from Imaguire's proposal.

An important feature of some recent jurisprudential writings is the tendency to reject the precept of liberal individualism which affirms the priority of the principles of the "right conduct" over the substantive conceptions of "the good". This rejection, explicit in a recent book by Rogers M. Smith, and implicit in a recent work by Guido Calabresi, leads to strikingly illiberal consequences; hence, this provides indirect confirmation that the priority of the right over the good constitutes the most reliable (...) defense of individual liberty against majoritarian oppression. In Smith, an attempt to replace this priority with the principle of "rational liberty" leads to the disappearance of the guarantees of minority rights against orthodox majorities; in Calabresi, the doctrine of weighing and balancing competing moral principles of "the good" fails to provide an explanation for the strongly held moral intuition that some external preferences have to be disqualified at the outset, before they enter the forum of moral bargaining. (shrink)

All health care systems face problems of justice and efficiency related to setting priorities for allocating a limited pool of resources to a population. Because many of the central issues are the same in all systems, the United States and other countries can learn from the successes and failures of countries that have explicitly addressed the question of health care priorities. We review explicit priority setting efforts in Norway, Sweden, Israel, the Netherlands, Denmark, New Zealand, the United Kingdom (...) and the state of Oregon in the US. The approaches used can be divided into those centered on outlining principles versus those that define practices. In order to establish the main lessons from their experiences we consider the process each country used, criteria to judge the success of these efforts, which approaches seem to have met these criteria, and using their successes and failures as a guide, how to proceed in setting priorities. We demonstrate that there is little evidence that establishment of a values framework for priority setting has had any effect on health policy, nor is there evidence that priority setting exercises have led to the envisaged ideal of an open and participatory public involvement in decision making. (shrink)

Germany has just started a public debate on priority-setting, rationing and cost-effectiveness due to the cost explosion within the German health care system. To date, the costs for German health care run at 11,6 % of its Gross Domestic Product (GDP, 278,3 billion €) that represents a significant increase from the 5,9 % levels present in 1970. In response, the German Parliament has enacted several major and minor legal reforms over the last three decades for the sake of cost (...) containment and maintaining stability of the health care system. The Statutory Health Insurance—SHI (Gesetzliche Krankenversicherung—GKV) is based on the fundamental principle of solidarity and provides an ethical and legal framework for implementing equity, comprehensiveness and setting the principles and rules for financing and providing health care services and benefits. Within the SHI system, several major actors can be identified: the Federal Ministry of Health, the 16 state ministries of health, the Federal Joint Committee (G-BA), the physicians (with their associations) and the hospitals (with their organizations) on the provider side, and the sickness funds with their associations on the purchasers’ side. This article reviews the structure and complexities of the German health care system with its major players and participants. The focus will be put on relevant ethical, legal and economic aspects for prioritization, rationalization, rationing and cost-effectiveness of medical benefits and services. In conclusion, this article pleads for open discussion on the challenging subject of priority-setting instead of accepting the implicit and non-transparent rationing of medical services that currently occurs at many different levels within the health care system, as it stands today. (shrink)

Background Ethical principles behind prioritization in healthcare are continuously relevant. However, applying ethical principles during times of increased need, such as during the COVID-19 pandemic, is challenging. Also, little is known about nursing home nurses’ prioritizations in their work to achieve well-being and health for nursing home residents. Aim The aim of this study was to explore nursing home nurses’ priority-setting for older nursing home residents in Sweden during the COVID-19 pandemic. Research design, participants, and research context We conducted (...) a qualitative interview study. Data were collected through in-depth interviews (retrospective self-reports) between February and May 2021 with 21 nursing home nurses. To help respondents to recall their memories, we used the critical incident technique (CIT). We analyzed data within the theoretical framework and the methodological orientation of content analysis. Ethical considerations Written and verbal consent was obtained before the interviews, and information was given to participants informing them that participation was entirely voluntary. The Swedish Ethical Review Agency gave an advisory opinion stating that there were no ethical objections to the research project (Dnr. 2020-05649). Findings We identified an overarching theme—nursing home nurses struggling on multiple fronts, “just do it”—and seven categories: striving for survival and caring about a dignified death; responding sensitively to relatives’ expectations; ranking the urgency of needed care; responding to input from different actors; combating the spread of infection in unconventional ways; taking the lead and doing what is required; and following the ideals of person-centered nursing. Conclusions Nurses’ priority-setting for older nursing homes residents during the COVID-19 pandemic meant strain and struggle. In some cases, nurses had taken responsibility for priorities falling outside their statutory powers. Different demands and interests affected nurses’ priorities. Nursing home nurses need organizational and managerial support to prioritize. (shrink)

ABSTRACT In this paper I respond to Fricker’s paradigm-based account of forgiveness, which aims to integrate two seemingly different versions of responses to wrongdoing—conditional forgiveness (what Fricker calls ‘Moral Justice Forgiveness’) and unconditional forgiveness (what Fricker calls ‘Gifted Forgiveness’)—into one explanatory order, as well as, she argues, showing the second to be derivative and parasitic on the basic functioning of the first, and more contingent. My aim is to endorse and draw on Fricker’s paradigm-based strategy and the way it enables (...) us to present a unified account, to endorse her view that both gifted and conditional forgiveness are versions of one loosely unified phenomenon, but to argue for the reverse account of the order of conceptual priority. I will argue that gifted forgiveness is the paradigm, and that once we understand what it is and its role we can see why and how forgiveness also makes sense as something offered in response to a wrongdoer’s remorse, but that this latter form of forgiveness retains an aspect of being something essentially gifted. (shrink)

We study the logic of so-called lexicographic or priority merge for multi-agent plausibility models. We start with a systematic comparison between the logical behavior of priority merge and the more standard notion of pooling through intersection, used to define, for instance, distributed knowledge. We then provide a sound and complete axiomatization of the logic of priority merge, as well as a proof theory in labeled sequents that admits cut. We finally study Moorean phenomena and define a dynamic (...) resolution operator for priority merge for which we also provide a complete set of reduction axioms. (shrink)

This chapter examines whether an individual’s being worse off than others should be a relevant consideration in the allocation of limited medical resources. It reviews arguments pressed by proponents of different theories of justice about whether being worse off than others makes special demands on health care resource prioritization. Even if there is good reason to restrict the concern for the worse off to those with worse health in the prioritization and allocation of health care resources, additional issues remain. One (...) is how to determine who has worse health, and whether the worse off are those with the worse overall health or those with the most serious medical condition now in need of treatment. Another issue is whether only individuals’ present health, or instead their lifetime health, including past and expected future health, is relevant. (shrink)

Existence monism is defended against priority monism. Schaffer's arguments for priority monism and against pluralism are reviewed, such as the argument from gunk. The whole does not require parts. Ontological vagueness is impossible. If ordinary objects are in the right ontology then they are vague. So ordinary objects are not included in the right ontology; and hence thought and talk about them cannot be accommodated via fully ontological vindication. Partially ontological vindication is not viable. Semantical theorizing outside the (...) ontology room and semantical theorizing in the doorway. Existence monism is theoretically preferable to priority monism. (shrink)

Consider a circle and a pair of its semicircles. Which is prior, the whole or its parts? Are the semicircles dependent abstractions from their whole, or is the circle a derivative construction from its parts? Now in place of the circle consider the entire cosmos (the ultimate concrete whole), and in place of the pair of semicircles consider the myriad particles (the ultimate concrete parts). Which if either is ultimately prior, the one ultimate whole or its many ultimate parts?

This essay, in the context of a conference on justice, reviews and reaffirms the main theses of “The Priority of Persons” (2000), and supplements them with the benefit of hindsight in six theses. The wrongness of Roe v. Wade goes wider than was indicated. The secularist scientistic or naturalist dimension of the reigning contemporary ideology is inconsistent with the spiritual reality manifested in every word or gesture of its proponents. The temporal continuity of the existence of human persons and (...) their communities is highly significant for the common good, which is the point and measure of social justice, properly understood. Forms of injustice that are more or less independent of this temporal dimension are nonetheless important. The nation and its lasting are neglected in much of the social-political theory assumed by contemporary legal theory. So too is the family and the “covenant” between its generations, a neglect that opens the door to euthanasia. (shrink)

Priority setting remains a big challenge for health managers and planners, yet there is paucity of literature on evaluating priority setting. The purpose of this paper is to present a framework for evaluating priority setting in low and middle income countries. We conducted a qualitative study involving a review of literature and Delphi interviews with respondents knowledgeable of priority setting in low and middle income countries. Respondents were asked to identify the measures of successful (...) class='Hi'>priority setting in low and middle income countries. Responses were grouped as: immediate internal or external/delayed internal or external. We also identified some pre-requisites for successful priority setting. The immediate internal measures included increased efficiency in decision making, improved quality of decisions and fairer priority setting. Immediate External measures included—improved public understanding and acceptance of decisions, increased public participation, increased trust. Delayed Internal measures included increased satisfaction, understanding, compliance, balanced budget, achievement of organization goals, and improved internal accountability. Delayed External measures include impact on policy and practice, improved population health and reduction of health inequalities, achievement of health system goals and strengthening of health care systems. Identified pre-requisites for successful priority setting included; the presence of credible priority setting institutions, incentives for participation and implementation and resources, capacity and political will to implement. These would be augmented in a conducive political, social and economic context. This framework, although not exhaustive, provides a practical basis for planning and evaluating priority setting in low and middle income countries. (shrink)

Coronavirus vaccines have made their debut. Now, allocation practices have stepped into the spotlight. Following Centers for Disease Control and Prevention guidelines, states and healthcare institutions initially prioritised healthcare personnel and elderly residents of congregant facilities; other groups at elevated risk for severe complications are now becoming eligible through locally administered programmes. The question remains, however: whoelseshould be prioritised for immunisation? Here, we call attention to individuals institutionalised with severe mental illnesses and/or developmental or intellectual disabilities—a group highly susceptible to (...) the damages of COVID-19, recent research shows, and critical to consider for priority vaccination. The language describing both federal-level and state-level intentions for this population remains largely vague, despite the population’s diversity across age, diagnosis, functional status and living arrangement. Such absence of specificity, in turn, leaves room for confusion and even neglect of various subgroups. We review data stressing this group’s vulnerability, as well as select state plans for priority vaccination, highlighting the importance of clarity when describing intentions to vaccinate, or even generally care for, diverse populations composed of distinct subgroups in need. (shrink)

A response to Roberto Gargarella’s review of Punishment, Participatory Democracy, and the Jury, by Albert W. Dzur.

For many years there has been a debate about the role of the parietal lobe in the generation of behavior. Does it generate movement plans (intention) or choose objects in the environment for further processing? To answer this, we focus on the lateral intraparietal area (LIP), an area that has been shown to play independent roles in target selection for saccades and the generation of visual attention. Based on results from a variety of tasks, we propose that LIP acts as (...) a priority map in which objects are represented by activity proportional to their behavioral priority. We present evidence to show that the priority map combines bottom-up inputs like a rapid visual response with an array of top-down signals like a saccade plan. The spatial location representing the peak of the map is used by the oculomotor system to target saccades and by the visual system to guide visual attention. (shrink)

Background Standard interpretations of the ethical principle of respect for persons have not incorporated the views and values of patients, especially patients from groups underrepresented in research. This limits the ability of research ethics scholarship, guidance, and oversight to support inclusive, patient-centered research. This study aimed to identify the practical approaches that patients in community-based settings value most for conveying respect in genomics research. Methods We conducted a 3-round, web-based survey using the modified Delphi technique to identify areas of agreement (...) among English-speaking patients at primary care clinics in Washington State and Idaho who had a personal or family history of cancer. In Round 1, respondents rated the importance of 17 items, identified in prior qualitative work, for feeling respected. In Round 2, respondents re-rated each item after reviewing overall group ratings. In Round 3, respondents ranked a subset of the 8 most highly rated items. We calculated each item’s mean and median rankings in Round 3 to identify which approaches were most important for feeling respected in research. Results Forty-one patients consented to the survey, 21 (51%) completed Round 1, and 18 (86% of Round 1) completed each of Rounds 2 and 3. Two sets of rankings were excluded from analysis as speed of response suggested they had not completed the Round 3 ranking task. Respondents prioritized provision of study information to support decision-making (mean ranking 2.6 out of 8; median ranking 1.5) and interactions with research staff characterized by kindness, patience, and a lack of judgment (mean ranking 2.8; median ranking 2) as the most important approaches for conveying respect. Conclusions Informed consent and interpersonal interactions are key ways that research participants experience respect. These can be supported by other approaches to respecting participants, especially when consent and/or direct interactions are infeasible. Future work should continue to engage with patients in community-based settings to identify best practices for research without consent and examine unique perspectives across clinical and demographic groups in different types of research. (shrink)

Affective dynamics are discussed from the perspective of a view of origin and functions of affective valence based in control processes. This view posits that affect reflects the error signal of a feedback loop managing rate of progress at goal attainment or threat avoidance. Negative feelings signal doing poorly, demanding more effort. Positive feelings signal doing better than necessary, allowing coasting, which yields goal attainment without unnecessary resource expenditure. Given multiple simultaneous goals, these functions assist in moment-to-moment priority management, (...) facilitating attainment of all. (shrink)

BackgroundViral pandemics present a range of ethical challenges for policy makers, not the least among which are difficult decisions about how to allocate scarce healthcare resources. One important question is whether healthcare workers should receive priority access to a vaccine in the event that an effective vaccine becomes available. This question is especially relevant in the coronavirus pandemic with governments and health authorities currently facing questions of distribution of COVID-19 vaccines.Main textIn this article, we critically evaluate the most common (...) ethical arguments for granting healthcare workers priority access to a vaccine. We review the existing literature on this topic, and analyse both deontological and utilitarian arguments in favour of HCW prioritisation. For illustrative purposes, we focus in particular on the distribution of a COVID-19 vaccine. We also explore some practical complexities attendant on arguments in favour of HCW prioritisation.ConclusionsWe argue that there are deontological and utilitarian cases for prioritising HCWs. Indeed, the widely held view that we should prioritise HCWs represents an example of ethical convergence. Complexities arise, however, when considering who should be included in the category of HCW, and who else should receive priority in addition to HCWs. (shrink)

This paper interprets the relation between justice and legitimacy found in John Rawls's Political Liberalism and then applies it to the field of transitional justice. The author argues that transitional mechanisms can be better defended in terms of “legitimacy” than in “justice,” because the circumstances of transitional justice admit of reasonable disagreement over “just” public policy. In such circumstances, policy recommendations can always be construed as falling short of justice, thus raising plausible concerns over their normative justification. This paper attempts (...) to answer such concerns by justifying transitional mechanisms as morally appropriate yet less than fully just. The author explains how the concept of legitimacy facilitates such a justification and how such a justification can secure the normative grounds that are ironically threatened by investigations relying on a concept of justice. (shrink)

Recent research on genetic and biological diversity suggests that they underlie, and are the source of renewable resources--which are themselves more fundamental than non-renewable resources. If this is the case, then our understandings of the "limits to growth" debate will need modification and current approaches to development--in both the industrial countries and in the Third World--will need reconceptualization. A major part of this will involve a reversal of roles and priorities for agricultural and industrial development. Also, more sustainable/regenerative types of (...) agriculture and food systems will need to be developed. Current explorations along these lines are briefly reviewed. Finally, the links between this and the wider need to develop more sustainable societies are examined. (shrink)

Should conflicts among human rights be dealt with by including general principles for priority setting at some prominent place in the practice of human rights? This essay argues that neither setting prominent and principled priorities nor a case-by-case approach are likely to be defensible as general solutions. The main reasons concern how best to realize all human rights for all. Conflicts among human rights are more defensibly addressed by checking whether the conflict has been correctly diagnosed: Do human rights (...) as a whole get due priority? Have feasibility considerations inherent in human rights been considered, and the possibility of bringing in additional dutybearers? If a conflict among human rights is genuine, formal principles for priority setting are of some help. Sometimes, it is clear that these should be “upgraded” to substantive principles and sometimes that they should not. Many cases, however, are as yet unclear and will need further investigation. (shrink)

Cleary discusses the origin, development, and use of the many senses of priority as a central thesis in Aristotle’s metaphysics. Cleary contends that one of the most revealing problems for the ambiguity of Aristotle’s relationship to Platonism is that of the ontological status of mathematical objects. In support of his claim, Cleary analyzes a curious passage from Aristotle’s _Topics, _where he appears to accept a schema of priorities that makes mathematical entities more substantial than sensible things. How does Aristotle (...) try to reconcile the ordering of things dictated by sciences like mathematics and dialectic with the ordering of sense experience upon which his own physics and metaphysics are based? To find the answer, Cleary reviews three different outlines of the many senses of priority given by Aristotle himself and found in _Categories _12-13, _Metaphysics _Delta 11, and _Metaphysics _Theta 8. Cleary suggests there is an implicit hierarchy for Aristotle that leads him to posit the Prime Mover at its apex as complete actuality and, therefore, as the focus for the concept of priority. Having reviewed Aristotle’s treatment of the many uses of priority, Cleary demonstrates how the concept is used in some typical arguments by Aristotle for his mature metaphysical positions. (shrink)