Dans le 4e livre de sa Chronique du monde, Jean Malalas décrit l'histoire du lieu de pèlerinage de l'archange Michel à Anaplous près de Constantinople. Cette histoire comprend deux parties dont la première relate la construction d'un temple par les argonautes qui rebaptise la place Sosthenion c'est-à-dire la place du salut et dont la seconde parle de la visite du site par Constantin qui aura la révélation de l'identité de la statue de Michel à travers un rêve. Pour l'A. ce (...) récit a une signification réelle au sein de l'oeuvre idéologique de la Chronique. Le lieu de pèlerinage se place dans la continuité de l'histoire du salut instaurée par le Christ et s'élargie sous l'empereur Constantin. Celui-ci joue un rôle essentiel dans la rédemption du sanctuaire païen de Sosthène : l'épisode de son rêve préfigure sa conversion. (shrink)

Recreational Drugs European Network (ReDNet) project aims to use the Psychonaut Web Mapping Project database (Psychonaut Web Mapping Group, 2009) containing novel psychoactive compounds usually not mentioned in the scientific literature and thus unknown to clinicians as a unique source of information. The database will be used to develop an integrated ICT prevention approach targeted at vulnerable individuals and focused on novel synthetic and herbal compounds and combinations. Particular care will be taken in keeping the health professionals working directly with (...) young people showing problematic behaviors regularly updated in terms of novel compounds and combinations as well. A user-friendly project website will be developed aimed primarily at delivering the information/prevention approaches, but will also be a way of communicating with project partners and relevant stakeholders (e.g. thematic forum facilities, instant messages, blogs, video chat, wikiblog, newsletters distributed via mailing list). The website will support various ICT prevention tools, including an SMS alert service. Different areas and sections will be aimed specifically at the different target groups. -/- . (shrink)

Alerting regulatory and professional bodies to lawyer misconduct has traditionally been a predominantly reactionary process, heavily reliant upon client complaint. It cannot be assumed, however, that client complaint will unearth all forms of lawyer misconduct. Accordingly, there is a legitimate question over whether lawyers should, as members of a profession, perform a self-policing function in reporting their peers' misconduct to the relevant body. The point assumes especial significance in the Australian context because Australia is unique, vis-à-vis comparable common law (...) jurisdictions, in not imposing any general professional obligation to report. This article addresses the core issues to be addressed in the debate surrounding whether or not Australian regulators ought to follow the lead of those other jurisdictions. (shrink)

Open peer commentary on the article “A Cybernetic Computational Model for Learning and Skill Acquisition” by Bernard Scott & Abhinav Bansal. Upshot: The paper is an admirable example of first-order cybernetics. It does not appear to be developed as part of the constructivist paradigm and of second-order cybernetics. It neglects research as the context that generates problems of observation.

This article defends the Fixed Point Thesis: that it is always a rational mistake to have false beliefs about the requirements of rationality. The Fixed Point Thesis is inspired by logical omniscience requirements in formal epistemology. It argues to the Fixed Point Thesis from the Akratic Principle: that rationality forbids having an attitude while believing that attitude is rationally forbidden. It then draws out surprising consequences of the Fixed Point Thesis, for instance that certain kinds of a priori justification are (...) indefeasible and that misleading all-things-considered evidence about rational requirements is impossible. Finally, the Fixed Point Thesis is applied to defend the Right Reasons position on peer disagreement, according to which an agent who has drawn the correct conclusion from her evidence should retain belief in that conclusion even in the face of disagreeing peers. (shrink)

This Open Access book about the Zadeh Project demonstrates and explores a core question in clinical ethics: how can ethics consultants be accountable in the face of a robust plurality of ethical standpoints, especially those that underwrite practices and methods for doing ethics consultation as well as those viewpoints and values encountered in daily clinical ethics practice? Underscoring this question is the recognition that the field of clinical ethics consultation has arrived at a crucial point in its maturation. Many efforts (...) are underway to more formally “professionalize” the field, with most aimed toward stabilizing a specific set of institutional considerations. Stretched between these institutional and practical initiatives resides a crucial set of of ethical considerations, chief among them the meaning and scope of responsibility for clinical ethics consultants. Developed around a long-form case scenario, the Zadeh Project provides a multi-layered series of “peer-reviews”: critique of the actions of the case scenario’s ethics consultant; reflection on clinical ethics method; examination of the many ways that commitments to method and practice can, and do, intersect, overlap, and alter one another. The design and format of this book thus models a key element for clinical ethics practice: the need and ability to provide careful and thoughtful explanation of core moral considerations that emerge among diverse standpoints. Specifically designed for those studying to become and those who are ethics consultants, this book, with its innovative and multi-layered approach, allows readers to share a peer-review-like experience that shows accountability to be what it is, an ethical, not merely procedural or administrative, undertaking. (shrink)

Open peer commentary on the article “The Autopoiesis of Social Systems and its Criticisms” by Hugo Cadenas & Marcelo Arnold. Upshot: I discuss two aspects of Cadenas & Arnold’s target article. The first concerns some clarifications of the sociological importance of the concept of autopoiesis and the second the criticisms of this concept and its applications in the social sciences.

It has often been recommended that the differing probability distributions of a group of experts should be reconciled in such a way as to preserve each instance of independence common to all of their distributions. When probability pooling is subject to a universal domain condition, along with state-wise aggregation, there are severe limitations on implementing this recommendation. In particular, when the individuals are epistemic peers whose probability assessments are to be accorded equal weight, universal preservation of independence is, with (...) a few exceptions, impossible. Under more reasonable restrictions on pooling, however, there is a natural method of preserving the independence of any fixed finite family of countable partitions, and hence of any fixed finite family of discrete random variables. (shrink)

BACKGROUND: There is relatively little research concerning the processes whereby Local Research Ethics Committees discharge their responsibilities towards society, potential participants and investigators. OBJECTIVES: To examine the criteria used by LRECs in arriving at their decisions concerning approval of research protocols through an analysis of letters sent to investigators. DESIGN: Four LRECs each provided copies of 50 letters sent to investigators after their submitted proposals had been considered by the committees. These letters were subjected to a content analysis, in which (...) specific comments and requests for additional information and changes in the protocols were recorded and compared. FINDINGS: Overall 24% of proposals were approved without request for changes or clarifications, but this varied by committee: one committee approved only 6% of proposals without change or clarification while the others ranged from 26% to 32%. The content analyses of responses indicated that they could be placed into four categories: (i) further information for the committee to aid in their deliberations; (ii) requests for changes to the design or justification for the design used; (iii) changes to the information sheets provided to potential participants; and (iv) changes to consent procedures. Of these, alterations to information sheets were the most common type of request. These four types of response could be seen as safeguarding the wellbeing of potential participants (the principle of non-maleficence), of promoting the scientific validity of the research (the principle of beneficence), and of enhancing the rights of potential participants (the principle of autonomy). CONCLUSIONS: The committees were consistent in the types of requests they made of investigators, which can be seen as attempts to protect participants' rights and ensure the scientific validity of studies. Without an analysis of the proposals sent to the committees, however, it is difficult to account for the variation in the requirements set by the committees before approval was given. (shrink)

Open peer commentary on the target article “How and Why the Brain Lays the Foundations for a Conscious Self” by Martin V. Butz. Excerpt: In this commentary to Martin V. Butz’s target article I am especially concerned with his remarks about language (§33, §§71–79, §91) and modularity (§32, §41, §48, §81, §§94–98). In that context, I would like to bring into discussion my own work on computational models of self-monitoring (cf. Neumann 1998, 2004). In this work I explore the idea (...) of an anticipatory drive as a substantial control device for modelling high-level complex language processes such as selfmonitoring and adaptive language use. My work is grounded in computational linguistics and, as such, uses a mathematical and computational methodology. Nevertheless, it might provide some interesting aspects and perspectives for constructivism in general, and the model proposed in Butz’s article, in particular. (shrink)

One of Schopenhauer’s pinnacle contributions to philosophy was the discovery of the nature of the noumenon. Whereas Kant was content to leave the question of the thing-in-itself forever a mystery, Schopenhauer devised a strategy by which to peer beyond the veil of phenomena. The key which unlocks the mystery of the noumenon lies in Schopenhauer’s analysis of bodily agency as an examination of concrete acts of willing presents “a way from within … to that real inner nature of things to (...) which we cannot penetrate from without” and thereby opens, “so to speak, a subterranean passage, a secret alliance, which, as if by treachery, places us all at once in the fortress that could not be taken by attack from without.”. (shrink)

Currently, patients are expected to take control over their health and their life and act as independent users and consumers. Simultaneously, health care policy demands patients are expected to self manage their disease. This article critically questions whether this is a realistic expectation. The paper presents the auto-ethnographic narrative of the first author, which spans a period of 27 years, from 1985 to 2012. In total nine episodes were extracted from various notes, conversations and discussions in an iterative process. Each (...) of these episodes was condensed around a ‘critical moment’ as perceived by the “self”. The critical moments in the illness process vary between newly encountered problems with basic needs and mourning, to renewed strength and the desire to grow, embracing new situations. Being confronted with and living with a chronic illness involves periods of anxiety and self centredness alternating with strength and advocating the interests of peer-patients. These episodes of emotion, confusion and refinding a balance have a cyclic pattern. The narrative illustrates the vulnerability and dependency of a patient with a chronic disease. The discussion relates this to mainstream dominant views on patients ‘in control of their own life’. The narrative illustrates, that the vulnerability and dependency of the patient are key factors to take into account in health care policy. The narrative provides a counter story, challenging current thinking in terms of strength, selfmanagement, patients’ own control and independent role. (shrink)

Open peer commentary on the article “Examining the Role of Re-Presentation in Mathematical Problem Solving: An Application of Ernst von Glasersfeld’s Conceptual Analysis” by Victor V. Cifarelli & Volkan Sevim. Upshot: The key philosophical premise of von Glasersfeld’s radical constructivism is not necessary to the insightful conceptual analysis presented by Cifarelli and Sevim, which could benefit from abandoning it.

Open peer commentary on the article “Learning about Urban Sustainability with Digital Stories: Promoting Collaborative Creativity from a Constructionist Perspective” by Maria Daskolia, Chronis Kynigos & Katerina Makri. Upshot: The target article by Daskolia, Kynigos and Makri shows the great potential of narrative learning to foster general learning skills, such as meaning-making, collaboration and creativity, while facilitating the construction of disciplinary content knowledge. This learning approach has much to recommend it, especially from a constructivist perspective, because it supports the implementation (...) of collaborative and creative learning processes apt to promote reflective dialogue as a basis for knowledge construction, capitalizing on students’ previous knowledge and experience. (shrink)

Open peer commentary on the target article “How and Why the Brain Lays the Foundations for a Conscious Self” by Martin V. Butz. Excerpt: One intriguing concept that the author introduces and uses throughout the paper is the idea of an “anticipatory drive,” which is described as explaining the systematic tendency to develop anticipatory capabilities that ultimately support goal-oriented action. Although the idea of a common mechanism that explains a multitude of capabilities can be appreciated, it is unclear if the (...) author uses the term “drive” in a literal or metaphorical sense. Should the evolutionary advantage, the selective “pressure” for anticipatory capacities and representation be considered a drive in the sense of Hull like, for example, the sex drive, or hunger? If this is true, it should be related to some bodily control structure like the other mentioned drives. Another possibility is that the anticipatory drive is an intrinsic motivation, like curiosity, which “pushes” towards certain situations, such as those that are more predictable. If this is true, it should be explained what is the exact nature of such intrinsic motivation. (shrink)

Open peer commentary on the article “Beyond Technocentrism: Supporting Constructionism in the Classroom” by Karen Brennan. Upshot: Brennan describes ways by which teachers can be supported to bypass a technocentric view of learning with technology in the classroom, from a constructionist perspective. She reports on the development of a corresponding model of professional development by describing the elements of the model and its design principles as well as the tensions that arose while trying to support teachers’ explorations and experiences in (...) the classroom. Questions arise about the potential of the model to be exploited to address issues underlying teachers’ professional development in different contexts. (shrink)

Open peer commentary on the article “A Computational Constructivist Model as an Anticipatory Learning Mechanism for Coupled Agent–Environment Systems” by Filipo Studzinski Perotto. Upshot: The CALM cognitive agent with its learning mechanism, as presented by the author, can be described as “trivially constructivist.” Probably, at best, it can be seen as a model of the empirical abstraction but not of the reflective abstraction. The “intrinsic motivations” in the simulated agent presented as “evaluative signals” sent from the agent’s “body” to its (...) “mind” can be seen as low-level physiological drives. They cannot account for far more sophisticated intrinsic motivations such as curiosity. (shrink)

Open peer commentary on the article “A Cybernetic Computational Model for Learning and Skill Acquisition” by Bernard Scott & Abhinav Bansal. Upshot: The target paper acknowledges some early computer modelling that I did in the years 1966–1968 when working with Pask at System Research Ltd in Richmond. In the commentary, I revisit the roots of this kind of modelling and follow the trajectory from then to today’s growing understanding of the dynamics of cognitive systems.

Open peer commentary on the article “Info-computational Constructivism and Cognition” by Gordana Dodig-Crnkovic. Upshot: Dodig-Crnkovic’s “info-computational constructivism” (IC), as an essential part of a constructivist approach, needs integration with the logical, mathematical and physical evidence coming from quantum field theory (QFT) as the fundamental physics of the emergence of “complex systems” in all realms of natural sciences.

Open peer commentary on the article “Second-Order Cybernetics as a Fundamental Revolution in Science” by Stuart A. Umpleby. Upshot: Connecting Umpleby’s article with Piaget and García’s genetic epistemology, I will argue that the revolution the former discerns is more comprehensive. Additionally, since the latter differ from cybernetic and radical traditions in their philosophical assumptions about society and its conditioning on knowledge, I will suggest that these assumptions must be considered to explain each constructivist program’s achievements and challenges.

Open peer commentary on the article “Subsystem Formation Driven by Double Contingency” by Bernd Porr & Paolo Di Prodi. Upshot: I acknowledge the value of Porr & Di Prodi’s piece for simulating Luhmann’s key process of subsystem formation and exploring how the concepts of “differentiation” and “binary code” relate to their model.

Open peer commentary on the article “Constructionism and Deconstructionism” by Pavel Boytchev. Upshot: Boytchev’s deconstructionism looks at first glance like a game of words. Upon a deeper view of the subject, he focuses our attention on the importance of deconstruction to the construction process, which is highly connected to creativity. In my contribution, I want to point out the close relationship of Boytchev’s deconstruction to the software development process, where requirements analysis corresponds to deconstruction and software design and implementation correspond (...) to construction. Creativity is an important asset in any kind of software development, where life-long learning is essential. (shrink)

Different people reason differently, which means that sometimes they reach different conclusions from the same evidence. We maintain that this is not only natural, but rational. In this essay we explore the epistemology of that state of affairs. First we will canvass arguments for and against the claim that rational methods of reasoning must always reach the same conclusions from the same evidence. Then we will consider whether the acknowledgment that people have divergent rational reasoning methods should undermine one’s confidence (...) in one’s own reasoning. Finally we will explore how agents who employ distinct yet equally rational methods of reasoning should respond to interactions with the products of each others’ reasoning. We find that the epistemology of multiple reasoning methods has been misunderstood by a number of authors writing on epistemic permissiveness and peer disagreement. (shrink)

This book explores the universe and its subsystems from the three lenses of evolutionary (diversifying), developmental (converging), and complex (adaptive) processes at all scales. It draws from prolific experts within the academic disciplines of complexity science, physical science, information and computer science, theoretical and evo-devo biology, cosmology, astrobiology, evolutionary theory, developmental theory, and philosophy. The chapters come from a Satellite Meeting, "Evolution, Development and Complexity" (EDC) hosted at the Conference on Complex Systems, in Cancun, 2017. The contributions will be peer-reviewed (...) and contributors from outside the conference will be invited to submit chapters to ensure full coverage of the topics. This book explores many issues within the field of EDC such as the interaction of evolutionary stochasticity and developmental determinism in biological systems and what they might teach us about these twin processes in other complex systems. This text will appeal to students and researchers within the complex systems and EDC fields.. (shrink)

BackgroundHealthcare professionals are exposed to advertisements for prescription drugs in medical journals. Such advertisements may increase prescriptions of new drugs at the expense of older treatments even when they have no added benefits, are more harmful, and are more expensive. The publication of medical advertisements therefore raises ethical questions related to editorial integrity.MethodsWe conducted a descriptive cross-sectional study of all medical advertisements published in the Journal of the Danish Medical Association in 2015. Drugs advertised 6 times or more were compared (...) with older comparators: comparative evidence of added benefit; Defined Daily Dose cost; regulatory safety announcements; and completed and ongoing post-marketing studies 3 years after advertising.ResultsWe found 158 medical advertisements for 35 prescription drugs published in 24 issues during 2015, with a median of 7 advertisements per issue. Four drug groups and 5 single drugs were advertised 6 times or more, for a total of 10 indications, and we made 14 comparisons with older treatments. We found: ‘no added benefit’ in 4 of 14 comparisons, ‘uncertain benefits’ in 7, and ‘no evidence’ in 3 comparisons. In no comparison did we find evidence of ‘substantial added benefit’ for the new drug; advertised drugs were 2 to 196 times more expensive per Defined Daily Dose; 11 safety announcements for five advertised drugs were issued compared to one announcement for one comparator drug; 20 post-marketing studies were requested for the advertised drugs versus 10 studies for the comparator drugs, and 7 studies assessed both an advertised and a comparator drug at 3 year follow-up.Conclusions and relevanceIn this cross-sectional study of medical advertisements published in the Journal of the Danish Medical Association during 2015, the most advertised drugs did not have documented substantial added benefits over older treatments, whereas they were substantially more expensive. From January 2021, the Journal of the Danish Medical Association no longer publishes medical advertisements. (shrink)

Open peer commentary on the article “The Banathy Conversation Methodology” by Gordon Dyer, Jed Jones, Gordon Rowland & Silvia Zweifel. Upshot: This commentary will address the implicit and explicit connections between Banathy’s Conversation Methodology, which is the heart of the process used at the IFSR Conversations held every two years in Austria, and constructivist theories in application.

This chapter critically reflects on the critiques, reviews, and many proposals presented in Parts Two, Three, and Four, and provides a summary conclusion for the entire Zadeh Project. Obvious differences between experience and reporting on experience are highlighted, with particular attention to the ways such differences are detailed by the Zadeh Scenario and in our colleagues’ responses to it. In addition, we discuss a key challenge associated with clinical ethics practice and the peer review of such practice: identifying what actually (...) matters for those engaged in these kinds of activities. In each case, we argue, the work of discovering what matters to the individuals actually involved cannot be overlooked. Furthermore, that work may even be the primary ingredient to responsible conduct for both consultation and peer review. Building on this idea that responding responsibly to that which is actually encountered in clinical practice serves as a primary activity of, and thus grounds responsibility in, clinical ethics practice, we then argue that ethical analysis of Finder’s activities in the Zadeh Scenario, and for clinical ethics peer review more generally, has at least three layers: that which addresses the immediate interactions between an ethics consultant and those whom the consultant engages; that which addresses the ethics consultant’s own sense of self-responsibility; that which addresses peer reviewers’ own frames for evaluating another’s clinical ethics practice. We conclude that the Zadeh Project exemplifies what is at stake in ethics consultation and peer review. Taken as a whole, then, the Zadeh Project reveals how peer review, in acknowledgement of the responsibility to create a context for peer education, rests upon a commitment to model – and demand critical engagement with – what is held to be most worthwhile for clinical ethics practice and the field of clinical ethics consultation as a whole. (shrink)

Abstract. Richard Feldman’s Uniqueness Thesis holds that “a body of evidence justifies at most one proposition out of a competing set of proposi- tions”. The opposing position, permissivism, allows distinct rational agents to adopt differing attitudes towards a proposition given the same body of evidence. We assess various motivations that have been offered for Uniqueness, including: concerns about achieving consensus, a strong form of evidentialism, worries about epistemically arbitrary influences on belief, a focus on truth-conduciveness, and consequences for peer disagreement. (...) We argue that each of these motivations either misunderstands the commitments of permissivism or is question-begging. Better understanding permissivism makes it a much more plausible position. (shrink)

Over the past two decades an increasing number of research papers have signalled growing interest in more responsible, sustainable and ethical modes of management education. This systematic literature review of peer-reviewed publications on, and allied to, the concept of responsible management learning and education confirms that scholarly interest in the topic has accelerated over the last decade. Rather than assuming that RMLE is one thing, however, this review proposes that the literature on responsible management education and learning can be divided (...) into four distinct categories: Teaching Responsible Management; Organizing for Responsible Education; Responsible Individual Learning, and; Responsible Organizational Learning. Although the literature on RMLE has grown, work on how managers learn responsible management in organizational or workplace settings, particularly without the intervention of external educational providers, is minimal. The Special Issue of the Journal of Business Ethics is the first to address this significant lacuna. The vast majority of published peer-reviewed research is related to organizational provider-centric organizing for responsible management education. Each category is explored and the implications of organizing the literature this way for the field of RMLE are discussed. Finally, an agenda for future research and theory development on RMLE is proposed. (shrink)

BackgroundDeveloping a comprehensive, reproducible literature search is the basis for a high-quality systematic review (SR). Librarians and information professionals, as expert searchers, can improve the quality of systematic review searches, methodology, and reporting. Likewise, journal editors and authors often seek to improve the quality of published SRs and other evidence syntheses through peer review. Health sciences librarians contribute to systematic review production but little is known about their involvement in peer reviewing SR manuscripts.MethodsThis survey aimed to assess how frequently librarians (...) are asked to peer review systematic review manuscripts and to determine characteristics associated with those invited to review. The survey was distributed to a purposive sample through three health sciences information professional listservs.ResultsThere were 291 complete survey responses. Results indicated that 22% (n = 63) of respondents had been asked by journal editors to peer review systematic review or meta-analysis manuscripts. Of the 78% (n = 228) of respondents who had not already been asked, 54% (n = 122) would peer review, and 41% (n = 93) might peer review. Only 4% (n = 9) would not review a manuscript. Respondents had peer reviewed manuscripts for 38 unique journals and believed they were asked because of their professional expertise. Of respondents who had declined to peer review (32%, n = 20), the most common explanation was “not enough time” (60%, n = 12) followed by “lack of expertise” (50%, n = 10).The vast majority of respondents (95%, n = 40) had “rejected or recommended a revision of a manuscript| after peer review. They based their decision on the “search methodology” (57%, n = 36), “search write-up” (46%, n = 29), or “entire article” (54%, n = 34). Those who selected “other” (37%, n = 23) listed a variety of reasons for rejection, including problems or errors in the PRISMA flow diagram; tables of included, excluded, and ongoing studies; data extraction; reporting; and pooling methods.ConclusionsDespite being experts in conducting literature searches and supporting SR teams through the review process, few librarians have been asked to review SR manuscripts, or even just search strategies; yet many are willing to provide this service. Editors should involve experienced librarians with peer review and we suggest some strategies to consider. (shrink)

There seems to be reluctance amongst scientists to invest some of their own time in the peer-review of manuscripts. As a result, journal editors often struggle to secure reviewers for a given manuscript in a timely manner. Here, two simple principles are proposed, which could fairly allocate the contribution of individual researchers to the peer-review process.

There has been substantial growth of interest in sustainability in business, management and organisational studies in recent years. This article applies Oswick’s :15–25, 2009) method of bibliometric research to ascertain how this growth has been reflected in scholarly publishing, particularly as it relates to business and management education over the 20 years 1994–2013. The research has found that sustainability as a general topic in business and management studies, as evidenced by scholarly publishing, has accelerated rapidly both in terms of items (...) published and cited. In the mid-2000s, the emphasis of books published in this area began to change from one which advocated ‘sustainable development’ to one which viewed sustainability as a management practice which could help businesses and society simultaneously. The literature on sustainability within the field of management and business education has been smaller, but has enjoyed a similar growth rate which accelerated sharply in the most recent 5 years of the dataset. Most of the scholarly, peer-reviewed articles analysed tend to advocate the inclusion of sustainability on business school curricula, or to demonstrate the various ways in which faculty have integrated sustainability-related principles in their teaching. A smaller amount of research has been undertaken on the learning experiences of the ‘recipients’ of these approaches. There is evidence of an extensive variety of approaches used by educators, but the most significant research need which presented is for more empirically driven studies on how and why business and management students engage with the principles of sustainability. (shrink)

Background Scientific and technological advancements in mapping and understanding the interrelated pathways through which biological and environmental exposures affect disease development create new possibilities for detecting disease risk factors. Early detection of such risk factors may help prevent disease onset or moderate the disease course, thereby decreasing associated disease burden, morbidity, and mortality. However, the ethical implications of screening for disease risk factors are unclear and the current literature provides a fragmented and case-by-case picture. Methods To identify key ethical considerations (...) arising from the early detection of disease risk factors, we performed a systematic scoping review. The Scopus, Embase, and Philosopher’s Index databases were searched for peer-reviewed, academic records, which were included if they were written in English or Dutch and concerned the ethics of (1) early detection of (2) disease risk factors for (3) disease caused by environmental factors or gene-environment interactions. All records were reviewed independently by at least two researchers. Results After screening 2034 titles and abstracts, and 112 full papers, 55 articles were included in the thematic synthesis of the results. We identified eight common ethical themes: (1) Reliability and uncertainty in early detection, (2) autonomy, (3) privacy, (4) beneficence and non-maleficence, (5) downstream burdens on others, (6) responsibility, (7) justice, and (8) medicalization and conceptual disruption. We identified several gaps in the literature, including a relative scarcity of research on ethical considerations associated with environmental preventive health interventions, a dearth of practical suggestions on how to address expressed concerns about overestimating health capacities, and a lack of insights into preventing undue attribution of health responsibility to individuals. Conclusions The ethical concerns arising with the early detection of risk factors are often interrelated and complex. Comprehensive ethical analyses are needed that are better embedded in normative frameworks and also assess and weigh the expected benefits of early risk factor detection. Such research is necessary for developing and implementing responsible and fair preventive health policies. (shrink)

Our society has long sanctioned, at least tacitly, a degree of conflict of interest in medical practice and clinical research as an unavoidable consequence of the different interests of the physician or clinical investigator, the patient or clinical research subject, third party payers or research sponsors, the government, and society as a whole, to name a few. In the past, resolution of these conflicts has been left to the conscience of the individual physician or clinical investigator and to professional organizations. (...) The public is no longer willing to allow health care providers to wholly govern their own conflicts of interest for several reasons. These include: new forms of health care financing and delivery that provide innovative and lucrative opportunities for physician or insurer enrichment at patient expense; the increased importance of commercial research support as peer-reviewed governmental research support has decreased; evidence that physicians and clinical investigators too frequently resolve conflicts of interest in their own favor; and a general societal mistrust of authority. This volume represents a multidisciplinary effort, drawing from philosophy, medicine, law, economics and public policy to identify and categorize conflicts of interest in medical practice and clinical research, and, where possible, to offer a mechanism for resolving them. Part I addresses conflicts of interest from a theoretical perspective, offering basic concepts and analytical frameworks. The second part discusses two topics prominent in current health care policy debates--self-referral and financial incentives to limit care. Part III examines conflicts of interest generated by pharmaceutical industry involvement in clinical practice and research. The final section deals with conflicts of interest in clinical research in several contexts, including institutional reviews boards, clinical trials, Cooperative Research and Development Agreements between government and private researchers, brokerage of research subjects by Contract Research Organizations, and cost-effectiveness studies. (shrink)

Peer review of grant applications, it has been suggested, might be distorted by what is popularly termed old boyism, cronyism, or particularism. We argue that the existing debate emphasizes the more uninteresting aspects of the peer review system and that the operation of old boyism, as currently understood would have little effect on the overall direction of science. We identify a phenomenon of cognitive particularism, which we consider to be more important than the institutional cronyism analyzed in previous studies. We (...) illustrate with material drawn from observation of grant-awarding commit tees of the Science and Engineering Research CounciL In the concluding discussion, we explore some of the possible implications for the peer review system. (shrink)

BackgroundMulti-centre studies generally cost more than single-centre studies because of larger sample sizes and the need for multiple ethical approvals. Multi-centre studies include clinical trials, clinical quality registries, observational studies and implementation studies. We examined the costs of two large Australian multi-centre studies in obtaining ethical and site-specific approvals.MethodsWe collected data on staff time spent on approvals and expressed the overall cost as a percent of the total budget.ResultsThe total costs of gaining approval were 38 % of the budget for (...) a study of 50 centres (mean cost AUD $6960 per site) and 2 % for a study of 11 centres (mean cost AUD $2300 per site). Seventy-five and 90 % of time was spent on repeated tasks, respectively, and many time-consuming tasks, such as reformatting documents, did nothing to improve the study design or participant safety.ConclusionsImprovements have been made to the ethical approval application system, but more gains could be made without increasing risks of harm to research participants. We propose that ethical review bodies and individual sites publish statistics on how long they take to process approvals which could then be nationally benchmarked. (shrink)

All organizations have gray areas where the border between right and wrong behavior is blurred, but where a major part of organizational decision-making takes place. While gray areas can be sources of problems for organizations, they also have benefits. The author proposes that gray areas are functional in organizations. Gray areas become problematic when the process for dealing with them is flawed, when gatekeeper managers see themselves as more ethical than their peers, and when leaders, by their own inattention, (...) inaction, and poor modeling, minimize the importance of building a moral community by delegating gray area issues to second-tier administrators. Gray areas provide wiggle room in coping with ethical dilemmas in organizations. (shrink)

Background: Despite procedural innovations and increasing numbers of uterus transplant attempts worldwide, the perspectives of uterus transplant (UTx) trial participants are lacking. Methods: We conducted a mixed-methods study with women with absolute uterine factor infertility (AUFI). Participants included women who had previously contacted the Cleveland Clinic regarding the Uterine Transplant Trial and met the initial eligibility criteria for participation. In-depth interviews were conducted in conjunction with FertiQoL, a validated and widely used tool to measure the impact of infertility on the (...) quality of life of infertility patients. Results: All (n = 19) rated their overall health as good; some experienced grief and social isolation. AUFI is a life-framing experience that influences acceptance by family, partners, peers, and one’s self. UTx is a means to gain control of reproductive autonomy. UTx allows family-building and the ability to play an active role in prenatal health and well-being. Establishing and maintaining a supportive relationship is a key issue of AUFI and when considering UTx. Risks of UTx are perceived relative to risks to self/child/family posed by adoption/surrogacy. Participants had no overall preference regarding living or deceased donor. Conclusions: The ways in which women with AUFI conceptualize this condition in their lives and choices around UTx and participating in a study of the procedure are multifaceted and textured. These perspectives are critical to understanding its ethical, legal, and social implications. (shrink)