On September 18, 1995, the U.S. Court of Appeals for the Seventh Circuit handed down a decision in Blue Cross & Blue Shield United of Wisconsin v. Marshfield Clinic ) that sets two important precedents regarding the status of health maintenance organizations under antitrust law. Chief Judge Posner, writing for the court, concluded that HMOs do not constitute a market separate from the general market for medical services and that agreements, between HMOs in a region, to operate in separate areas (...) constitute a prohibited form of market splitting.This case primarily involves two HMOs in north central Wisconsin: one a subsidiary of Blue Cross, the other a subsidiary of the Marshfield Clinic. The Blue Cross HMO claimed that the Marshfield HMO had an illegal monopoly in the region's HMO market and therefore violated the Sherman Act ). (shrink)

Pitcher has taken upon himself the task of refining and defending the thesis that sense perception is the acquiring of true beliefs concerning particular facts about one's environment, by means of the senses. The book is divided into four parts, the first part being a critical treatment of the sense-data theories via an examination of several of the major arguments traditionally forwarded in defense of the view. The theory advocated by the author is presented in the second part, where the (...) view is first stated in unpolished form and gradually refined and qualified as problems and objections are dealt with. Any philosophical theory of perception, the author maintains, is related to the empirical sciences in that its task is to render intelligible the facts about perception, as uncovered by the relevant sciences. Thus, in the third part of the book, some recent experiments in the psychology of perception are discussed in relation to the theory of perception held by the author. In the final part of the book, Pitcher discusses color perception, since the perception of colors seems, at first glance, to present a problem for his theory. If a dispositional analysis is given for perceptual belief, what behavior is peculiar to the perception of a color? An interesting discussion of the primary-secondary quality contrast follows Pitcher's solution to this problem. Though the author does not claim originality for the theory of perception he offers, there is still much to be said for his treatment of the materials presented.--R. L. M. (shrink)

A systematic account of explanation and meaning, on an introductory level. The book is designed not only for students who are primarily interested in philosophy, but also for students whose primary interests may lie in the physical or social sciences, literature, or history. There are fifteen relatively brief chapters, the first eight of which are concerned with the concept of explanation while the remaining seven chapters deal with the concept of meaning. The author begins his treatment of explanation by dismissing (...) as fruitless disputes over what a 'real' explanation must be. Instead, he proposes to examine different types of explanation in order to determine their differences and the relative importance of their differences. "Scientific Explanation," "What-explanations," and "Reason-giving Explanation" are then distinguished and discussed in the early chapters, and this is followed with chapters on historical explanation and explanation in literary criticism. In the remaining chapters on meaning, the author maintains the view that meanings are not a sort of thing, mental or physical. He supports this thesis through his criticisms of causal theories of meaning, "Fido"-Fido theories of meaning, and theories which attempt to identify the meaning of a word with a mental event or an essential definition. The author favors identifying the meaning of a work with its use and deals with some of the problems connected with this view. A list of additional references for each chapter is provided at the end of the book. Though the book is primarily a systematic account of explanation and meaning, a variety of issues from different areas of contemporary philosophical concern are touched upon along the way. These issues concern, for example, natural laws, explaining human behavior, the nature of historical explanation, interpretation in literature, definition, synonymy, and metaphor. This is a clearly written introduction to contemporary philosophy.--R. L. M. (shrink)

Von Wright describes his position as "teleological" yet distinguishes it from Aristotle's "notion of the good of man relative to a notion of the nature of man," by likening it to that of the utilitarian tradition. There is painstaking attention to the staggering diversity of functions of "good" and related words, and an examination of instrumental, technical, medical, hedonic and utilitarian goodness. Von Wright regards the moral sense of "good" as derivative and defines it in terms of the beneficial, a (...) sub-class of Utilitarian Goodness. Chapters on Virtue, "Good" and "Must," Duty, Justice are included. There are rather few references to other works, very many distinctions, and an Index which includes, among others, the word "all right."--R. L. M. (shrink)

This volume contains fourteen essays, all of which were written by Ebersole over a period of seven years, on various epistemological problems. A few of the essays have appeared before as journal articles, but the bulk of the essays are here printed for the first time. The essays deal with three principle topics: sense-datum theories of perception, memory and the past, and the possibility of knowledge of existence without experience. In style and approach, the essays can be characterized as belonging (...) to the school of analytic philosophy, dealing with philosophical problems with an emphasis on the use and function of relevant linguistic expressions. Although some of the essays are interesting, readers of Wittgenstein will find the material all too familiar.--R. L. M. (shrink)

Background Central to the involvement of children in health research is the notion of risk. In this paper we present one of the factors, a matter of trust, that shaped Canadian parents' and children's perceptions and assessments of risk in child health research. Participants and methods Part of a larger qualitative research study, 82 parents took part an in-depth qualitative interview, with 51 parents having children who had participated in health research and 31 having children with no research history. 51 (...) children ranging from 6 to 19 years of age were also interviewed, with 28 having a history of participation in child health research and 23 having no history. Children also took part in 3 focus groups interviews. Themes emerged through a grounded theory analysis of coded interview transcripts. Findings The presence or absence of trust was not only perceived by parents and children as a contributing factor to involving children in health research, but also shaped their perceptions and assessments of risk. Three interrelated subthemes identified were: (1) relationships of trust; (2) placing trust in symbols of authority; and (3) the continuum of trust. Conclusions Our study reinforces that trust is an important factor when parents assess risk in child health research and shows that children use the language of trust in relation to risk. More discussion regarding trust in training researchers is warranted given the trust in researchers and institutions evident in this study. We also recommend further study of the continuum of trust in child health research. (shrink)

In this new and third edition, the additional fragments contained in the appendix of the second edition have been incorporated in the main text. Some further discoveries have been included, and reference has been made to the results of recent research on the relative placing of certain papyrus fragments. The index of names has been brought up to date.

Background Clients are invited to play a role in decisions about their care. Collaborative deliberation comprises constructive engagement, recognition of alternative actions, comparative learning, construction and elicitation of preferences and preference integration. Collaborative deliberation between clients and professionals is a process that requires an interest in each other, sharing of views on alternatives and preferences and integrating into decisions. The aim is to gain insight into collaborative deliberation in consultations and the clients’ perception of arranging long-term care. Design A descriptive (...) qualitative study to explore collaborative deliberation in consultations between clients and professionals. Six organisations providing long-term care were included. Data collection of nine clients involved observations of consultation with field notes and audio-records, interviews with clients and professionals shortly and 3–6 months after the consultation and questionnaires to collect background information. The data were analysed by deductive content analysis. Findings Constructive engagement was visible in all consultations. Clients and professionals showed respect, empathy and curiosity towards each other. In most consultations, two or more alternative actions are recognised and discussed. Comparative learning appears to be two sided, the client and the professional learn from each other's knowledge and experiences. Construction and elicitation of preference, and preference integration, seems to be present, but difficult to recognise in all consultations. Discussion/conclusion Although all propositions could be identified, there seems room for improvement in preference elicitation and integration of these preferences in the discussions on courses of action. Assistance seems needed with preference elicitation, both for the clients and for the professional. (shrink)

Mutual perceptions of ethical behaviour among managers in nine EU-countries were quantatively measured and related to perceptions concerning "ease of cooperation". A strong positive correlation obtains: the more ethical a country is perceived to be, the higher it is valued as an international business partner. Germany, however, is a typical exception to this rule: German managers are perceived as the most ethical, but are considered relatively difficult to cooperate with.

This study provides evidence regarding the level of ethical cognition of business students at the entry to college as compared to a national norm. It also provides comparative evidence on the effects of group versus individual ethical cognition upon completion of a business ethics course. The Principled Score (P-score) from the Defining Issues Test (DIT) was used to measure the ethical cognition of a total sample of 301 business students (273 entering students plus 28 students in a business ethics course). (...) The results indicate that (1) business students are not significantly different from the national norms at entry to college and (2) group reasoning helps male students improve their P-scores significantly in the business ethics course at a loss of P-score (albeit not statistically significant) for female students. (shrink)

BackgroundLarge-scale, centralized data repositories are playing a critical and unprecedented role in fostering innovative health research, leading to new opportunities as well as dilemmas for the medical sciences. Uncovering the reasons as to why citizens do or do not contribute to such repositories, for example, to population-based biobanks, is therefore crucial. We investigated and compared the views of existing participants and non-participants on contributing to large-scale, centralized health research data repositories with those of ex-participants regarding the decision to end their (...) participation. This comparison could yield new insights into motives of participation and non-participation, in particular the behavioural change of withdrawal.MethodsWe conducted 36 in-depth interviews with ex-participants, participants, and non-participants of a three-generation, population-based biobank in the Netherlands. The interviews focused on the respondents’ decision-making processes relating to their participation in a large-scale, centralized repository for health research data.ResultsThe decision of participants and non-participants to contribute to the biobank was motivated by a desire to help others. Whereas participants perceived only benefits relating to their participation and were unconcerned about potential risks, non-participants and ex-participants raised concerns about the threat of large-scale, centralized public data repositories and public institutes, such as social exclusion or commercialization. Our analysis of ex-participants’ perceptions suggests that intrapersonal characteristics, such as levels of trust in society, participation conceived as a social norm, and basic societal values account for differences between participants and non-participants.ConclusionsOur findings indicate the fluidity of motives centring on helping others in decisions to participate in large-scale, centralized health research data repositories. Efforts to improve participation should focus on enhancing the trustworthiness of such data repositories and developing layered strategies for communication with participants and with the public. Accordingly, personalized approaches for recruiting participants and transmitting information along with appropriate regulatory frameworks are required, which have important implications for current data management and informed consent procedures. (shrink)

The basic reproduction ratio, R0, is a fundamental concept in epidemiology. It is defined as the total number of secondary infections brought on by a single primary infection, in a totally susceptible population. The value of R0 indicates whether a starting epidemic reaches a considerable part of the population and causes a lot of damage, or whether it remains restricted to a relatively small number of individuals. To calculate R0 one has to evaluate an integral that ranges over the duration (...) of the infection of the host. This duration is, of course, limited by remaining host longevity. So, R0 depends on remaining host longevity and in this paper we show that for long-lived hosts this aspect may not be ignored for long-lasting infections. We investigate in particular how this epidemiological measure of pathogen fitness depends on host longevity. For our analyses we adopt and combine a generic within- and between-host model from the literature. To find the optimal strategy for a pathogen from an evolutionary point of view, we focus on the indicator $$R_0^{{opt}}$$, i.e., the optimum of R0 as a function of its replication and mutation rates. These are the within-host parameters that the pathogen has at its disposal to optimize its strategy. We show that $$R_0^{{opt}}$$ is highly influenced by remaining host longevity in combination with the contact rate between hosts in a susceptible population. In addition, these two parameters determine whether a killer-like or a milker-like strategy is optimal for a given pathogen. In the killer-like strategy the pathogen has a high rate of reproduction within the host in a short time span causing a relatively short disease, whereas in the milker-like strategy the pathogen multiplies relatively slowly, producing a continuous small amount of offspring over time with a small effect on host health. The present research allows for the determination of a bifurcation line in the plane of host longevity versus contact rate that forms the boundary between the milker-like and killer-like regions. This plot shows that for short remaining host longevities the killer-like strategy is optimal, whereas for very long remaining host longevities the milker-like strategy is advantageous. For in-between values of host longevity, the contact rate determines which of both strategies is optimal. (shrink)

Developments in medical big data analytics may bring societal benefits but are also challenging privacy and other ethical values. At the same time, an overly restrictive data protection regime can form a serious threat to valuable observational studies. Discussions about whether data privacy or data solidarity should be the foundational value of research policies, have remained unresolved. We add to this debate with an empirically informed ethical analysis. First, experiences with the implementation of the General Data Protection Regulation (GDPR) within (...) a European research consortium demonstrate a gap between the aims of the regulation and its effects in practice. Namely, strictly formalised data protection requirements may cause routinisation among researchers instead of substantive ethical reflection, and may crowd out trust between actors in the health data research ecosystem; while harmonisation across Europe and data sharing between countries is hampered by different interpretations of the law, which partly stem from different views about ethical values. Then, building on these observations, we use theory to argue that the concept of trust provides an escape from the privacy-solidarity debate. Lastly, the paper details three aspects of trust that can help to create a responsible research environment and to mitigate the encountered challenges: trust as multi-agent concept; trust as a rational and democratic value; and trust as method for priority setting. Mutual cooperation in research—among researchers and with data subjects—is grounded in trust, which should be more explicitly recognised in the governance of health data research. (shrink)