Given the profound influence of social media and emerging evidence of its effects on human behavior and health, bioethicists have an important role to play in the development of professional standards of conduct for health professionals using social media and in the design of online systems themselves. In short, social media is a bioethics issue that has serious implications for medical practice, research, and public health. Here, we inventory several ethical issues across four areas at the intersection of social media (...) and health: the impact of social networking sites on the doctor‐patient relationship, the development of e‐health platforms to deliver care, the use of online data and algorithms to inform health research, and the broader public health consequences of widespread social media use. In doing so, we review discussions of these topics and emphasize the need for bioethics to focus more deeply on the ways online technology platforms are designed and implemented. We argue that bioethicists should turn their attention to the ways in which consumer engagement, bias, and profit maximization shape online content and, consequently, human behavior and health. We also offer a set of recommendations and suggest future directions for addressing ethical challenges in these domains. (shrink)

The shift away from paternalistic decision-making and toward patient-centered, shared decision-making has stemmed from the recognition that in order to practice medicine ethically, health care professionals must take seriously the values and preferences of their patients. At the same time, there is growing recognition that minor and seemingly irrelevant features of how choices are presented can substantially influence the decisions people make. Behavioral economists have identified striking ways in which trivial differences in the presentation of options can powerfully and predictably (...) affect people's choices. Choice-affecting features of the decision environment that do not restrict the range of choices or significantly alter the incentives have come to be known as “nudges.” Although some have criticized conscious efforts to influence choice, we believe that clinical nudges may often be morally justified. The most straightforward justification for nudge interventions is that they help people bypass their cognitive limitations—for example, the tendency to choose the first option presented even when that option is not the best for them—thereby allowing people to make choices that best align with their rational preferences or deeply held values. However, we argue that this justification is problematic. We argue that, if physicians wish to use nudges to shape their patients’ choices, the justification for doing so must appeal to an ethical and professional standard, not to patients’ preferences. We demonstrate how a standard with which clinicians and bioethicists already are quite familiar—the best-interest standard—offers a robust justification for the use of nudges. (shrink)

Incentive programs have been criticized due to concerns that extrinsic rewards can ‘crowd out’ intrinsic motivation, and also that such programs might exert a corrupting influence on those receiving the incentive. Jonathan Wolff has argued that while these worries are in some instances well grounded, incentives can also operate by liberating people from social pressures that stand in the way of their intrinsic motivations. We further develop Wolff's insight by articulating a framework for assessing such incentives and discussing several areas (...) of public health where incentives may play a positive role. In so doing, we describe the limitations of Wolff's thesis as well as the opportunities it presents. Finally, we suggest that there is an additional attractive feature of incentives that has been overlooked, which is their capacity to serve as ‘conversation makers’. By providing people an occasion to discuss reasons for and against various health behaviors, incentives have the potential not only to impact the health behavior of individuals but to affect cultural change at the population level. (shrink)

Volume 19, Issue 7, July 2019, Page 26-28.

Utilitarian objections to the consumption of factory-farmed products center primarily on the harms such farms cause to animals. One problem with the utilitarian case against the consumption of factory-farmed products is that the system of production is so vast and complex that no typical, individual consumer can, through her consumer behavior, make any difference to the welfare of animals. I grant for the sake of argument that this causal inefficacy objection is sound and go on to argue that the utilitarian (...) nevertheless has the resources to conclude that at least in some cases it is wrongful on utilitarian grounds for an individual to consume factory-farmed products. When a consumer who believes that factory farming is wrongful consumes the products of factory farms, she endorses wrongful practices, and by doing so she engages in a form of self-harm. Self harm, like harm to others, must be taken into consideration when a utilitarian agent deliberates about the permissibility of her proposed course of action. Therefore, the causal inefficacy objection, while powerful, is not decisive against utilitarian objections to consuming factory-farmed products. (shrink)

So-called “manipulation arguments” have played a significant role in recent debates between compatibilists and incompatibilists. Incompatibilists take such arguments to show that agents who lack ultimate control over their characters or actions are not free. Most compatibilists agree that manipulated agents are not free but think this is because certain of the agent’s psychological capacities have been compromised. Chandra Sekhar Sripada has conducted an interesting study in which he applies an array of statistical tools to subjects’ intuitive responses to a (...) manipulation case, and he insists that the results of his study provide compelling evidence that people favor compatibilist views of freedom. I argue that because the case that forms the centerpiece of his study is relevantly different from the sort of cases incompatibilists have developed and because he fails to build deterministic conditions into this case, Sripada’s data cannot help settle the disagreement between compatibilists and incompatibilists. (shrink)

-- ch. 2. Tekhnosfera i osnovy sovremennykh tekhnologiĭ.

En focalisant notre attention sur l'atelier comme lieu de formation des improvisateurs et improvisatrices de théâtre, cet article vise à réintroduire le Théâtre d'Improvisation dans le processus d'apprentissage qui l'accompagne. Dirigé par un·e chef·fe d'atelier chargé·e de la gestion des exercices, des consignes ainsi que des retours, l'atelier se construit comme un jeu interactionnel et discursif visant à transmettre des compétences à improviser. Ce processus suppose des modalités d'ajustements collectifs et de compréhension mutuelle entre les comédien·ne·s qui s'exercent et le·la (...) chef·fe d'atelier qui prend le rôle de conseiller·ère, d'évaluateur·rice et d'enseignant·e. En ce sens, le travail d'atelier relève d'une dynamique particulière en tant que performance avant la performance publique, impliquant d'élargir la notion d'exercice à ses débordements interactionnels. Au sein de ce cadre pédagogique, le retour, moment d'échanges en aval de l'exercice, devient un phénomène primordial. S'il recouvre différentes fonctions telles que l'évaluation, la critique ou le conseil, le retour offre aussi la possibilité de déréférencer le propos de l'exercice en question pour traiter du Théâtre d'Improvisation comme pratique. Le retour dans sa dimension épisémiotique permet dès lors de saisir le passage de l'exercice, comme phénomène éphémère et localisé à la pratique du Théâtre d'Improvisation, comme discipline stabilisée et collective. (shrink)

En focalisant notre attention sur l'atelier comme lieu de formation des improvisateurs et improvisatrices de théâtre, cet article vise à réintroduire le Théâtre d'Improvisation dans le processus d'apprentissage qui l'accompagne. Dirigé par un·e chef·fe d'atelier chargé·e de la gestion des exercices, des consignes ainsi que des retours, l'atelier se construit comme un jeu interactionnel et discursif visant à transmettre des compétences à improviser. Ce processus suppose des modalités d'ajustements collectifs et de compréhension mutuelle entre les comédien·ne·s qui s'exercent et le·la (...) chef·fe d'atelier qui prend le rôle de conseiller·ère, d'évaluateur·rice et d'enseignant·e. En ce sens, le travail d'atelier relève d'une dynamique particulière en tant que performance avant la performance publique, impliquant d'élargir la notion d'exercice à ses débordements interactionnels. Au sein de ce cadre pédagogique, le retour, moment d'échanges en aval de l'exercice, devient un phénomène primordial. S'il recouvre différentes fonctions telles que l'évaluation, la critique ou le conseil, le retour offre aussi la possibilité de déréférencer le propos de l'exercice en question pour traiter du Théâtre d'Improvisation comme pratique. Le retour dans sa dimension épisémiotique permet dès lors de saisir le passage de l'exercice, comme phénomène éphémère et localisé à la pratique du Théâtre d'Improvisation, comme discipline stabilisée et collective. (shrink)

En focalisant notre attention sur l'atelier comme lieu de formation des improvisateurs et improvisatrices de théâtre, cet article vise à réintroduire le Théâtre d'Improvisation dans le processus d'apprentissage qui l'accompagne. Dirigé par un·e chef·fe d'atelier chargé·e de la gestion des exercices, des consignes ainsi que des retours, l'atelier se construit comme un jeu interactionnel et discursif visant à transmettre des compétences à improviser. Ce processus suppose des modalités d'ajustements collectifs et de compréhension mutuelle entre les comédien·ne·s qui s'exercent et le·la (...) chef·fe d'atelier qui prend le rôle de conseiller·ère, d'évaluateur·rice et d'enseignant·e. En ce sens, le travail d'atelier relève d'une dynamique particulière en tant que performance avant la performance publique, impliquant d'élargir la notion d'exercice à ses débordements interactionnels. Au sein de ce cadre pédagogique, le retour, moment d'échanges en aval de l'exercice, devient un phénomène primord... (shrink)

Imagine a drug—let's call it Curebitt—that is safe, cheap, and very effective: take a pill once a day and you will be healthier. Curebitt's taste is so unpleasant, so bitter, however, that a significant proportion of patients cannot bring themselves to ingest the pill regularly. Now suppose that after some time, another drug, Curesweet, hits the market. This drug is clinically equivalent to Curebitt and costs the same, but it is much more palatable, so adherence rates for it are significantly (...) higher than for Curebitt. Should physicians continue prescribing Curebitt, now that Curesweet is available? No, prescribing the bitter pill puts patients at a greater risk of nonadherence and ultimately results in reduced clinical benefit for a significant proportion of patients, whereas prescribing Curesweet benefits more patients and increases the probability that any given patient's health will improve. The Curebitt versus Curesweet scenario draws our attention to how a physician can fail her patients by prescribing drugs with lower adherence rates when equivalent drugs with higher adherence rates are available. What does this fictional case tell us about the real world? A lot. We know that adherence rates vary with out‐of‐pocket costs. Name‐brand drugs carry higher out‐of‐pocket costs than their generic counterparts; as a result, when name‐brand drugs are prescribed rather than their generic counterparts, fewer patients receive health benefits. If prescribing Curebitt is unethical, then so is prescribing the name‐brand drug. (shrink)

PURPOSE:To report the localization of a gene causing drusen and macular degeneration in a previously undescribed North American family. METHODS:Genetic mapping studies were performed using linkage analysis in a single family with drusen and atrophic macular degeneration. RESULTS:The clinical manifestations in this family ranged from fine macular drusen in asymptomatic middle-aged individuals to atrophic macular lesions in two children and two elderly patients. We mapped the gene to chromosome 6q14 between markers D6S2258 and D6S1644. CONCLUSIONS:In a family with autosomal dominant (...) drusen and atrophic macular degeneration, the gene maps to a 3.2-cM region on chromosome 6q14. This locus appears to be distinct from, but adjacent to, the loci for cone-rod dystrophy 7 (CORD7) and North Carolina macular dystrophy (MCDR1). Future identification of the gene responsible for the disease in this family will provide a better understanding of macular degeneration. (shrink)

PurposeTo use the power of knowledge acquisition and machine learning in the development of a collaborative computer classification system based on the features of age-related macular degeneration (AMD).MethodsA vocabulary was acquired from four AMD experts who examined 100 ophthalmoscopic images. The vocabulary was analyzed, hierarchically structured, and incorporated into a collaborative computer classification system called IDOCS. Using this system, three of the experts examined images from a second set of digital images compiled from more than 1000 patients with AMD. Images (...) were annotated, and features were identified and defined. Decision trees, a machine learning method, were trained on the data collected and used to extract patterns. Interrelationships between the data from the different clinicians were investigated.ResultsSix drusen classes in the structured vocabulary were largely sufficient to describe all the identified features. The decision trees classified the data with 76.86% to 88.5% accuracy and distilled patterns in the form of hierarchical trees composed of 5 to 15 nodes. Experts were largely consistent in their characterization of soft, and to a lesser extent, hard drusen, but diverge in definition of other drusen. Size and crystalline morphology were the main determinants of drusen type across all experts.ConclusionsMachine learning is a powerful tool for the characterization of disease phenotypes. The creation of a defined feature set for AMD will facilitate the development of an IDOCS-based classification system. (shrink)

The purpose of the study is to study the demographic situation in the Russian Federation using a system of general and particular statistical indicators, to identify the problems of socio-economic policy and suggest possible ways to solve them. The article examines various factors that influenced the demographic situation in Russia in 2000-2021; demographic problems, the consequences of which affect the socio-economic life of Russian society; the demographic situation that has arisen due to the epidemiological situation in our country. The scientific (...) novelty of the research consists in considering the influence of various factors, including pandemics, on the demographic processes in the Russian Federation. As a result of the study, possible measures were proposed to improve the socio-economic policy of the state. (shrink)