Harris’ reply to our defence of the National Institute for Clinical Excellence’s (NICE) current cost-effectiveness procedures contains two further errors. First, he wrongly draws a conclusion from the fact that NICE does not and cannot evaluate all possible uses of healthcare resources at any one time and generally cannot know which National Health Service (NHS) activities would be displaced or which groups of patients would have to forgo health benefits: the inference is that no estimate is or can be made (...) by NICE of the benefits to be forgone. This is a non-sequitur. Second, he asserts that it is a flaw at the heart of the use of quality-adjusted life years (QALYs) as an outcome measure that comparisons between people need to be made. Such comparisons do indeed have to be made, but this is not a consequence of the choice of any particular outcome measure, be it the QALY or anything else. (shrink)

This essay seeks to characterise the essential features of an equitable health care system in terms of the classical Aristotelian concepts of horizontal and vertical equity, the common language of “need” and the economic notion of cost-effectiveness as a prelude to identifying some of the more important issues of value that policy-makers will have to decide for themselves; the characteristics of health that can cause policy to be ineffective ; the information base that is required to support a policy directed (...) at securing greater equity, and the kinds of research that are needed to underpin such a policy. (shrink)

This editorial provides a review of the current ways in which health economics is impacting on policy and reviews some of the key ethical and value-judgmental issues that commonly arise in and as a result of the work of economists. It also briefly highlights the contributions of the authors of this special issue of the journal, all of which illustrate how economists have approached ethical issues in health service policy , and some of which explore the major methodological matters that (...) arise and go on to discuss their potential as sources of conflict or harmony with other approaches to the same questions. (shrink)

The bottom line is that Claxton and Culyer believe, and are on record as saying, that a therapy or procedure is not cost effective if “the health benefits that it is estimated could be gained from the technology are less than those estimated to be forgone by other patients as other procedures are necessarily curtailed or not undertaken. It is this comparison of health gained and health forgone that is at the heart of the rationale of cost-effectiveness analysis”. To (...) estimate whether the gains made …. (shrink)

Correspondence to: John Harris The Centre for Social Ethics and Policy, Institute of Medicine Law and Bioethics, School of Law, University of Manchester, Williamson Building, Oxford Road, Manchester M13 0JH, UK; [email protected] and Culyer1 have written an interesting and considered response, as people intimately connected to the National Institute for Health and Clinical Excellence , to the two editorials that I wrote on recent NICE decisions. Before commenting on their response, I would like to consider a point they made, which (...) echoes a point already made by Rawlins and Dillon,2 about the tone of my editorials. Claxton and Culyer accuse me of making “personally abusive charges”. In my original editorial, I criticised an institution, NICE, in robust terms, but in doing so I was continuing a long and respected tradition in English philosophy. Consider the following extract from Jeremy Bentham:" In English law, fiction is a syphilis, which runs in every vein, and carries into every part of the system the principle of rottenness...Fiction of use to justice? Exactly as swindling is to trade...It affords presumptive and conclusive evidence of moral turpitude in those by whom it was invented and first employed.3"My remarks were not an ad hominem criticism of anyone but directed at the published, but anonymous statements of an institution—a body corporate. In robustly criticising NICE, I no more attacked any individual associated with NICE than I attacked Tony Blair or the various ministers of state who are ultimately responsible for NICE. And, contra Claxton and Culyer’s claims, I have not denigrated the views of people who beg to differ from me.i If the apologists for NICE, whether they are Tony Culyer or Tony Blair, choose to identify themselves with criticism of NICE, that is entirely a matter for them. The only ad hominem remarks in this entire exchange have been made by Rawlins and Dillon, and Claxton and Culyer. The idea that criticism of the anonymously authored publications of …. (shrink)

C. A. J. Coady offers to clear up confusion about what terrorism is. His "tactical definition" focuses on terrorist acts as violent attacks upon non-combatants. He discusses what it means to be a non-combatant, considers various philosophical attempts to defend terrorism, and examines the idea of a connection between religion and terrorism.

Legal theorists are familiar with John Finnis's book Natural Law and Natural Rights, but usually overlook his interventions in US constitutional debates and his membership of a group of conservative Catholic thinkers, the 'new natural lawyers', led by theologian Germain Grisez. In fact, Finnis has repeatedly advocated conservative positions concerning lesbian and gay rights, contraception and abortion, and his substantive moral theory derives from Grisez. Bamforth and Richards provide a detailed explanation of the work of the new natural lawyers within (...) and outside the Catholic Church - the first truly comprehensive explanation available to legal theorists - and criticize Grisez's and Finnis's arguments concerning sexuality and gender. New natural law is, they argue, a theology rather than a secular theory, and one which is unappealing in a modern constitutional democracy. This book will be of interest to legal and political theorists, ethicists, theologians and scholars of religious history. (shrink)

This essay shows how Conrad Hal Waddington is at the very center of divergent genealogies of theoretical biology: he is at once remembered for his contribution to epigenetics and complex systems biology (in its current formation) and largely forgotten for the debt that he owes to Alfred North Whitehead’s philosophy of organism. The essay traces Waddington's debt to Whitehead and demonstrates the way in which this conceptual lineage challenges the transcendental conditions of biological knowledge presupposed by the reigning paradigm of (...) complex systems biology. (shrink)

Rationale, aims and objectives To compare the pharmacotherapeutic approaches to diabetic hypertension of family physicians (FPs) and general practitioners (GPs). Methods A retrospective prescription-based study was conducted in 15 out of a total of 20 health centres, involving 115 primary care physicians – 77 FPs and 38 GPs, representing 74% of the primary care physicians of Bahrain. Prescriptions were collected during May and June 2000 to comprise a study population of 1266 diabetic-hypertensive patients. Results As monotherapy, angiotensin-converting enzyme (ACE) inhibitors (...) (37.9%) and β-blockers (38.3%) were the most commonly prescribed classes of antihypertensives by FPs and GPs, respectively. Calcium channel blockers (CCBs) were ranked third by both categories of physicians. For two-drug combinations, a β-blocker and an ACE inhibitor was the combination of choice for both physician categories. Patients managed by the FPs were more likely to receive a β-blocker–CCB combination (17.4 vs. 14.9%) or a diuretic–ACE inhibitor combination (16.7 vs. 11.4%) and less likely to receive a β-blocker–diuretic combination (11.8 vs. 16.7%) than those managed by the GPs. The proportion of patients receiving antihypertensive combinations was 40.6 and 38.5% for FPs and GPs, respectively. While the GPs prescribed CCB as a monotherapy to the elderly most often, the FPs choice was a β-blocker. Diuretics were less preferred by both FPs and GPs. β-Blocker–ACE inhibitor was again the most preferred combination of both FPs and GPs. FPs prescribed CCB–β-blocker combinations more often than GPs (P = 0.01), whereas CCB–ACE inhibitor combinations were less preferred (P = 0.09). A trend towards excessive use of short-acting nifedipine as monotherapy for elderly patients, both by FPs and by GPs, was noticed. Glibenclamide, alone or in combination with metformin, was the foremost antidiabetic drug prescribed by FPs and GPs. Middle-aged (45–64 years) patients seen by GPs were more likely to receive glibenclamide than those treated by FPs (P = 0.001) and less likely to receive gliclazide (P = 0.01). Combinations of a β-blocker with either glibenclamide or insulin were prescribed considerably more often by GPs.Conclusions Within the same practice setting, a substantial difference was observed between FPs and GPs in terms of preference for different classes of drugs in the management of diabetic hypertension. The compliance of both FPs and GPs was suboptimal; overall, the compliance of the FPs was closer to the recommended guidelines, however. Educational programmes should specifically address these inadequacies in order to improve the quality of health care. (shrink)

Incidental perceptual memory tests reveal priming when words are generated orally from a semantic cue at study, and this priming could reflect contamination by voluntary retrieval. We tested this hypothesis using a generate condition and two read conditions that differed in depth of processing . An intentional word-stem completion test showed an advantage for the read-semantic over the generate condition and an advantage for the generate over the read-phonemic condition, and completion times were longer than in a control test, prior (...) to which there was no study phase. An incidental word-stem completion test showed equivalent priming for the read-semantic and read-phonemic study conditions, despite considerable power, and completion times were no longer than control, indicating that retrieval was involuntary, and insensitive to prior conceptual processing. The generate condition produced less priming than the read conditions, but significant priming nonetheless. The results show that priming from generating can be involuntary and suggest that lexical processes are responsible. They are also the first results conjointly showing a crossed double dissociation, a single dissociation, and a parallel effect across memory tests with identical physical retrieval cues. (shrink)

This chapter contains sections titled: The Just War: Jus ad Bellum The Jus in Bello Terrorism.

This is the first full discussion of Philoponus' account of matter. It is shown here that philosophical problems in Neoplatonism motivated the definition of prime matter as three-dimensional extension, and that Plotinus, Syrianus, and Proclus prepared the way for Philoponus.

C. A. J. Coady; VIII*—Descartes' Other Myth, Proceedings of the Aristotelian Society, Volume 83, Issue 1, 1 June 1983, Pages 121–142, https://doi.org/10.1093/ar.

There is in the British Museum a twelfth-century manuscript, Egerton 3055, of Suetonius' De Vita Caesarum which has not previously been noticed by editors or in the reports of manuscripts of Suetonius made by Professor C. L. Smith and Professor A. A. Howard, though summarily classified by E. G. Millar.

This article argues for the relevance of mythical signification in our geological epoch. More than this, it contends that we need to revise our assumptions about media and communication systems in order to grasp the importance of myth in an era where the future of human and nonhuman life on the Earth is entirely uncertain. To make this case, I focus on the growing consensus in the sciences and theoretical humanities that mythical stories about geological and planetary processes cannot simply (...) be disqualified or disregarded because they do not conform to the norms of modern scientific epistemology. Whether these stories come to us from pre-modern civilizations and attempt to give... (shrink)

This paper summarizes ideas about the nature of gases proposed during the period following the discovery of Boyle's law. Particular stress is laid on the hypotheses of the Bernoullis, and later, on the equally speculative work of Herapath. Reasons for the success of Herapath's theory, and the neglect of Daniel Bernoulli's are discussed, but it has not been thought necessary to take the story beyond the initial acceptance of Herapath's theory by J. P. Joule, because the paper is concerned only (...) with the antecedents of the modern kinetic theory. (shrink)

Since the publication of Jonathan Dancy's 'Moral Reasons' in 1991, many English speaking ethicists have been especially interested in the role of abstract theory in moral life and the extent to which principles analogous to those employed in the hard sciences like physics are central to the development of ethical knowledge. Unlike earlier generations of philosophers who had, on the whole, accepted that principles had an integral role in the life of a morally serious person, contemporary ethicists are largely divided (...) about the merits of such principles and whether ethical knowledge is gained through principles. This debate about the form of ethical knowledge raises questions about the epistemic status of intuitions. Can intuitions about right and wrong provide an alternative source of genuine ethical knowledge? Is reflection upon a belief enough to show that it is true? This edited collection, consisting of 11 essays by distinguished philosophers, pursues and advances that debate. The early chapters of the book are concerned primarily with intuitions and intuitionism. John Cottingham, in an essay that casts doubt on the possibility of secular intuitions, argues that if intuitions are uprooted from their traditional theological foundations then they lose their plausibility. The claim is that theism and moral intuitionism are natural partners and morality is doomed if we reject theistic picture that 'provides a home for these intuitions'. James Lenman provides an indirect response to Cottingham, questioning whether evolutionary explanations of intuitions genuinely debunk them. Explaining the causal origins of intuitions within a naturalistic framework is not damning of them or of morality itself. (shrink)

We inhabit a world in which the market is a dominant institutional form of social organization. This influence is not without its critics, and there is considerable debate amongst political philosophers and policy-makers about whether the range of the market should expand or contract and, further, about the extent to which the market should be subject to constraints and government regulation. The expansion of the market into realms hitherto unknown is the theme of a number of recent books, including Michael (...) Sandel's What Money Can't Buy and Debra Satz's Why Some Things Should Not Be for Sale, which build on earlier work by, amongst others, Elizabeth Anderson, Margaret Jane Radin, and Michael Walzer. (shrink)