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)

A hypothesis about sensorimotor integration (the λ model) is described and applied to movement control and kinesthesia. The central idea is that the nervous system organizes positional frames of reference for the sensorimotor apparatus and produces active movements by shifting the frames in terms of spatial coordinates. Kinematic and electromyographic patterns are not programmed, but emerge from the dynamic interaction among the system s components, including external forces within the designated frame of reference. Motoneuronal threshold properties and proprioceptive inputs to (...) motoneurons may be cardinal components of the physiological mechanism that produces positional frames of reference. The hypothesis that intentional movements are produced by shifting the frame of reference is extended to multi-muscle and multi-degrees-of-freedom systems with a solution of the redundancy problem that allows the control of a joint alone or in combination with other joints to produce any desired limb configuration and movement trajectory. The model also implies that for each motor behavior, the nervous system uses a strategy that minimizes the number of changeable control variables and keeps the parameters of these changes invariant. Examples are provided of simulated kinematic and electromyographic signals from single- and multi-joint arm movements produced by suggested patterns of control variables. Empirical support is provided and additional tests of the model are suggested. The model is contrasted with others based on the ideas of programming of motoneuronal activity, muscle forces, stiffness, or movement kinematics. (shrink)

The eighteenth century saw the publication of many scientific and technical dictionaries, particularly in France, one of the most important being P. J. Macquer's Dictionnaire de chymie. Both the original text of 1766 and the revised and enlarged version of 1778 were translated into several languages, sometimes with authoritative notes and additions by the translators. No mere list of definitions, Macquer's work contained long articles that made it a comprehensive treatise on chemistry, and it set the pattern for many subsequent (...) chemical dictionaries. We have endeavoured to give an account of the circumstances in which the various editions, reprints and translations were published, and we add detailed bibliographical descriptions of them. Bibliographical purists consider that all the copies of a book printed from the same setting of type constitute an ‘edition’, and that there is a new edition when all or most of the type has been reset. However, Macquer described his revised and expanded text of 1778 as the ‘second edition’ and this designation has been adopted by subsequent writers, even though the original text was reprinted several times from different settings of type before 1778. In order to avoid confusion we therefore refer to all versions of the 1766 and 1778 editions as ‘issues’, ‘printings’ or ‘reprints’ of the first and second edition respectively. (shrink)

We report the results of a randomized trial to assess the impact of an innovative ethics curriculum on the knowledge and confidence of 85 medical house officers in a university hospital programme, as well as their responses to a simulated clinical case. Twenty-five per cent of the house officers received a lecture series, 25 per cent received lectures and case conferences, with an ethicist in attendance, and 50 per cent served as controls. A post-intervention questionnaire was administered. Knowledge scores did (...) not differ among the groups. Confidence regarding ethical issues was significantly greater in the aggregate intervention group compared to the control group. Confidence regarding procedural issues related to ethics was significantly higher for the EI group than for the controls. Responses to a simulated case showed that significantly fewer house officers in the EI group would intubate a patient for whom such therapy would be futile. We conclude that ethics education can have an impact on house officers' confidence and their responses to a simulated case, and that the EI was more effective than the LI. Such results have implications regarding the implementation of ethics education during residency. (shrink)

Non-knowledge should not be simply regarded as the opposite of knowledge, but as complementary to it: each derives its character and meaning from the other and from their interaction. Knowledge does not colonize the space of ignorance in the progressive march of science; rather, knowledge and ignorance are mutually shaped in social and political domains of partial, shifting, and temporal relationships. This volume’s ethnographic analyses provide a theoretical frame through which to consider the production and reproduction of ignorance, non-knowledge, and (...) secrecy, as well as the wider implications these ideas have for anthropology and related disciplines in the social sciences and humanities. (shrink)

Taking as its point of departure Derrida's essay “Shibboleth: For Paul Celan,” this article is concerned with the relation between the poetic discourse of several Celan lyrics and the problematic of circumcision—as religious operation, wound, inscription, linguistic structure—foregrounded in Derrida's reading, and thus on the relation between the event of Celan's lyric, the critical language with which Derrida and other readers engage it, and the discourse of Jewish identity. Also crucial is the relation to Kafka, since the lyric principally under (...) investigation here, Celan's “Einem, der vor der Tür stand,” alludes to Kafka's parable “Before the Law.”. (shrink)

Taking as its point of departure Derrida's essay “Shibboleth: For Paul Celan,” this article is concerned with the relation between the poetic discourse of several Celan lyrics and the problematic of circumcision—as religious operation, wound, inscription, linguistic structure—foregrounded in Derrida's reading, and thus on the relation between the event of Celan's lyric, the critical language with which Derrida and other readers engage it, and the discourse of Jewish identity. Also crucial is the relation to Kafka, since the lyric principally under (...) investigation here, Celan's “Einem, der vor der Tür stand,” alludes to Kafka's parable “Before the Law.”. (shrink)

Derrida’s “What is a ‘Relevant’ Translation?”, first delivered at the fifteenth annual Assises de la Traduction Littéraire à Arles in 1998, is an address that appears at first to speak from the outside and with a certain deference to professional translators. Yet, it quickly becomes apparent that Derrida not only counts himself among them but uses the occasion to reflect on his own surprising success as a translator of Hegel. This success has to do first and foremost with the proven (...) “relevance” of his translation of the notoriously untranslatable term Aufhebung as relève [in English: sublation]. Not a little perplexed by this apparent triumph, Derrida takes up the French term again, this time redeploying it in the translation of a crucial line from Shakespeare’s Merchant of Venice. In doing so, he relaunches his engagement with Hegel, asking what energies bound up in the concept of relève might yet be released, what internal resistances silently at work in it might still be mobilized to take it in an entirely new direction. Such an engagement enables him to explore in turn what resistances may be at work in the notion of translation itself. Inhabited by an internal otherness, by a constitutive resistance to itself, translation must be understood from the very first as transference. While translation studies have long been attentive to the transferential dynamics in which individual translators find themselves enmeshed, Derrida’s text views transference in more impersonal terms as the tenacious grip in which certain structures of thought hold us, structures which also inform our understanding of translation. How to work with and against this structural unconscious? To address this question, it is necessary to examine Derrida’s own translational practice and the privilege he accords to the term trouvaille. (shrink)

Derrida's essay, ‘Devant la loi’, opens with the citation of an1897 letter from Freud to his friend, Wilhelm Fliess, in which he confides that he has a presentiment he shall soon discover the origin of morality. What interests Derrida is not only the discovery that will indeed soon follow but the temporal structure of presentiment itself. Seeking to give such a vague intimation a more rigorous sense, he theorizes presentiment as a way of ‘precognizing’ something that will never otherwise have (...) been known as such. Through close readings of Kafka, Freud and Kant, Derrida asks how the moral law itself might be thinkable only in the mode of a certain pre-, a mode whose very ‘beforeness’ has to be radically rethought. (shrink)

In his final work, Donald N. Levine, one of the great late-twentieth-century sociological theorists, brings together diverse social thinkers. Simmel, Weber, Durkheim, Parsons, and Merton are set into a dialogue with philosophers such as Hobbes, Smith, Montesquieu, Comte, Kant, and Hegel and pragmatists such as Peirce, James, Dewey, and McKeon to describe and analyze dialogical social theory. This volume is one of Levine's most important contributions to social theory and a worthy summation of his life's work. Levine demonstrates that approaching (...) social theory with a cooperative, peaceful dialogue is a superior tactic in theorizing about society. He illustrates the advantages of the dialogical model with case studies drawn from the French Philosophes, the Russian Intelligentsia, Freudian psychology, Ushiba's aikido, and Levine's own ethnographic work in Ethiopia. Incorporating themes that run through his lifetime's work, such as conflict resolution, ambiguity, and varying forms of social knowledge, Levine suggests that while dialogue is an important basis for sociological theorizing, it still vies with more combative forms of discourse that lend themselves to controversy rather than cooperation, often giving theory a sense of standing still as the world moves forward. The book was nearly finished when Levine died in April 2015, but it has been brought to thoughtful and thought-provoking completion by his friend and colleague Howard G. Schneiderman. This volume will be of great interest to students and teachers of social theory and philosophy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Writing Anxiety: Christa Wolf’s KindheitsmusterMichael G. Levine (bio)For Diane C.Christa Wolf’s Kindheitsmuster, published in English as Patterns of Childhood, takes very little for granted—least of all the question of beginnings. The novel literally opens with the words of another: “Das Vergangene ist nicht tot; es ist nicht einmal vergangen,” a slightly altered translation of a line from Faulkner’s Requiem for a Nun: “The past is never dead. It’s not (...) even past.” 1 Lacking a proper opening and haunted by the specter of an unmastered and perhaps unmasterable past—of a “model childhood” spent in the East Prussian town of L. during the Third Reich, the text begins by questioning the very possibility of a clean break and a fresh start. This insistent question, raised in a variety of ways throughout the novel, is posed at the outset as a kind of textual stutter, as a perseverating question rehearsed from the beginning—and in lieu of simply beginning—as a series of false starts, as repeated attempts to start over, as a desperate struggle to restart a narrative paralyzed by the anticipation of difficulties still to come. “You lay aside stacks of tentatively filled pages, insert a fresh sheet in the typewriter, and start once again with Chapter 1. As in so many times during the last eighteen months, when you were forced to learn: the difficulties haven’t even begun [die Schwierigkeiten haben noch gar nicht angefangen].” 2 The temporal structure of this passage, found in the second paragraph of the novel, is worth commenting upon, for here the difficult question of how to begin seems to be folded back on itself, turned inside-out, as it were, and reposed as a question of difficulties that apparently have not yet even started. Indeed, only in a text that stammers from the start and begins by beginning over and over again could it be said both that the difficulties have already started and that they have not yet even begun.Already/not yet: such is the split temporal framework of a difficult encounter, of an encounter with difficulties that will never have been confronted as such. 3 The language of confrontation, of squaring off face-to-face, is particularly inappropriate in this context since, as we will see, the difficulties that force “you,” the writer, to begin again are not simply identifiable or avoidable obstacles in the way of writing but, rather, irreducible and irreducibly conflicted aspects of the writing itself. They are what keeps the writing from ever having a self, from ever being one with or self-consciously coming to itself. 4 [End Page 106]While it is tempting to describe Kindheitsmuster as a novel that is self-conscious in the extreme—difficult writing that writes about the difficulties of writing—one should bear in mind that it is a text that repeatedly calls into question the presumed authority and the capacity for self-knowledge of an instance derisively referred to in a passage inexplicably deleted from the English translation as “His Majesty the Ego [Seine Majestät das Ich]” [83]. In an apparent attempt to suspend the privileges usually accorded to—or, rather, autocratically arrogated to itself by—das Ich, the narrator makes a point of scrupulously avoiding the first-person pronoun when referring to herself in the text. (There is, of course, one important exception to this rule toward the end of the novel to which we will return much later.) As was already evident in the passage cited earlier, “You lay aside stacks of tentatively filled pages, insert a fresh sheet in the typewriter, and start once again with Chapter 1,” the narrator employs the second person rather than the first when speaking in the present—as though she could speak of herself at the moment only by speaking to herself. More significant still in this autobiographical novel that deals at length with the narrator’s memories of growing up in Landsberg on the Warthe (now the Polish town of Gorzmploys the second person rather than the first when speaking in the presenerson when referring to the child she used to be.What is one to make of... (shrink)