Next SectionThere has been considerable debate surrounding the ethics of sham-controlled trials of procedures and interventions. Critics argue that these trials are unethical because participants assigned to the control group have no prospect of benefit from the trial, yet they are exposed to all the risks of the sham intervention. However, the placebo effect associated with sham procedures can often be substantial and has been well documented in the scientific literature. We argue that, in light of the scientific evidence supporting (...) the benefits of sham interventions for pain and Parkinson's disease that stem from the placebo effect, these sham-controlled trials should be considered as offering potential direct benefit to participants. If scientific evidence demonstrates the positive effect of placebo from sham interventions on other conditions, sham-controlled trials of interventions for the treatment of these conditions should be considered to have prospects of benefit as well. This potential benefit should be taken into account by research ethics committees in risk-benefit analyses, and be included in informed consent documents. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Pains And Gains Of Rural Health Practice:Lessons Books Never TaughtSridevi Seetharam, Bindu Balasubramaniam, G. S. Kumar, and M. R. SeetharamHow The Journey BeganIn the early 1980s, as fresh graduates from Mysore Medical College in southern India, we were brimming with a zeal to "cure the sick" and "change the world." We had an ideal of evidence-based, rational, ethical and equitable health care and set out to serve rural and (...) under-served communities which included displaced forest-based tribes. In the initial years, with the naivety of the inexperienced, we believed that by correcting the dehydration of the doe-eyed six-year-old Mare and giving her a free course of antibiotics, we had made health care accessible to her. Much to our dismay, within a month, Mare was back in the outpatient clinic, with diarrhea all over again and looking thinner than ever. We realized that it was a losing battle to keep her healthy as long as she continued to drink water from the same contaminated stream, live in unhygienic surroundings, and eat only the paltry meals that her family could barely afford. We gradually began to connect these living examples to what our preventive medicine text books had stressed all along—there are many social determinants of health which, if left unaddressed, do not permit realization of the vision of health for all.Such instances continually pulled us out of the hospital building and into the villages and tribal hamlets. We discovered that our textbook of Preventive and Social Medicine (Park, 1986) (P&SM as we used to call it), was our most valuable possession. [End Page 106] We devoured the descriptions of national health programs, sanitation procedures, water treatment protocols, and maintenance of cold chain for vaccines with a completely new perspective. We discovered the Manual of Basic Techniques for a Health Laboratory, (World Health Organization, 1980) detailing how to set up a laboratory with low cost, reliable and simple methods. We learned to drive a jeep to haul supplies and patients. To step up the level of clinical care, some of us pursued post-graduate programs and equipped ourselves to provide more specialized care too. It has been over two decades since we embarked on this journey. We have encountered a variety of perplexing dilemmas with no clear solutions. We have sometimes been compelled to adopt health practices that were not really evidence-based, seemingly irrational, inequitable and even downright unethical. This narration describes only a few of our thousands of cases, and hopefully conveys our periods of self-doubt, despair and hope, as well as, the challenges we face to reconcile with the difficult choices we are forced to make every day.Unforeseen Challenges in Saving Mothers and ChildrenHigh maternal and child mortality rates have been one of the most disturbing aspects of the health care scenario in rural India. To ensure immunization of all children, health workers with vaccine carriers go from village to village and hamlet to hamlet to reach those infants that would have missed visits to the immunization clinics. Our grass-root workers facilitate these visits by identifying households with such children. Occasionally, they encounter families who spirit away the infant into the adjoining woods as soon as the health worker is seen approaching, and blandly proclaim that the child is not at home. Despite reassurance and counseling about the safety and necessity of the vaccine, their apprehensions and misconceptions are insurmountable. What is the extent of the responsibility of the health worker? Is it ethical to hunt down the child and force the administration of the vaccine in view of the public health gains, besides the child's welfare?A few months ago, a pre-term neonate was admitted to our hospital, but worsened and needed referral to a higher centre in the city. The family refused to go despite repeated persuasion and detailed explanation about the technical limitations of care at our centre. From the family's perspective, the variety of social, cultural, and monetary challenges they would face in the city were themselves limitations for care. We were compelled to retain the baby and continue giving the best care we could.Two... (shrink)

Scientific data are often subjected to two contradictory over-simplifications. People who have no personal experience in science often say that a certain idea has been scientifically established and feel that the question is therewith settled. They do not distinguish among methods, or generalizations in different fields. This implies that all science is infallible. The other oversimplification comes from the specialist; he may dismiss the work of men who study the problems approaching his own but who use methods different from his. (...) This view implies that only one type of scientific investigation is really sound. Both groups are wrong, for science is neither infallible nor wholly untrustworthy. In fact, science as an abstract whole is nothing; it is the name given collectively to all methods which men have used to explore natural processes and the results obtained by the use of such methods. Some problems are sufficiently simple and accessible to be explored in detail while others can be treated only after a set of postulates have been set as a starting point. A mechanism must be established within which it is possible to deal with the problems at hand. In other words, there are levels of scientific research which may be arranged in a series based on increasing assumptions. The more complex levels are formed by assuming the data and methods of those simpler and adding to them a new set of assumptions with the aid of which it is possible to treat the phenomena to be studied. Material cannot be carried directly from one level to another unless attention is given to the premises on which the conclusions have been drawn. Since such attention is not always given, entire fields of research have sometimes been brought into suspicion on the part of those working in what they themselves style “a more fundamental field.” Yet there may be data available at a different level which, when properly used, would be of value in their own work. (shrink)

This essay, written in memory of the Chinese astrophysicist and dissident Fang Lizhi, reexamines the period in Fang's life when he was vice president of the University of Science and Technology of China and, because of his activities as an educational and political reformer, came to be dubbed “China's Andrei Sakharov.” It also retells, from the perspective of an insider, the dramatic narrative of Fang's year with his wife, Li Shuxian, living in the US embassy in Beijing following the Tiananmen (...) Square demonstrations and subsequent massacre. But the special focus of this overview of Fang's career is on his development as a thinker on questions of politics and human rights. Though Fang never returned to China and, while living in the United States, kept his distance from dissident movements, he continued to develop intellectually in ways that made him, in later life, China's Václav Havel. (shrink)

This article reconsiders Robyn Wiegman’s Object Lessons (2012) as a book that helps to discern a necessary relation between Queer Studies and Working-Class Studies, two fields that do not often share a footprint in the US academy. That relation emerges for the author in the unexpected resonance between Object Lessons and Vivian Gornick’s recently republished The Romance of American Communism (2020), a classic text about the politics of passionate longing for a better world. Likewise, Wiegman understands political desire as the (...) animating force behind the field of Queer Studies and other identity knowledges. Brim argues that, alongside this affective threshold of belonging that constitutes the field of US Queer Studies, there exists a material threshold of belonging that renders politically indispensable academic fields as, nonetheless, sites of class-based exclusion. In the increasingly class-stratified and race-sorted academy, disciplines such as Working-Class Studies that are attentive to the material exclusions of knowledge production can help scholars to proactively set material conditions alongside political desire in a future-oriented, sustainable vision of Queer Studies. (shrink)

Vagueness in law can lead to indeterminacies in legal rights and obligations. This book responds to the challenges that those indeterminacies pose to theories of law and adjudication.

As the country becomes increasingly diverse, new issues arise within the American educational system. This book examines the effects of underrepresentation of African Americans in colleges and universities. It also discusses the challenges facing Blacks trying to get into the academy and issues that confront those who penetrate the system.

As the country becomes increasingly diverse, new issues arise within the American educational system. This book examines the effects of underrepresentation of African Americans in colleges and universities. It also discusses the challenges facing Blacks trying to get into the academy and issues that confront those who penetrate the system.

This is a welcome reprint of a book that continues to grow in importance.

Two attitudes are possible: one, that the world is an absolute jungle and that the exercise of coercive power by rulers is only a manifestation of this; and the other, that it is both necessary and right that there should be this exercise of power, that through it the world is much less of a jungle than it could possibly be without it, so that one should in principle be glad of the existence of such power, and only take exception (...) to its unjust exercise. (shrink)

In a series of recent papers, Jonathan Schaffer presents a novel framework for understanding grounding. Metaphysical laws play a central role. In addition, Schaffer argues that, contrary to what many have thought, there is no special 'explanatory gap' between consciousness and the physical world. Instead, explanatory gaps are everywhere. I draw out and criticize the methodology for metaphysics implicit in Schaffer's presentation. In addition, I argue that even if we accept Schaffer's picture, there remains a residual explanatory gap between consciousness (...) and the physical. The residual gap does most of the same philosophical work as the original. Schaffer has introduced a troublesome metaphysical methodology that fails to follow through on its biggest promise: to deflate the explanatory gap. (shrink)