Background: Expenditure on industry products (mostly drugs and devices) has spiraled over the last 15 years and accounts for substantial part of healthcare expenditure. The enormous financial interests involved in the development and marketing of drugs and devices may have given excessive power to these industries to influence medical research, policy, and practice.Material and methods: Review of the literature and analysis of the multiple pathways through which the industry has directly or indirectly infiltrated the broader healthcare systems. We present the (...) analysis of the industry influences at the following levels: (i) evidence base production, (ii) evidence synthesis, (iii) understanding of safety and harms issues, (iv) cost-effectiveness evaluation, (v) clinical practice guidelines formation, (vi) healthcare professional education, (vii) healthcare practice, (viii) healthcare consumer’s decisions.Results: We located abundance of consistent evidence demonstrating that the industry has created means to intervene in all steps of the processes that determine healthcare research, strategy, expenditure, practice and education. As a result of these interferences, the benefits of drugs and other products are often exaggerated and their potential harms are downplayed, and clinical guidelines, medical practice, and healthcare expenditure decisions are biased. Conclusion: To serve its interests, the industry masterfully influences evidence base production, evidence synthesis, understanding of harms issues, cost-effectiveness evaluations, clinical practice guidelines and Healthcare professional education and also exerts direct influences on professional decisions and health consumers. There is an urgent need for regulation and other action towards redefining the mission of medicine towards a more objective and patient-, population- and society-benefit direction that is free from conflict of interests. (shrink)

Payment to recruit research subjects is a common practice but raises ethical concerns relating to the potential for coercion or undue influence. We conducted the first national study of IRB members and human subjects protection professionals to explore attitudes as to whether and why payment of research participants constitutes coercion or undue influence. Upon critical evaluation of the cogency of ethical concerns regarding payment, as reflected in our survey results, we found expansive or inconsistent views about coercion and (...) undue influence that may interfere with valuable research. In particular, respondents appear to believe that coercion and undue influence lie on a continuum; by contrast, we argue that they are wholly distinct: whereas undue influence is a cognitive distortion relating to assessment of risks and benefits, coercion is a threat of harm. Because payment is an offer, rather than a threat, payment is never coercive. (shrink)

For decades, worries about undue inducement have Pervaded clinical research, and are especially common when research is accompanied by payment or conducted in developing countries. Few ethical judgments carry as much moral opprobrium or are thought to undermine the ethical soundness of a clinical trial as thoroughly as undue inducement. Indeed, the admonition to prevent undue inducement is one of the few explicit instructions in the Common Rules requirements for informed consent.Despite their long history and pervasiveness, charges (...) of undue inducement in clinical research are almost always mistaken. Indeed, I will advance an even more radical claim: Aresearch trial that otherwise fulfills the fundamental ethical requirements for human subjects research inherently cannot create the possibility of undue inducement because substantial risk of serious harm isprecluded. Charges of undue inducement tend to express displaced and mislabeled ethical concerns about other aspects of human subjects research. Consequently, claims of undue inducement should rarely be made, and when they are advanced should be treated with skepticism, placing a heavy burden of proofon those advancing such charges. (shrink)

For decades, worries about undue inducement have Pervaded clinical research, and are especially common when research is accompanied by payment or conducted in developing countries. Few ethical judgments carry as much moral opprobrium or are thought to undermine the ethical soundness of a clinical trial as thoroughly as undue inducement. Indeed, the admonition to prevent undue inducement is one of the few explicit instructions in the Common Rules requirements for informed consent.Despite their long history and pervasiveness, charges (...) of undue inducement in clinical research are almost always mistaken. Indeed, I will advance an even more radical claim: Aresearch trial that otherwise fulfills the fundamental ethical requirements for human subjects research inherently cannot create the possibility of undue inducement because substantial risk of serious harm isprecluded. Charges of undue inducement tend to express displaced and mislabeled ethical concerns about other aspects of human subjects research. Consequently, claims of undue inducement should rarely be made, and when they are advanced should be treated with skepticism, placing a heavy burden of proofon those advancing such charges. (shrink)

ABSTRACT We have previously argued that there are forms of greenhouse gas offsetting for which, when one emits and offsets, one imposes no risk. Orri Stefansson objects that our argument fails to distinguish properly between the people who stand to be harmed by one’s emissions and the people who stand to be benefited by one’s offsetting. We reply by emphasizing the difference between acting with a probability of making a difference to the distribution of harm and acting in a (...) way that worsen’s someone’s prospect. (shrink)

Beneficence is usually regarded as adequate when it results in an actual benefit for a beneficiary and satisfies her self-chosen end. However, beneficence that satisfies these conditions can harm beneficiaries' free agency, particularly when they are robustly dependent on benefactors. First, the means that benefactors choose can have undesirable side-effects on resources that beneficiaries need for future free action. Second, benefactors may undermine beneficiaries' ability to freely deliberate and choose. It is therefore insufficient to satisfy someone's self-chosen ends. Instead, (...) good beneficence depends on whether the benefactor avoids undue influence over a beneficiary's deliberation and whether the choice of means is compatible with the beneficiary's conception of her good. Consequently, benefactors must have substantial respect for a beneficiary's free agency and the practical competence to choose means that take into account the beneficiary's conception of her good and the wider set of circumstances that influence her life. (shrink)

Dignity is an expansive ideal, figuring in international covenants, codes of research involving human participants, and debates about decision making at the end of life. One result of this expansiveness is that human dignity can be appropriated by proponents on both sides of many issues, thereby appearing more as a rhetorical flourish than as a serious element in argumentation. However, an appreciation of narrative inquiry shows that opposing representations of dignity constitute alternative assessments of responsible action, both of which can (...) be morally reasonable. One implication is that normative disagreements, as between deathbed decisions about palliative care or euthanasia, can be expected to occur, so that the ideal of dignity should be legally expressed in a practice of supportive laissez-faire in preference to any undue regulation of dying. (shrink)

The clinical trial is the major investigational tool of clinical medicine. Two recent reports highlight the fact that the most often quoted mechanisms for the protection of research subjects, viz., research ethics board review and eligibility criteria, are insufficient to achieve this end. In this paper, we argue that the prime mechanism for the protection of persons in clinical trials should be the clinical judgement of the physician-investigator. The clinical investigator has a duty to protect subjects from both harm (...) and undue risk. It is argued that the clinical investigator has a duty to screen for, and exclude, potential research subjects who may be unduly vulnerable to the risks of a particular clinical trial. In order to fulfill this obligation, the investigator should personally screen each potential research subject at the time of accrual. In larger trials in which this is not feasible, this task could be delegated to another appropriately qualified health care professional, with the principal investigator retaining personal responsibility. To reinforce and make explicit this legal and moral duty, we propose that the investigator sign a statement, appended to each subject's consent form, to attest that this duty has been responsibly discharged. (shrink)

In liberal moral theory, interfering with someone’s deliberate engagement in a self-harming practice in order to promote their own good is often considered wrongfully paternalistic. But what if self-harming decisions are the product of an oppressive social context that imposes harmful norms on certain individuals, such as, arguably, in the case of cosmetic breast surgery? Clare Chambers suggests that such scenarios can mandate state interference in the form of prohibition. I argue that, unlike conventional measures, Chambers’ proposal recognises that harmful, (...) discriminatory norms entail a twofold collective moral obligation: to eliminate the harmful norm in the long run, but also to address unjust harm that is inflicted in the meantime. I show that these two obligations tend to pull in opposite directions, thus generating a serious tension in Chambers’ proposal which eventually leads to an undue compromising of the second obligation in favour of the first. Based on this discussion, I develop an alternative proposal which, instead of prohibiting breast implant surgery, offers compensation for the disadvantages suffered by individuals who decide not to have surgery. (shrink)

Using a new method, we examined whether incidental perception of need-rewarding (positive) objects unintentionally prepares motor action. Participants who varied in their level of need for water were presented with glasses of water (and control objects) that were accompanied by go and no-go cues that required a response (key-press) or withholding a response. Importantly, if need-rewarding objects unintentionally prepare action, presentation of no-go cues should lead to motor inhibition of these prepared motor impulses. Consistent with this hypothesis, results showed that (...) participants relatively high in need for water (and hence, who perceive water as a rewarding, positive object) were slower to react to a successive action probe after withholding a response during perception of water than during perception of the control object, suggesting motor inhibition of unintentionally prepared motor impulses. We propose that incidental perception of need-rewarding objects unintentionally potentiates preparation of motor action to these objects. (shrink)

In August 2019, the fifth international congress of the 'International Association for the Study of the Philosophy of Edith Stein' (IASPES) took place at the University of Cologne. Of the 57 papers presented at this prominent conference prepared and chaired by the historian and theologian Harm Klueting, 54 were accepted for publication in revised versions. Professor Klueting was able to add three other contributions -- among them by the director of the Research Institute of the German Province of the (...) Carmelites at Bamberg, the historian and theologian Edeltraud Klueting, who acts as co-editor. The congress volume, published only a little more than a year after the congress despite significant constraints due to the Corona pandemic, contains 29 contributions in English, 21 in German, and seven in Spanish or French on the subjects 'Biographical questions', 'Edith Stein and thinkers of the past', 'Edith Stein and other contemporary thinkers', 'Anthropology -- Women and men', 'Philosophy -- phenomenology and Christian philosophy', 'Society and politics', 'Theology and spirituality', and 'Experiences with Edith Stein'. (shrink)

Rudolf Harms entwickelt seine reich differenzierte Ästhetik des Films in Anlehnung an die Ästhetik seines Lehrers Johannes Volkelt und sucht deren auf Kant zurückgehende Polarität des Schönen und Erhabenen für das Verständnis des neuen Mediums fruchtbar zu machen. Doch sein systematisches Interesse richtet sich auf die Suggestionskraft, durch die sich der Film vor den traditionellen Künsten auszeichnet. Für Harms, der den Film mit Blick auf die photographische Wiedergabe als realistische Kunst einschätzt, ist der Film das Reich des Sichtbaren. Es gibt (...) für ihn keine Kunst, die so berufen wäre, das 'Gesicht der Dinge' darzustellen, wie der Film. Da dieser zu allererst eine Handlung in Bildern gibt, ist er zugleich das Märchenbuch des modernen Erwachsenen. Obwohl noch ausschließlich auf den Schwarzweißfilm und den Stummfilm beschränkt, bietet das Buch in seiner Konzentration auf die wahrnehmungsästhetische und die narrative Dimension des Mediums - auf die Wirkung von Handlung als Bewegung in sinnlicher Anschauung - Einsichten in seine konstitutiven Möglichkeiten, die sich bis heute als Anschlussfähig erweisen. (shrink)

Ten years ago, researchers using event-related brain potentials to study language comprehension were puzzled by what looked like a Semantic Illusion: Semantically anomalous, but structurally well-formed sentences did not affect the N400 component—traditionally taken to reflect semantic integration—but instead produced a P600 effect, which is generally linked to syntactic processing. This finding led to a considerable amount of debate, and a number of complex processing models have been proposed as an explanation. What these models have in common is that they (...) postulate two or more separate processing streams, in order to reconcile the Semantic Illusion and other semantically induced P600 effects with the traditional interpretations of the N400 and the P600. Recently, however, these multi-stream models have been called into question, and a simpler single-stream model has been proposed. According to this alternative model, the N400 component reflects the retrieval of word meaning from semantic memory, and the P600 component indexes the integration of this meaning into the unfolding utterance interpretation. In the present paper, we provide support for this “Retrieval–Integration ” account by instantiating it as a neurocomputational model. This neurocomputational model is the first to successfully simulate the N400 and P600 amplitude in language comprehension, and simulations with this model provide a proof of concept of the single-stream RI account of semantically induced patterns of N400 and P600 modulations. (shrink)

Expectation-based theories of language comprehension, in particular Surprisal Theory, go a long way in accounting for the behavioral correlates of word-by-word processing difficulty, such as reading times. An open question, however, is in which component of the Event-Related brain Potential signal Surprisal is reflected, and how these electrophysiological correlates relate to behavioral processing indices. Here, we address this question by instantiating an explicit neurocomputational model of incremental, word-by-word language comprehension that produces estimates of the N400 and the P600—the two most (...) salient ERP components for language processing—as well as estimates of “comprehension-centric” Surprisal for each word in a sentence. We derive model predictions for a recent experimental design that directly investigates “world-knowledge”-induced Surprisal. By relating these predictions to both empirical electrophysiological and behavioral results, we establish a close link between Surprisal, as indexed by reading times, and the P600 component of the ERP signal. The resultant model thus offers an integrated neurobehavioral account of processing difficulty in language comprehension. (shrink)

This book is intended to help transform epistemology - the traditional study of knowledge - into a rigorous discipline by removing conceptual roadblocks and developing formal tools required for a fully naturalized epistemology. The evolutionary approach which Harms favours begins with the common observation that if our senses and reasoning were not reliable, then natural selection would have eliminated them long ago. The challenge for some time has been how to transform these informal musings about evolutionary epistemology into a rigorous (...) theoretical discipline capable of complementing current scientific studies of the evolution of cognition with a philosophically defensible account of meaning and justification. (shrink)

Conventional wisdom has it that evolution makes a sham of morality, even if morality is an adaptation. I disagree. I argue that our best current adaptationist theory of meaning offers objective truth conditionsfor signaling systems of all sorts. The objectivity is, however, relative to species – specifically to the adaptive history of the signaling system in question. While evolution may not provide the kind of species independent objective standards that (e.g.) Kantians desire, this should be enough for the practical work (...) of justifying our confidence in the objectivity of moral standards. If you believe morality is an adaptation, you should be a moral realist. (shrink)

Moral norms are the rules of morality, those that people actually follow, and those that we feel people ought to follow, even when they don’t. Historically, the social sciences have been primarily concerned with describing the many forms that moral norms take in various cultures, with the emerging implication that moral norms are mere arbitrary products of culture. Philosophers, on the other hand, have been more concerned with trying to understand the nature and source of rules that all cultures ought (...) to follow, with relatively little regard for what people actually do. The tension between the two approaches has to do with whether there are any standards higher than the whims of culture in determining right and wrong. Typically, the social sciences say “no”, pointing at the diversity of moral beliefs. Most philosophers (along with people of moral conviction) feel that there must be some deeper source of morality than the trends and fads of culture. Unfortunately, the nature and source of such standards has remained something of a mystery. Recent work on the evolution of norms has changed this picture dramatically. (shrink)

During the last two decades virtue ethics has become the focal point of renewed ethical and theological interest. To lead a good life, it proves useful to watch those who have mastered the art of living. The conviction that living is an art is at the heart of virtue ethics. Living a good life requires exercise, and is a question of acquiring a virtuous character rather than of complying with external ethical and legal rules. This renaissance partly builds on Thomas (...) Aquinas. He in turn recovered Aristotelian, Ciceronian and Augustinian thought on virtue ethics. The interpretation and development of virtues and vices form the core of his authorship, as the 'secunda pars' of his 'Summa Theologiae' readily displays. And yet, the most important virtues for him are not the moral ones, such as Justice, Temperance, Prudence and Fortitude, but those virtues that are both infused by and aimed at God: Faith, Hope and Love. These are virtues that the philosophers of antiquity were not aware of. To account for them, Aquinas had to adapt the classical understanding of virtues. For Aquinas, the moral virtues come to full fruition only when they are embedded in a life before God, a life lived exercising the God given theological virtues. By ignoring Faith, Hope and Love, the present discussion of virtue ethics not only ignores those virtues that were for Aquinas of utmost importance, but also fails to arrive at a complete understanding of his view of the moral virtues. (shrink)

Empirical research in the field of legal interpretation shows that, in many cases, analogy argumentation is complex rather than simple. Traditional analytical approaches to analogy argumentation do not explore that complexity. In most cases analogy argumentation is reconstructed as a simple form of argumentation that consists of two premises and a conclusion. This article focuses on the question of how to analyze and evaluate complex analogy argumentation. It is shown how the pragma-dialectical approach provides clues for analyzing complex analogy argumentation (...) and how the criteria for evaluating analogy argumentation can be used to reconstruct these types of complex analogy argumentation in Dutch case law. The critical questions in the argumentation scheme do not only serve as a tool for analyzing arguments justifying analogy argumentation, but are also helpful in analyzing arguments against a specific analogy argumentation. (shrink)

The concept of information tempts us as a theoretical primitive, partly because of the respectability lent to it by highly successful applications of Shannon’s information theory, partly because of its broad range of applicability in various domains, partly because of its neutrality with respect to what basic sorts of things there are. This versatility, however, is the very reason why information cannot be the theoretical primitive we might like it to be. “Information,” as it is variously used, is systematically ambiguous (...) between whether it involves continuous or discrete quantities, causal or noncausal relationships, and intrinsic or relational properties. Many uses can be firmly grounded in existing theory, however. Continuous quantities of information involving probabilities can be related to information theory proper. Information defined relative to systems of rules or conventions can be understood relative to the theory of meaning . A number of causal notions may possibly be located relative to standard notions in physics. Precise specification of these distinct properties involved in the common notion of information can allow us to map the relationships between them. Consequently, while information is not in itself the kind of single thing that can play a significant unifying role, analyzing its ambiguities may facilitate headway toward that goal. (shrink)

Information theory offers a measure of "mutual information" which provides an appropriate measure of tracking efficiency for the naturalistic epistemologist. The statistical entropy on which it is based is arguably the best way of characterizing the uncertainty associated with the behavior of a system, and it is ontologically neutral. Though not appropriate for the naturalization of meaning, mutual information can serve as a measure of epistemic success independent of semantic maps and payoff structures. While not containing payoffs as terms, mutual (...) information places both upper and lower bounds on payoffs. This constitutes a non-trivial relationship to utility. (shrink)

It is common in attempts to extend the theory of evolution to culture to generalize from the causal basis of biological evolution, so that evolutionary theory becomes the theory of copying processes. Generalizing from the formal dynamics of evolution allows greater leeway in what kinds of things cultural entities can be, if they are to evolve. By understanding the phenomenon of cultural transmission in terms of coordinated phenotypic variability, we can have a theory of cultural evolution which allows us to (...) avoid the various difficulties with the elaboration of informational entities such as the cultural replicator, or meme. Such an account is a boon to the project of evolutionary epistemology since it confirms the presumption in favor of the general adaptiveness of culture, illuminating rather than obscuring the inherent intimacy of our relationship to (e.g.) our ideas. (shrink)

BackgroundIn about one in 10,000 cases, a published article is retracted. This very often means that the results it reports are flawed. Several authors have voiced concerns about the presence of retracted research in the memory of science. In particular, a retracted result is propagated by citing it. In the published literature, many instances are given of retracted articles that are cited both before and after their retraction. Even worse is the possibility that these articles in turn are cited in (...) such a way that the retracted result is propagated further.MethodsWe have conducted a case study to find out how a retracted article is cited and whether retracted results are propagated through indirect citations. We have constructed the entire citation network for this case.ResultsWe show that directly citing articles is an important source of propagation of retracted research results. In contrast, in our case study, indirect citations do not contribute to the propagation of the retracted result.ConclusionsWhile admitting the limitations of a study involving a single case, we think there are reasons for the non-contribution of indirect citations that hold beyond our case study. (shrink)

Existing research demonstrates a positive connection between psychedelics and increased nature relatedness. Enhanced affective ties toward nature are widely framed as being built into the pharmakon itself, and the relevance of experiences remains little understood. This paper turns to neoshamanic ayahuasca ceremonies in Europe, exploring the way specialists and attendants refer to nature in speech and performance. I argue that ritual framings performed during these ceremonies provide fertile ground for affective ties to emerge through substance‐induced experiences. I trace such framings (...) by exploring how medicine and healers are being coded; how specific materialities are rendered meaningful; and how individual experiences are discussed at such retreats. I argue that even while participants prioritize individual healing, personal development, or the satisfaction of psychonautical curiosity, environmentalism appears to be anchored by the proceedings themselves. Thus, this paper opens up for analysis ceremonial substance use as a contact zone where coherence is produced intersubjectively. (shrink)

Skyrms describes how evolutionary models are helping us understand unselfish or cooperative behaviour in humans and animals. Mechanisms which can stabilize cooperative behaviour are sensitive to population densities, however. This creates the need for agent-based evolutionary models which depict individual interactions, spatial locations, and stochastic effects. One such model suggests that hostile environments may provide conditions conducive to the emergence and stabilization of cooperative behaviour. In particular, simulations show that random extinctions can keep population densities low, provide ongoing colonization opportunities, (...) and insulate cooperative communities from invasion. Agent-based and population models play complementary roles in furthering our understanding evolutionary processes. (shrink)

Empirical research has discovered that experimental subjects in ultimatum bargaining situations generally fail to play the decision-theoretic optimum strategy, and instead play something between that strategy and a fair split. In evolutionary dynamics, fair division and nearly fair division strategies often go to fixation and weakly dominated strategies can do quite well. Computer simulations were done using three different ultimatum bargaining games as determinates of fitness. (1) No tendency toward the elimination of weakly dominated strategies was observed, with or without (...) mutation. (2) Strategies making fair demands had sizable basins of attraction. (3) In a system where five different demands can be made, demands closest to (approximately) 91% had the largest basins of attraction. (4) If the strategies have thresholds for acceptable demands, rather than individuated responses to each demand, the apparent optimum demand may be quite low: 64% for one set of trials. (shrink)

Evolving signaling systems can be said to induce partitions on the space of world states as they approach equilibrium. Formalizing this claim provides a general framework for understanding what it means for language to “cut nature at its seams”. In order to avoid taking our current best science as providing the adaptive target for all evolving systems, the state space of the world must be characterized exclusively in terms of the coincidence of stimuli and payoffs that drives the evolution of (...) cognitive complexity. Cognition exploits the reliable clustering of events in this space. Using this framework to analyze our ordinary concepts of truth and justification, it appears that while justification can be a simple matter of conforming to historically entrenched strategies, truth cannot be fully specified on the basis of the system’s causal history, but requires a robust clustering in the larger world state space. (shrink)