Drug exceptional access programs (DEAPs) exist across Canada to address gaps in access to pharmaceuticals. These programs circumvent standard procedures, raising epistemic, economic, social and political issues. This commentary provides insights into these issues by revealing the context and procedures on which these programs depend.

Fragile states have been raising increasing concern among donors since the mid-2000s. The policies of the Global Fund to fight HIV/AIDS, Malaria, and Tuberculosis have not excluded fragile states, and this source has provided financing for these countries according to standardized procedures. They represent interesting cases for exploring the meaning and role of measurement in a globalized context. Measurement in the field of HIV/AIDS and its treatment has given rise to a private outsourcing of expertise and auditing, thereby creating a (...) new form of value based on the social process of registration and the creation of realities produced by the intervention itself. These “scriptural economies” must be questioned in terms of the production of knowledge, but also in terms of social justice. Governing HIV/AIDS treatments by numbers in a fragile state is explored in this article through the experience of the Central African Republic in terms of epidemiology and access to antiretroviral drugs. The unexpected effects of performance-based programs in this context underline the need for global health governance to be re-embedded into a social justice framework. (shrink)

BackgroundLittle is known about volunteers from Northern research settings who participate in vaccine trials of highly infectious diseases with no approved treatments. This article explores the motivations of HIV immunocompromised study participants in Canada who volunteered in a Phase II clinical trial that evaluated the safety and immunogenicity of an Ebola vaccine candidate.MethodsObservation at the clinical study site and semi-structured interviews employing situational and discursive analysis were conducted with clinical trial participants and staff over one year. Interviews were recorded, transcribed (...) and analysed using critical qualitative interpretivist thematic analytical techniques. Patterns were identified, clustered and sorted to generate distinct and comprehensive themes. We then reassembled events and contexts from the study participants’ stories to develop two ideal portraits based on "composite characters" based on study participants features. These provide ethnographically rich details of participants’ meaningful social worlds while protecting individual identities.ResultsTen of the 14 clinical trial participants, and 3 study staff were interviewed. Participant demographics and socio-economic profiles expressed limited contextual diversity. Half were men who have sex with men, half were former injection drug users experiencing homelessness, one was female, none were racialized minorities and there were no people from HIV endemic countries. Fully 90% had previous involvement in other clinical studies. Their stories point to particular socio-economic situations that motivated their participation as clinical labor through trial participation.ConclusionsOur findings support Fisher’s argument of “structural coercion” in clinical trial recruitment of vulnerable individuals experiencing precarious living conditions. Clinical trials should provide more detail of the structural socio-economic conditions and healthcare needs which lie “under consent” of study participants. Going well beyond an overly convenient narrative of altruism, ethical deliberation frameworks need to sufficiently address the structural conditions of clinical trials. We offer concrete possibilities for this and acknowledge that further research and clinical data should be made available underlying study participant contexts with regards to recruitment and participation in resource poor settings, in both the South and the North. (shrink)

An amendment to this paper has been published and can be accessed via the original article.

Cancers rely on multiple, heterogeneous processes at different scales, pertaining to many biomedical fields. Therefore, understanding cancer is necessarily an interdisciplinary task that requires placing specialised experimental and clinical research into a broader conceptual, theoretical, and methodological framework. Without such a framework, oncology will collect piecemeal results, with scant dialogue between the different scientific communities studying cancer. We argue that one important way forward in service of a more successful dialogue is through greater integration of applied sciences (experimental and clinical) (...) with conceptual and theoretical approaches, informed by philosophical methods. By way of illustration, we explore six central themes: (i) the role of mutations in cancer; (ii) the clonal evolution of cancer cells; (iii) the relationship between cancer and multicellularity; (iv) the tumour microenvironment; (v) the immune system; and (vi) stem cells. In each case, we examine open questions in the scientific literature through a philosophical methodology and show the benefit of such a synergy for the scientific and medical understanding of cancer. (shrink)

The current debate over systematicity concerns the formal conditions a scheme of mental representation must satisfy in order to explain the systematicity of thought.1 The systematicity of thought is assumed to be a pervasive property of minds, and can be characterized (roughly) as follows: anyone who can think T can think systematic variants of T, where the systematic variants of T are found by permuting T’s constituents. So, for example, it is an alleged fact that anyone who can think the (...) thought that John loves Mary can think the thought that Mary loves John, where the latter thought is a systematic variant of the former. (shrink)

The current debate over systematicity concerns the formal conditions a scheme of mental representation must satisfy in order to explain the systematicity of thought.1 The systematicity of thought is assumed to be a pervasive property of minds, and can be characterized (roughly) as follows: anyone who can think T can think systematic variants of T, where the systematic variants of T are found by permuting T’s constituents. So, for example, it is an alleged fact that anyone who can think the (...) thought that John loves Mary can think the thought that Mary loves John, where the latter thought is a systematic variant of the former. (shrink)

Through readings of works by Marivaux, Diderot, Rousseau, and Mary Shelley, David Marshall provides a new interpretation of the eighteenth-century preoccupation with theatricality and sympathy. Sympathy is seen not as an instance of sensibility or natural benevolence but rather as an aesthetic and epistemological problem that must be understood in relation to the problem of theatricality. Placing novels in the context of eighteenth-century writing about theater, fiction, and painting, Marshall argues that an unusual variety of authors and texts were (...) concerned with the possibility of entering into someone else's thoughts and feelings. He shows how key eighteenth-century works reflect on the problem of how to move, touch, and secure the sympathy of readers and beholders in the realm of both "art" and "life." Marshall discusses the demands placed upon novels to achieve certain effects, the ambivalence of writers and readers about those effects, and the ways in which these texts can be read as philosophical meditations on the differences and analogies between the experiences of reading a novel, watching a play, beholding a painting, and witnessing the spectacle of someone suffering. The Surprising Effects of Sympathy traces the interaction of sympathy and theater and the artistic and philosophical problems that these terms represent in dialogues about aesthetics, moral philosophy, epistemology, psychology, autobiography, the novel, and society. (shrink)

Amor Dei, “love of God” raises three questions: How do we know God is love? How do we experience love of God? How free are we to love God? This book presents three kinds of love, worldly, spiritual, and divine to understand God’s love. The work begins with Augustine’s Confessions highlighting his Manichean and Neoplatonic periods before his conversion to Christianity. Augustine’s confrontation with Pelagius anticipates the unresolved disputes concerning God’s love and free will. In the sixteenth-century the Italian humanist, (...) Gasparo Contarini introduces the notion of “divine amplitude” to demonstrate how God’s goodness is manifested in the human agent. Pierre de Bérulle, Guillaume Gibieuf, and Nicolas Malebranche show connections with Contarini in the seventeenth-century controversies relating free will and divine love. In response to the free will dispute, the Scottish philosopher, William Chalmers, offers his solution. Cornelius Jansen relentlessly asserts his anti-Pelagian interpretation of Augustine stirring up more controversy. John Norris, Malebranche’s English disciple, exchanges his views with Mary Astell and Damaris Masham. In the tradition of Cambridge Platonism, Ralph Cudworth conveys a God who “sweetly governs.” The organization of sections represents the love of God in ascending-descending movements demonstrating that, “human love is inseparable from divine love.”. (shrink)

A truly accessible introduction to the fundamentals of classical philosophy and metaphysics. In a series of three small books, Pierre-Marie Emonet brings the riches of philosophy within reach of us all, not just those with the time and inclination to work through erudite philosophical language.

Dans le traité De la divination dans le sommeil, Aristote entend réfuter la thèse d’une origine divine des rêves qui semblent annoncer les événements futurs. Pour cela, il ne se contente pas de soutenir une thèse différente. Il dénonce également la faiblesse épistémologique de la pratique divinatoire, en proposant un modèle scientifique alternatif : une méthode de classification des rêves et de division par épuisement, qui exclut les rêves inspirés. Cette méthode conduit à souligner le caractère irréductible des faits de (...) hasard et à admettre le caractère inexplicable d’un grand nombre de rêves « véridiques ». La notion de coïncidence ( sumptôma ) joue sur ce point un rôle essentiel. Ce rôle est à la fois descriptif et critique : il permet de définir la classe des rêves dont la dimension véridique est absolument fortuite, et il dénonce l’illusion commune qui les relie à des événements réels. De ce point de vue, le chapitre 1 du De divinatione apporte une contribution, modeste mais spécifique, à la théorie des modalités physiques. (shrink)

Pierre-Marie Beaude | : Dans cette étude, l’auteur analyse deux manières très opposées de se servir des mots : la glossolalie et la prophétie-anathème d’une part, et l’expérience de langage rapportée par l’apôtre Paul en 2 Co 12. | : In this paper, the author considers two different and opposite ways of using words : on one side, the glossolaly and the prophecy-anathema, on the other side, the experience of the language of which Paul testifies in 2 Co (...) 12. (shrink)

Les atomistes de l'Antiquité doivent résoudre le problème suivant : comment expliquer la formation des mondes et des corps composés à partir de corps élémentaires - les atomes - qui n'ont en eux-mêmes aucune propriété cosmogonique? La solution d'Épicure, selon la Lettre à Hérodote, § 45, consiste à adopter une conception subtile de la causalité atomique : les atomes ne sont pas seulement des composants, ou des causes matérielles, mais aussi, par l'intermédiaire d'un processus de sélection spontanée, les véritables agents (...) de la production des mondes et des composés. Ancient atomists face the following difficulty : how can the becoming of worlds and compounds be explained by the elementary bodies, when these - the atoms - do not possess any cosmogonie property? Epicurus ' answer, according to Letter to Herodotus, § 45, is a subtle account of atomic causality : atoms are not only components or material causes, but also, through a spontaneous process of selection, the real agents of the production of worlds and compounds. (shrink)

La référence à la nature, qu'elle soit normative ou descriptive, croise les thèmes essentiels de l'éthique d'Aristote : la fin ultime, l'acquisition des vertus, le plaisir et les émotions, les liens relationnels, la justice et la vie en cité, la responsabilité. L'éthique aristotélicienne n'est pas pour autant "naturaliste" au sens où le bien humain dériverait de tendances et de prédispositions naturelles. Cet ouvrage, en procédant à une étude systématique de la référence à la nature dans l'éthique aristotélicienne, défend une nouvelle (...) interprétation du naturalisme pratique d'Aristote : un naturalisme critique, le plus souvent dialectique, qui s'interroge sur les conditions de base du bien humain ; non pas un naturalisme scientifique, en vertu duquel la biologie serait source de prescriptions morales, mais un naturalisme problématique qui délimite des possibilités d'agir. L'une des tâches primordiales du théoricien de l'éthique, comme celle du politique actif, est précisément d'évaluer dans quelle mesure le bien humain dépend de la nature ou s'en affranchit."--Page 4 of cover. (shrink)

Ed. by John J. Cleary and Gary M. Gurtler ( this volume contains papers and commentaries presented to the Boston Area Colloquium in Ancient Philosophy during the academic year 2006-7).

The Greek and Roman atomistic tradition (whose most famous representatives are Democritus, Epicurus and Lucretius), defends radical and immanentist ideas about the discovery of technologies in human societies. The appearance of new technologies, insofar as it is due to the satisfaction of human needs and derives from natural necessity, reveals that human work is in some way a natural process. Consequently, human beings do not need any kind of Promethean intervention, which would provide them with new skills and technologies. However, (...) the Epicurean tradition, as evidenced by several texts (especially in Lucretius), echoes the mythological figure of Prometheus, in showing that human beings, through their discoveries, are independent from the gods. Epicurus himself, in Lucretius’ De rerum natura, embodies, like Prometheus, the ideal of human emancipation from superstitious representations of the gods. It does not mean, however, that work and technical discoveries are the best means of emancipation: for Epicurus and his followers, philosophy itself remains the safest way to tranquillity and freedom. (shrink)

La formule célèbre d’Aristote « la nature ne fait rien en vain », telle qu’elle est utilisée dans le traité sur la Locomotion des animaux, invite à reformuler le problème général du finalisme en zoologie et de la conformité à la nature. Bien que cette formule, en première approche, semble aller dans le sens d’une téléologie cosmique ou globale, elle conduit en fait à privilégier une téléologie relative, c’est-à-dire locale, qui opère à l’échelle des êtres vivants. Elle s’applique en effet, (...) non pas de manière absolue, mais relativement aux possibilités définies par la nature de l’espèce (propriétés spécifiques et génériques). Toutefois, elle n’exprime pas seulement le rapport à la finalité organique stricto sensu, mais aussi les conditions nécessaires externes du mouvement animal, conditions qui définissent, pour les espèces et les genres, un régime commun d’organisation. (shrink)

La conception épicurienne du temps comporte trois difficultés principales : il y a un temps physique objectif, bien que le temps semble dépendre en lui-même de nos représentations ; le temps peut être perçu par la raison, mais, selon certains textes, il n'est perçu que par la sensation ; Epicure, enfin, se refuse à lui attribuer une unité réelle. Ces difficultés trouvent en partie leur solution à la lumière de la théorie épicurienne du langage, ainsi que dans le statut accidentel (...) et secondaire du temps par rapport aux événements, internes et externes. The Epicurean conception of time leads to three major difficulties : there is indeed a physical objective time, though time seems to depend in itself of our representations ; time may be perceived by reason, but, according to a few texts, it is only perceived but by sensation ; finally, Epicure refuses to grant it some real unity. The latter difficulties find in part their solution in the light of the Epicurean theory of language as well as in the accidental and secondary status of time as related to events be them internal or external. (shrink)

In the last lines of Politics VII, 3, Aristotle states that the happy city acts nobly. This implies that the city has a practical life, and that this life has its end in itself. This claim seems to contradict the famous distinction, which has been made elsewhere by Aristotle, between the practical and theoretical lives. It is argued in this paper that there is, here, neither contradiction nor inconsistency in Aristotle’s conception of human action. Some readings, according to which this (...) passage deals with the role of the philosophers in the happy city, are also ruled out. The proposed solution consists in showing that this text refers to a broader conception of action, one that is beyond the sphere of human practical activities: any genuine praxis has its goal in itself, even when it produces external effects. (shrink)

On décèle une tension entre deux tendances dans la philosophie aristotélicienne de la praxis : d’une part; une insistance claire sur la spécificité de l’action humaine par rapport à la conduite animale ; d’autre part; la volonté de définir un genre commun pour les différents types d’activités; humaines et animales. Si cette tension peut être surmontée; c’est sans doute en distinguant les différents registres (axiologique; psychologique; éthologique) du discours aristotélicien. C’est aussi en précisant le type de ressemblance qui; à la (...) fois; rapproche et distingue l’homme de l’animal : si la conduite humaine et la conduite animale appartiennent à un genre commun; elles demeurent distinguées par un rapport d’analogie; c’est-à-dire par une différence irréductible. L’analyse éthologique d’Aristote; loin de conduire à une naturalisation du comportement humain; conduit à sa spécification. (shrink)

Pourquoi Aristote semble-t-il refuser aux artefacts le statut de substances? Cette question fait l’objet d’interprétations divergentes. Partant d’un passage généralement négligé de Métaphysique H 3 et en s’appuyant sur plusieurs textes de Metaph. Z 7-9, on défend la thèse selon laquelle il ne suffit pas d’évoquer le fait que les formes des êtres naturels sont éternelles. La différence entre les artefacts et les êtres naturels repose surtout sur le statut ontologique et la fonction de leurs formes respectives. Le livre H (...) de la Métaphysique, pris dans son ensemble, fournit plusieurs arguments permettant d’établir que les formes d’artefact ne sont pas des formes substantielles, des formes de plein droit, mais seulement des « différences » de la matière prochaine et de simples déterminations « analogues » à la substance proprement dite. Elles ont un statut intermédiaire entre la matière prochaine et la forme substantielle ; l’artefact n’est lui-même qu’un composé accidentel. (shrink)

This chapter contains sections titled: Introduction Physics Cosmology and Anthropology Epistemology Ethics Conclusion Bibliography.