Selective reporting is prevalent in the medical literature, particularly in industry-sponsored research. In this paper, we expose selective reporting that is not evident without access to internal company documents. The published report of study 329 of paroxetine in adolescents sponsored by GlaxoSmithKline claims that “paroxetine is generally well tolerated and effective for major depression in adolescents”. By contrast, documents obtained during litigation reveal that study 329 was negative for efficacy on all 8 protocol specified outcomes and positive for harm.

Despite popular representations to the contrary, creative people are rarely insane. But creativity and madness may be connected in other ways; we find suggestions of schizotypy in the biographies of many artists, and schizophrenia and related conditions seem to be disproportionately represented in talented and creative families. There are attractions, therefore, in the idea that creativity depends on the controlled deployment of capacities that are uncontrolled in psychosis: an idea explored by psychoanalytically inclined writers such as Ernst Kris and Hanna (...) Segal. (shrink)

The lingering controversy concerning the usefulness and safety of antidepressants for children and adolescents is likely to confuse clinicians. Recent papers perpetuate the claim that antidepressants are shown to be safe and effective in randomised controlled trials. Others claim that antidepressants have been shown to prevent suicides. In this editorial we address the manipulation of outcomes that result from academics’ alliance with industry. We explain how industry and key opinion leaders have distorted the clinician’s perception of the safety and usefulness (...) of antidepressants for the treatment of depression in children and adolescents through publication bias, poor methodology, and selective reporting. (shrink)

We outline a theory of one puzzling aspect of human cognition: a tendency to exaggerate the degree to which agency is manifested in the world. We call this over‐coherent thinking. We use Pylyshyn's idea of cognitive penetrability to help characterize this notion. We argue that this kind of thinking is essentially narrative in form rather than theoretical. We develop a theory of the relation between the degree of narrativity in a representation and its aptness to represent, and to express, mind. (...) We review the prospects for several theories about how over‐coherent thinking gains a purchase on motivation. We argue that progress in this difficult area may require the abandonment of a categorical belief/imagination distinction in favour of vaguely specified clusterings in a many‐dimensional cognitive space. We conclude with the idea that an error‐prone system for the retention of ideas that are low in some of the characteristics generally thought desirable in belief might emerge as a result of an arms‐race between deceivers and deceiver‐detectors. (shrink)

In recent years, a number of contemporary proponents of psychoanalysis have sought to derive support for their conjectures about the _dynamic_ unconscious from the empirical evidence in favor of the _cognitive_ unconscious. It is our contention, however, that far from supporting the dynamic unconscious, recent work in cognitive science suggests that the time has come to dispense with this concept altogether. In this paper we defend this claim in two ways. First, we argue that any attempt to shore up the (...) dynamic unconscious with the cognitive unconscious is bound to fail, simply because the latter, as it is understood in contemporary cognitive science, is incompatible with the former, as it is traditionally conceived by psychoanalytic theory. Second, we show how psychological phenomena traditionally cited as evidence for the operation of a dynamic unconscious can be accommodated more parsimoniously by other means. (shrink)

© 2003 by The Johns Hopkins University Press.

In this case study from litigation, we show how ghostwriting of clinical trial results can contribute to the manipulation of data to favor the study medication. Study 329 for paroxetine pediatric use was negative for efficacy and positive for harm. Yet the ghostwritten publication from this study concluded that paroxetine provided evidence of efficacy and safety and continues to be influential. Despite the role of named authors in revisions of the manuscript, the sponsor company remained in control of the message.

This paper is a deconstruction of a ghostwritten report of a randomized, double-blind, placebo-controlled efficacy and safety trial of citalopram in depressed children and adolescents conducted in the United States. Court documents revealed that protocol-specified outcome measures showed no statistically significant difference between citalopram and placebo. However, the published article concluded that citalopram was safe and significantly more efficacious than placebo for children and adolescents, with possible adverse effects on patient safety.

We live in an age alleged devoted to evidence-based medicine. Evidence-based medicine, however, depends on reliable data and if the data are largely, if not completely, manipulated by the manufacturer of pharmaceuticals, then the data are not reliable. Evidence-based medicine is an illusion. This book raises and attempts to answer the following questions: What are the ways in which the profit motive of industry undermines the integrity of science? How is science protected from corporate malfeasance in a capitalist economy? Our (...) particular focus is the relationship between the pharmaceutical industry and medicine. We argue that medicine desperately needs to re-evaluate its relationship with the pharmaceutical industry and re-affirm the ideal of evidence-based medicine. In our view, Karl Popper’s philosophy of science, Falsificationism and Critical Rationalism, provides a rigorous conception of science required to preserve the integrity of the scientific basis of medicine against the commercial influences. (shrink)

Corporate interests corrupt clinical trials, physicians and universities, undermining the foundation of evidence-based medicine. Philosopher Leemon McHenry and psychiatrist Jon Jureidini argue that the principles underlying Popper’s philosophy of science can protect clinical research from corporate malfeasance in a capitalist economy. -/- Evidence-based medicine was a paradigm shift that is often praised as one of the greatest achievements of medicine in the twentieth century. This radical change in medical practice is based on epistemological hierarchies of evidence, from opinions of (...) respected authorities, mechanistic reasoning and reports of expert committees at the bottom to various levels of observational studies and finally to randomized, placebo-controlled clinical trials at the apex. Randomized, placebo-controlled clinical trials, recognized as the gold standard of clinical experimentation, generally maintain their position in the hierarchies because when well-designed and well-conducted, they provide a basis for assessing harms and benefits, and help deter extravagant claims of efficacy and safety. (shrink)

Journals are failing in their obligation to ensure that research is fairly represented to their readers, and must act decisively to retract fraudulent publications. Recent case reports have exposed how marketing objectives usurped scientific testing and compromised the credibility of academic medicine. But scant attention has been given to the role that journals play in this process, especially when evidence of research fraud fails to elicit corrective measures. Our experience with The Journal of the American Academy of Child and Adolescent (...) Psychiatry (JAACAP) illustrates the nature of the problem. The now-infamous Study 329 of paroxetine in adolescent depression was negative for efficacy on all eight protocol-specified outcomes and positive for harm, but JAACAP published a report of this study that concluded that “paroxetine is generally well tolerated and effective for major depression in adolescents.” The journal’s editors not only failed to exercise critical judgment in accepting the paper, but when shown evidence that the paper misrepresented the science, refused either to convey this information to the medical community or to retract the article. (shrink)

The goal of this paper is to expose the research misconduct of pharmaceutical industry-sponsored clinical trials via three short case studies of corrupted psychiatric trials that were conducted in the United States. We discuss the common elements that enable the misrepresentation of clinical trial results including ghostwriting for medical journals, the role of key opinion leaders as co-conspirators with the pharmaceutical industry and the complicity of top medical journals in failing to uphold standards of science and peer review. We conclude (...) that the corruption of industry-sponsored clinical trials is one of the major obstacles facing evidence-based medicine. (shrink)

A task force of pharmaceutical industry employees and medical journal editors propose ten recommendations to address the problem of erosion of confidence in reporting industry-sponsored clinical trial results. These recommendations do not solve the fundamental problem of industry-sponsored biomedical research. A radical solution is required that severs the relationship between the industry and the journals and restores the integrity of the medical literature.

Scientific and ethical misconduct has increased at an alarming rate as a result of the privatization of knowledge. What began as an effort to stimulate entrepreneurship and increase discovery in biomedical research by strengthening the ties between industry and academics has led to an erosion of confidence in the reporting of research results. Inherent tensions between profit-directed inquiry and knowledge-directed inquiry are instantiated in psychopharmacology, especially in the co-option of academic activity to corporate objectives. The effects of these tensions are (...) visible in research agendas, publication practices, postgraduate education, academic-industry partnerships and product promotion. (shrink)

The advent of evidence-based medicine was a paradigm shift intended to provide a solid scientific foundation for medicine. The validity of this paradigm, however, depends on reliable data from clinical trials, mostly conducted by the pharmaceutical industry and reported in the names of senior academics. The release of previously confidential pharmaceutical industry documents into the public domain has given the medical community valuable insight into the degree to which industry-sponsored clinical trials are manipulated and misrepresented. Until this problem is corrected, (...) evidence-based medicine is an illusion. (shrink)

This book is designed to remedy that lack.

This book was first published in 1984, as the revised edition of a 1979 original. The text is composed of studies in a descending sequence from perfect rationality, through imperfect and problematical rationality, to irrationality. Specifically human rationality is characterized by its capacity to relate strategically to the future, in contrast to the myopic 'gradient climbing' of natural selection. There is trenchant analysis of some of the parallels proposed in this connection between the biological and the social sciences. In the (...) chapter on imperfect rationality the crucial notion is that of 'binding oneself', as Ulysses did before setting out to the Sirens, when weakness of will may prevent us from using our capacity for perfect rationality. The second half of the book deals with rational-actor theory, comparing its logical power and success to rival approaches, and with the varieties of irrationality expressed in contradictory beliefs and desires. (shrink)

A Theory of Justice, by John Rawls, is widely regarded as the most important twentieth-century work of Anglo-American political philosophy. It transformed the field by offering a compelling alternative to the dominant utilitarian conception of social justice. The argument for this alternative is, however, complicated and often confusing. In this book Jon Mandle carefully reconstructs Rawls's argument, showing that the most common interpretations of it are often mistaken. For example, Rawls does not endorse welfare-state capitalism, and he is not a (...) "luck egalitarian" as is widely believed.Mandle also explores the relationship between A Theory of Justice and the developments in Rawls's later work, Political Liberalism, as well as discussing some of the most influential criticisms in the secondary literature. His book will be an invaluable guide for anyone seeking to engage with this ground-breaking philosophical work"--Provided by publisher. (shrink)

The increasing application of artificial intelligence (AI) to healthcare raises both hope and ethical concerns. Some advanced machine learning methods provide accurate clinical predictions at the expense of a significant lack of explainability. Alex John London has defended that accuracy is a more important value than explainability in AI medicine. In this article, we locate the trade-off between accurate performance and explainable algorithms in the context of distributive justice. We acknowledge that accuracy is cardinal from outcome-oriented justice because it helps (...) to maximize patients’ benefits and optimizes limited resources. However, we claim that the opaqueness of the algorithmic black box and its absence of explainability threatens core commitments of procedural fairness such as accountability, avoidance of bias, and transparency. To illustrate this, we discuss liver transplantation as a case of critical medical resources in which the lack of explainability in AI-based allocation algorithms is procedurally unfair. Finally, we provide a number of ethical recommendations for when considering the use of unexplainable algorithms in the distribution of health-related resources. (shrink)

This volume of essays is very much a sequel to the two earlier collections by Jon Elster, Ulysses and the Sirens and Sour Grapes. His topic is rationality - its scope, its limitations, and its failures. Elster considers rational responses to the insufficiency of reason itself, and to the 'indeterminacies' in deploying rational-choice theory and discusses the irrationality of not seeing when, where, and what these are. A key essay which gives the collection its title examines disputes in cases of (...) child custody, which are paradigmatically indeterminate. Leaving aside cases where one parent is patently unfit and assuming that protracted dispute is against the immediate interests of the child, Elster argues that three options present themselves: a strong presumption in favour of the mother, a strong presumption in favour of the primary caretaker (also likely to be the mother), and tossing a coin. Though the first two options may be preferable in the short/medium term, Elster argues that there is a case for randomisation in the long term. The book will be read with interest by anyone concerned with political and social science. (shrink)

I systematically defend a novel account of the grounds for identity and distinctness facts: they are all uniquely zero‐grounded. First, this Null Account is shown to avoid a range of problems facing other accounts: a relation satisfying the Null Account would be an excellent candidate for being the identity relation. Second, a plenitudinist view of relations suggests that there is such a relation. To flesh out this plenitudinist view I sketch a novel framework for expressing real definitions, use this framework (...) to give a definition of identity, and show how the central features of the identity relation can be deduced from this definition. (shrink)

A concise and comprehensive introduction to Marx's social, political and economic thought for the beginning student. Jon Elster surveys in turn each of the main themes of marxist thought: methodology, alienation, economics, exploitation, historical materialism, classes, politics, and ideology; in a final chapter he assesses 'what is living and what is dead in the philosophy of Marx'. The emphasis throughout is on the analytical structure of Marx's arguments and the approach is at once sympathetic, undogmatic, and rigorous.

Migration and Islamic Ethics, Issues of Residence, Naturalization and Citizenship addresses how Islamic ethical and legal traditions can contribute to current global debates on migration and displacement; how Islamic ethics of muʼakha, ḍiyāfa, ijāra, amān, jiwār, sutra, kafāla, among others, may provide common ethical grounds for a new paradigm of social and political virtues applicable to all humanity, not only Muslims. The present volume more broadly defines the Islamic tradition to cover not only theology but also to encompass ethics, customs (...) and social norms, as well as modern political, humanitarian and rights discourses. The first section addresses theorizations and conceptualizations using contemporary Islamic examples, mainly in the treatment of asylum-seekers and refugees; the second, contains empirical analyses of contemporary case studies; the third provides historical accounts of Muslim migratory experiences. (shrink)

In recent years, poetry and videogames have begun talking to one another in earnest. Poets have found inspiration in digital-interactive landscapes, while game developers now look to poetry as a source of textual enrichment. This book examines the p.

The chief concepts involved are those of piety and impiety, and after a thorough analysis of the philosophical texts Mikalson offers a refined definition of ...

This chapter presents an overview of the major interpretations of probability followed by an outline of the objective Bayesian interpretation and a discussion of the key challenges it faces. I discuss the ramifications of interpretations of probability and objective Bayesianism for the philosophy of mathematics in general.

The semeiotic of Charles Sanders Peirce is irreducibly triadic, positing that a sign mediates between the object that determines it and the interpretant that it determines. He eventually holds that each sign has two objects and three interpretants, standardizing quickly on immediate and dynamical for the objects but experimenting with a variety of names for the interpretants. The two most prominent terminologies are immediate/dynamical/final and emotional/energetic/logical, and scholars have long debated how they are related to each other. This paper seeks (...) to shed new light on the matter by reviewing the numerous manuscript drafts where Peirce develops the latter nomenclature while attempting to introduce his pragmatism to a general audience. It then goes on to examine an additional set of interpretants, intentional/effectual/communicational, and shows that the three different trichotomies can be understood as complementary, rather than redundant or conflicting. (shrink)

In this volume a diverse group of economists, philosophers, political scientists, and psychologists address the problems, principles, and practices involved in comparing the well-being of different individuals. A series of questions lie at the heart of this investigation: What is the relevant concept of well-being for the purposes of comparison? How could the comparisons be carried out for policy purposes? How are such comparisons made now? How do the difficulties involved in these comparisons affect the status of utilitarian theories? This (...) collection constitutes the most advanced and comprehensive treatment of one of the cardinal issues in social theory. (shrink)

The remarkable lectures that Hegel gave in Berlin in the 1820s generated an exciting intellectual atmosphere which lasted for decades. From the 1830s, many students flocked to Berlin to study with people who had studied with Hegel, and both his original students, such as Feuerbach and Bauer, and later arrivals including Kierkegaard, Engels, Bakunin, and Marx, evolved into leading nineteenth-century thinkers. Jon Stewart's panoramic study of Hegel's deep influence upon the nineteenth century in turn reveals what that century contributed to (...) the wider history of philosophy. It shows how Hegel's notions of 'alienation' and 'recognition' became the central motifs for the era's thinking; how these concepts spilled over into other fields – like religion, politics, literature, and drama; and how they created a cultural phenomenon so rich and pervasive that it can truly be called 'Hegel's century.' This book is required reading for historians of ideas as well as of philosophy. (shrink)

Tired of all the confusion about truth? Join us on a journey to discover your truth lens. Through the River is a challenging and fascinating book that takes the reader on a poignant journey through River Town, providing an eye-opening view on how people can live in close proximity while having radically contrasting perspectives. River Town 's three communities live and act so differently because each group is using a distinct set of assumptions about truth (truth lens). This journey exposes (...) the eternal consequences of how our truth lens influences whether we tell others what we know, insist that others accept what we know or be resigned to keep what we know to ourselves. Today the confusion about truth is great but the stakes are even greater. Our understanding of the different ways people view truth is crucial to building and maintaining constructive relationships. Through the River explores the tools God has given us to engage people who have different assumptions thereby enabling us to communicate Christ to a lost and damaged world. CONTENTS Chapter 1: Three Communities along the River Chapter 2: The River Town Story: How History Affects Truth Lenses Chapter 3: Positivism: Settling on the Rocky Shore Chapter 4: Instrumentalism: Into the River Chapter 5: Critical Realism Chapter 6: Experiencing Truth in Love Chapter 7: Holding Truth Lenses Up to the Bible Chapter 8: The Great Disturbance Chapter 9: Truth Lenses and Relationships Chapter 10: Interacting with Others on the Journey Chapter 11: The World through Your Truth Lens Chapter 12: Journeys through the River. (shrink)

Cover -- Title -- Copyright -- Contents -- Acknowledgements -- How to use this book -- Answering examination questions -- Timeline -- Part I Philosophy of religion -- Ancient philosophical influences -- 1 Plato -- 2 Aristotle -- 3 Soul, mind and body -- The existence of God -- 4 Arguments based on observation -- 5 Arguments based on reason: the ontological argument -- God and the world -- 6 Religious experience -- 7 The problem of evil -- Part II (...) Religious ethics -- 8 What is ethics? -- 9 Moral absolutism and moral relativism -- Normative ethical theories: religious approaches -- 10 Natural moral law -- 11 Situation ethics -- Normative ethical theories -- 12 Kantian ethics -- 13 Utilitarianism -- Applied ethics -- 14 Euthanasia -- 15 Business ethics -- Part III Developments in Christian thought -- 16 Introduction -- Insight -- 17 Augustine's teaching on human nature -- 18 Death and the afterlife -- Foundations -- 19 Knowledge of God's existence -- 20 The person of Jesus Christ -- Living -- 21 Christian moral principles -- 22 Christian moral action -- Glossary -- Bibliography -- Index. (shrink)

A new perspective on the interaction of science, religion and politics in Restoration England, based on discussion of Cumberland's De legibus naturae.

The key to understanding what is problematic about The Man's behavior lies in considering his inflexible attitude toward following a particular kind of rule: the construction instructions accompanying his various LEGO sets. The Man treats the LEGO instructions he is following—which clearly have, at best, the status of conventional, rather than moral, rules—in a manner fitting only for moral requirements. To understand the severity of The Man's mistake, people need only contrast his attitude with that of Emmet Brickowoski at the (...) start of The LEGO Movie. Emmet is largely to be pitied rather than blamed for his inflexible rule‐following behavior. By contrast, there is no indication that The Man's rule‐following behavior is in any way aimed, even unsuccessfully, at attaining some genuine good. Rather, The Man follows the rules merely because they are, well, the rules. (shrink)

In this paper, we reply to Eric Moore’s argument that Lance Armstrong did not cheat, at least according to one, standard account of cheating. If that is the case, we argue, so much the worse for th...

Although maxims are central to Kant’s ethical theory, his account of them remains obscure. We can make progress towards understanding Kantian maxims by examining not only their role as the object of moral judgement but also their connection to freedom of the will and causality. This requires understanding maxims as causal laws that explain the actions that we impute to agents. In this way, they are analogous to causal laws of nature, but they are limited in scope to the agents (...) who are responsible for them. Understanding maxims in this way explains our limited epistemic access to them and helps to clarify Kant’s account of virtue and character as well as how they mediate the relationship between practical and theoretical reason. (shrink)

Value change is a phenomenon that is gaining increasing attention in ethical analyses of technologies. However, a comprehensive study of how reprogenetic technologies and values coevolve is lacking. To remedy this gap, in this overview article, I address the relationship between reprogenetics and value change. This contribution thus argues for the importance of investigating the phenomenon of value change in relation to the technological controversies discussed in bioethics. To meet this goal, I begin by clarifying, first, how technologies shape reproductive (...) choice. I then clarify what “values” and “moral values” are, how reprogenetic technologies are value laden, and what values are often discussed in reprogenetics debates. Next, I show five types of value changes that have occurred in advance in reproductive and genetic technologies. Finally, I argue for the bioethical relevance of discussing future techno-value change, pointing out the descriptive and normative challenges of this philosophical endeavor. (shrink)

While some authors have published excellent essays on various chapters and aspects of the book, few authors have successfully tackled the whole.In The Unity of ...

Technical change, defined as the manufacture and modification of tools, is generally thought to have played an important role in the evolution of intelligent life on earth, comparable to that of language. In this volume, first published in 1983, Jon Elster approaches the study of technical change from an epistemological perspective. He first sets out the main methods of scientific explanation and then applies those methods to some of the central theories of technical change. In particular, Elster considers neoclassical, evolutionary, (...) and Marxist theories, whilst also devoting a chapter to Joseph Schumpeter's influential theory. (shrink)