Research into epistemic injustice, the practice of discrediting people as knowers based on their social identity, has gained broad popularity in ethics. Racism in medicine often mani...

Randomised placebo-controlled trials (RPCTs) are the gold standard for evaluating novel treatments. However, this design is rarely used in the context of orthopaedic interventions where participants are assigned to a real or placebo surgery. The present study examines attitudes towards RPCTs for orthopaedic surgery among 687 orthopaedic surgeons across the USA. When presented with a vignette describing an RPCT for orthopaedic surgery, 52.3% of participants viewed it as ‘completely’ or ‘mostly’ unethical. Participants were also asked to rank-order the value of (...) five different types of evidence supporting the efficacy of a surgery, ranging from RPCT to an anecdotal report. Responses regarding RPCTs were polarised with 26.4% viewing it as the least valuable (even less valuable than an anecdote) and 35.7.% viewing it as the most valuable. Where equipoise exists, if we want to subject orthopaedic surgeries to the highest standard of evidence (RPCTs) before they are implemented in clinical practice, it will be necessary to educate physicians on the value and ethics of placebo surgery control conditions. Otherwise, invasive procedures may be performed without any benefits beyond possible placebo effects. (shrink)

Background: Therapeutic misconception, the misunderstanding of differences between research and clinical care, is widely prevalent among non-incarcerated trial participants. However, little attention has been paid to its presence among individuals who participate in research while incarcerated. Methods: This study examined the extent to which 72 incarcerated individuals may experience therapeutic misconception about their participation in one of six clinical trials, and its correlation with participant characteristics and potential influences on research participation. Results: On average, participants endorsed 70% of items suggestive (...) of therapeutic misconception. The tendency toward therapeutic misconception was significantly higher among African Americans and Latinos compared to Whites, among older and less educated participants, and among enrollment in a substance-abuse-related trial; it was also correlated with a belief that the trial was the only way to obtain needed treatment. Conclusions: Therapeutic misconception may be particularly high among select incarcerated individuals and is associated with a perceived lack of treatment options. Further examination of therapeutic misconception among incarcerated research participants is needed. (shrink)

Josiah Thompson, who has authored a previous work on Kierkegaard in 1967 and just recently edited Kierkegaard: A Collection of Critical Essays, has, with the present title, made a memorable contribution to Kierkegaardian literature. Kierkegaard may be best described as a philosophical-biographical essay. It studies the development of Kierkegaard’s life from his birth in 1813 to his burial in 1855 in a funeral which results in a "near riot" at the graveside. Thompson has produced a continuous, compelling narrative which (...) is vividly and often beautifully written. There are no footnotes to interrupt the almost novel-like quality of the prose, which often includes even bits of dialogue. Yet, at the end of the 238 pages of prose, there are 37 pages of notes, referring back to page and line, which richly document the facts, scenes, and often the conversation which Thompson has presented. In Chapter 12, "Master of Irony," in the most philosophically important discussion in the book, Thompson develops his thesis that the aim of the pseudonymous writings is to portray "the necessary failure of all human projects". There is a shattering discussion of Kierkegaard’s final reflections on Christianity in the next to the last chapter. In all, Thompson has written a superb and penetrating study of Kierkegaard.—J.D.C. (shrink)