Pharmacy Benefit Managers (PBM) induce drug manufacturers to offer rebates to insurers and employers by denying coverage through formulary exclusions, impeding physician prescription through prior authorization, and reducing patient drug use through cost sharing. As they tighten these access obstacles, PBMs reduce the net prices received by the manufacturers.

Cost-benefit analysis--applying economic reasoning to increasingly complex health policy decisions--continues to be a source of vehement disagreement among its practitioners. re than merely technical issues in measurement and accounting are involved; basic social values embedded in different intellectual traditions are coming into conflict. The "human capital" and "willingness-to-pay" approaches can each aid policy formulation, but neither can substitute for open political process.

The social rate of discount--that is, the way decision makers today evaluate future consequences of collective activity--raises difficult issues of intergenerational justice. When benefits are discounted at the present rate the United States government requires, serious efforts to promote public health over the long term will fail cost-benefit tests. No consensus exists among theorists to establish fair rates; philosophers support discounting with economic arguments that economists reject, while economists no less paradoxically support the concept using philosophical arguments that philosophers disavow. (...) A new emphasis on the role of consumers' and citizens' time preferences, however, will keep open rather than close debates on the social discount rate. (shrink)

It is a cliché of self-help advice that there are no problems, only opportunities. The rationale and actions of the BSHS in creating its Global Digital History of Science Festival may be a rare genuine confirmation of this mantra. The global COVID-19 pandemic of 2020 meant that the society's usual annual conference – like everyone else's – had to be cancelled. Once the society decided to go digital, we had a hundred days to organize and deliver our first online festival. (...) In the hope that this will help, inspire and warn colleagues around the world who are also trying to move online, we here detail the considerations, conversations and thinking behind the organizing team's decisions. (shrink)

Back injuries have a bad reputation. The workman looks upon them with apprehension, the insurance company with doubt, the medical examiner with suspicion, the lawyer with uncertainty. The medical examiner is faced with the difficulty of estimating the true value of the subjective symptoms in the comparative absence of physical signs. His suspicion is born of the frequent disparity between these two. This prophetic statement made almost 100 years ago highlights an ongoing problem - how people who are incapacitated by (...) painful conditions such as chronic low back pain can be evaluated consistently and equitably for purposes of disability compensation. We confronted this vexing problem when we participated in writing the chapter devoted to impairment associated with pain of the American Medical Association s Guides to the Evaluation of Permanent Impairment, 5th edition AMA Guides 5th Our purposes in this essay are to clarify several important conceptual issues associated with the assessment of pain among disability applicants, and to articulate reasons why pain should be considered in impairment and disability ratings. (shrink)

Back injuries have a bad reputation. The workman looks upon them with apprehension, the insurance company with doubt, the medical examiner with suspicion, the lawyer with uncertainty. The medical examiner is faced with the difficulty of estimating the true value of the subjective symptoms in the comparative absence of physical signs. His suspicion is born of the frequent disparity between these two. This prophetic statement made almost 100 years ago highlights an ongoing problem - how people who are incapacitated by (...) painful conditions such as chronic low back pain can be evaluated consistently and equitably for purposes of disability compensation. We confronted this vexing problem when we participated in writing the chapter devoted to impairment associated with pain of the American Medical Association s Guides to the Evaluation of Permanent Impairment, 5th edition AMA Guides 5th Our purposes in this essay are to clarify several important conceptual issues associated with the assessment of pain among disability applicants, and to articulate reasons why pain should be considered in impairment and disability ratings. (shrink)

This book is a collection of secondary essays on America's most important philosophic thinkers—statesmen, judges, writers, educators, and activists—from the colonial period to the present. Each essay is a comprehensive introduction to the thought of a noted American on the fundamental meaning of the American regime.

Off and on, of late years, I have studied the history and development of all religions with immense interest as being for me, at least, the most illuminating case histories of the inner life of man. Eugene O Neill writing to M. C. Sparrow, 1929While it is commonly accepted that Eugene O Neill studied Oriental mystical religions and that this study may be detected in some of his less successful experimental plays "(Lazarus Laughed, The Fountain, Marco Millions) "there has not (...) been an effort to consider systematically his immense interest and the influence it had on O Neill s thought and writing. Robinson explores the tension between Occidental and Oriental elements in the playwright s art, examining both the sources of the conflict and its manifestation in selected plays written between 1916 and 1942.Through an examination of O Neill s correspondence, research library, and manuscript materials (some of which have previously been unavailable for study) Robinson is able to reveal the origins of O Neill s Orientalism. An easy familiarity with the complex interrelationships of Eastern and Western religions and the Oriental thought that underlies the ideas of many Western philosophers, allows Robinson to address the intricate problem of Oriental influences on O Neill s favorite Western sources, including Nietzsche, Schopenhauer, Jung, Strindberg, and Emerson.Finally in a play-by-play exegesis, Robinson traces the course of O Neill s mysticism from its apparent repudiation in the deeply flawed "Dynamo "to its synthesis in "The Iceman Cometh, Long Day s Journey Into Night, "and "Hughie, "where Eastern ideas of "maya, "dynamic polarity, and the emptiness of the universe are again evident.". (shrink)

Integrated Information Theory (IIT) identifies consciousness with having a maximum amount of integrated information. But a thing’s having the maximum amount of anything cannot be intrinsic to it, for that depends on how that thing compares to certain other things. IIT’s consciousness, then, is not intrinsic. A mereological argument elaborates this consequence: IIT implies that one physical system can be conscious while a physical duplicate of it is not conscious. Thus, by a common and reasonable conception of intrinsicality, IIT’s consciousness (...) is not intrinsic. It is then argued that to avoid the implication that consciousness is not intrinsic, IIT must abandon its Exclusion Postulate, which prohibits overlapping conscious systems. Indeed, theories of consciousness that attribute consciousness to physical systems, should embrace the view that some conscious systems overlap. A discussion of the admittedly counterintuitive nature of this solution, along with some medical and neuroscientific realities that would seem to support it, is included. (shrink)

Recent work in experimental philosophy has shown that people are more likely to attribute intentionality, knowledge, and other psychological properties to someone who causes a bad side effect than to someone who causes a good one. We argue that all of these asymmetries can be explained in terms of a single underlying asymmetry involving belief attribution because the belief that one’s action would result in a certain side effect is a necessary component of each of the psychological attitudes in question. (...) We argue further that this belief-attribution asymmetry is rational because it mirrors a belief-formation asymmetry, and that thebelief-formation asymmetry is also rational because it is more useful to form some beliefs than others. (shrink)

Ludwig Wittgenstein's _Tractatus Logico-Philosophicus_ and _Philosophical Investigations_ are among the most influential philosophical books of the twentieth century, and also among the most perplexing. Wittgenstein warned again and again that he was not and would not be understood. Moreover, Wittgenstein's work seems to have little relevance to the way philosophy is done today. In _Wittgenstein in Exile_, James Klagge proposes a new way of looking at Wittgenstein -- as an exile -- that helps make sense of this. Wittgenstein's exile (...) was not, despite his wanderings from Vienna to Cambridge to Norway to Ireland, strictly geographical; rather, Klagge argues, Wittgenstein was never at home in the twentieth century. He was in exile from an earlier era -- Oswald Spengler's culture of the early nineteenth century. Klagge draws on the full range of evidence, including Wittgenstein's published work, the complete Nachlaß, correspondence, lectures, and conversations. He places Wittgenstein's work in a broad context, along a trajectory of thought that includes Job, Goethe, and Dostoyevsky. Yet Klagge also writes from an analytic philosophical perspective, discussing such topics as essentialism, private experience, relativism, causation, and eliminativism. Once we see Wittgenstein's exile, Klagge argues, we will gain a better appreciation of the difficulty of understanding Wittgenstein and his work. (shrink)

Posterior parietal cortex has traditionally been considered to be a sensory association area in which higher-order processing and intermodal integration of incoming sensory information occurs. In this paper, evidence from clinical reports and from lesion and behavioral-electrophysiological experiments using monkeys is reviewed and discussed in relation to the overall functional organization of posterior parietal association cortex, and particularly with respect to a proposed posterior parietal mechanism concerned with the initiation and control of certain classes of eye and limb movements. Preliminary (...) data from studies of the effects of posterior parietal lesions on oculomotor control in monkeys are reported.The behavioral effects of lesions of posterior parietal cortex in monkeys have been found to be similar to those which follow analogous damage of the minor hemisphere in humans, while behavioral-electrophysiological experiments have disclosed classes of neurons in this area which have functional properties closely related to the behavioral acts that are disrupted by lesions of the area. On the basis of current data from these areas of study, it is proposed that the sensory association model of posterior parietal function is inadequate to account for the complexities of the present evidence. Instead, it now appears that many diverse neural mechanisms are locatedin partin parietal cortex, that some of these mechanisms are involved in sensory processing and perceptual functions, but that others participate in motor control, and that still others are involved in attentional, motivational, or emotional processes. It is further proposed that the elementary units of these various neural mechanisms are distributed within posterior parietal cortex according to the columnar hypothesis of Mountcastle. (shrink)

“No man can see farther into a generalization than his knowledge of detail extends.” That saying of William James is true of all the branches of science; but it has a special value for students of social philosophy. Social life is so obviously a matter of personal experience that an academic Robinson Crusoe may easily be less competent in his knowledge of detail than a business man, if the business man thinks at all. This is not a compliment (...) to the business man, nor an insult to the academic scholar; for the majority of those who deal with practical issues seem to be far more incompetent than the majority of scholars. But it is essential for social philosophy that practical experience of some kind should be used. Indeed, just as a student of chemistry nowadays depends at every step upon experiment, so a student of social life should take care to play a part in some form of active social life, whether as directing, co-operating, or obeying. One cannot get chemistry out of books; still less can one find social philosophy there. Therefore the number of books written or read is no criterion of the vigour of social philosophy in any generation—it is so easy to write books about other books, and so easy to read the same material many times. (shrink)

A timely and accessible synthesis of the strengths, weaknesses and reality of science through the eyes of a practicing scientist.

One of the fundamental principles of good corporate governance is transparency, i.e., the disclosure of private information to external stakeholders, so that they may make judgments and decisions relating to the corporation. Equally important, but less discussed, is the competing value that corporations need to protect legitimate secrets. Corporations thus need a communication strategy for dealing with external stakeholders which addresses the conflict between disclosure and secrecy. This article focuses on an important element of that communication strategy in the context (...) of financial reporting: the possibility that corporate insiders may consider it in their interest, or in the interest of specific stakeholders, to alter or manipulate the financial information that it discloses publicly. Using concepts from the corporate governance and financial reporting literatures, it addresses the ethical question of who (management or the board of directors) should be responsible for making the fundamental strategic choices whether and (if so) how the corporation alters or manipulates the financial information. This article argues that the board of directors is responsible for formulating (and monitoring) the corporation's communication strategy, and that management is responsible for carrying it out. (shrink)

In the process of challenging epistemological assumptions that preclude relationships between knowers and the objects of knowing, feminist epistemologists Lorraine Code and Donna Haraway also can be interpreted as troubling forms of argumentation predicated on positivist-derived logic. Against the latter, Christopher Tindale promotes a rhetorical model of argument that appears able to better engage epistemologies of situated knowledges. I detail key features of the latter from Code, especially, and compare and contrast them with relevant parts of Tindale’s discussion of context (...) on the rhetorical model, and I suggest ways that his work could be expanded to accommodate rhetorical implications of situated knowledges. (shrink)

The few extant arguments concerning the autonomy of science in the rational acceptance of hypotheses are examined. It is concluded that science is not morally autonomous, and that the attendant notion of rationality in science decisionmaking is inadequate. A more comprehensive notion of scientific rationality, which encompasses the old one, is proposed as a replacement. The general idea is that scientists qua scientist ought, in their acceptance decisions, to take into account the ethical consequences of acceptance as well as the (...) consequences with regard to the attainment of "purely scientific" or "epistemic" objectives. The result constitutes an argument for a (presumably cooperative) game theoretic treatment of inductive logic. (shrink)

This article reviews models of the cerebellum and motor learning, from the landmark papers by Marr and Albus through those of the present time. The unique architecture of the cerebellar cortex is ideally suited for pattern recognition, but how is pattern recognition incorporated into motor control and learning systems? The present analysis begins with a discussion of exactly what the cerebellar cortex needs to regulate through its anatomically defined projections to premotor networks. Next, we examine various models showing how the (...) microcircuitry in the cerebellar cortex could be used to achieve its regulatory functions. Having thus defined what it is that Purkinje cells in the cerebellar cortex must learn, we then evaluate theories of motor learning. We examine current models of synaptic plasticity, credit assignment, and the generation of training information, indicating how they could function cooperatively to guide the processes of motor learning. (shrink)

In this book, he also demonstrates a skill shared by the greatest radical thinkers: to reveal positions we've been taught to think of as extremism to be emanations of simple human decency and common sense.

In 1844 Marx held that labor alienation was wholly eliminable, primarily through the abolition of private property. Work in the context of private property was alienating because it was performed for wages and the production of exchange-value. With such purposes, work was experienced as selfish and forced. With the abolition of private property, work would be performed for the production of use-¥alue, to satisfy human needs. With this human purpose, work would be experienced as a free and fulfilling expression of (...) life. (shrink)

Victor and Cullen (1988) identified several dimensions of ethical climate that exist in organizations and organizational subunits. We tested the relationship between these dimensions of ethical climate and ethical behavior at different levels of analysis. Using Within and Between Analysis (WABA) (cf. Dansereau, Alutto and Yammarino, 1984), partial support was found for a relationship between dimensions of ethical climate and ethical behavior.