Drugs, Misc

The aim of this dissertation is to build a concept of epistemic responsibility that takes seriously insights from feminist epistemology, addiction studies, and disability theory. I use John Greco’s knowledge-as-achievement account as a starting point, and demonstrate how an ability-centred account such as Greco’s can be undergirded with these insights to create a concept of epistemic responsibility that better captures the complex social and political nature of our epistemic practices. I begin in Chapter 1 by outlining the contours of the (...) project and making an argument for the importance of projects that create porousness between feminist epistemology and mainstream epistemology. In Chapter 2 I outline five key insights in feminist epistemology that I use both in assessing Greco’s theory and in guiding reconstruction. I argue that accommodating these insights will require, at a minimum, a thoroughly social/non-individualistic concept of epistemic responsibility. The strategy that I take to build such a concept is threefold. First, in Chapter 3, I provide a theoretical background of currently existing social/non-individualistic concepts of responsibility that serve to lay a groundwork for my notion of epistemic responsibility. The goal is not to provide a comprehensive survey of the work on responsibility, but rather to draw out tools and frameworks that are helpful in thinking through epistemic responsibility. Second, in Chapter 4, I develop an extended analysis of a concrete phenomenon that I take to be a thoroughly social/non-individualistic context of responsibility ascription: responsibility for addiction, or rather for the harms associated with drug use. And finally, in Chapter 5, taking all of the insights and tools that I have gathered in Chapters 2-4, I embark on the project of theory reconstruction. I begin by outlining the strengths and weaknesses in Greco’s theory with respect to the insights I have highlighted. I then bring in disability theory in order to shore up the notion of ability operative in Greco’s account which I argue allows us to better account for the social and political complexities of epistemic practice. (shrink)

Recently some bioethicists and neuroscientists have argued for an imperative of chemical cognitive enhancement. This imperative is usually based on consequentialist grounds. In this paper, the topic of cognitive self-enhancement is discussed from a Kantian point of view in order to shed new light on the controversial debate. With Kant, it is an imperfect duty to oneself to strive for perfecting one’s own natural and moral capacities beyond one’s natural condition, but there is no duty to enhance others. A Kantian (...) approach does not directly lead to a duty of chemical cognitive self-enhancement, but it also does not clearly rule out that this type of enhancement can be an appropriate means to the end of self-improvement. The paper shows the benefits of a Kantian view, which offers a consistent ideal of self-perfection and teaches us a lesson about the crucial relevance of the attitude that underlies one’s striving for cognitive self-improvement: the lesson of treating oneself as an end in itself and not as mere means to the end of better output. (shrink)

Programs of drug testing welfare recipients are increasingly common in US states and have been considered elsewhere. Though often intensely debated, such programs are complicated to evaluate because their aims are ambiguous – aims like saving money may be in tension with aims like referring people to treatment. We assess such programs using a proportionality approach, which requires that for ethical acceptability a practice must be: reasonably likely to meet its aims, sufficiently important in purpose as to outweigh harms incurred, (...) and lower in costs than feasible alternatives. In the light of empirical findings, we argue that the programs fail the three requirements. Pursuing recreational drug users is not important in the light of costs incurred, while dependent users who may require referral are usually identifiable without testing and typically need a broader approach than one focussing on drugs. Drug testing of welfare recipients is therefore not ethically acceptable policy. (shrink)

Every day the news shows us provoking stories about what's going on in the world, about events which raise moral questions and problems. In Philosophers Take On the World a team of philosophers get to grips with a variety of these controversial issues, from the amusing to the shocking, in short, engaging, often controversial pieces. This chapter covers drug use, making you think again about the judgements we make on a daily basis and the ways in which we choose to (...) conduct our lives. (shrink)

Seeking treatment for substance abuse or addiction is half the battle--staying sober is the other. In this important book, physician Stanley Block and addiction specialist Guy du Plessis present a powerful program for overcoming addiction utilizing the mind-body bridging modality. Proven effective in both clinical and research settings, these easy-to-use self-help exercises teach readers how to uncover addiction triggers, stay grounded, and prevent future relapse.

Lifelong smokers lose on average a decade of life vis-à-vis non-smokers. Globally, tobacco causes about 5–6 million deaths annually. One billion tobacco-related deaths are predicted for the 21st century, with about half occurring before the age of 70. In this paper, we consider a complete ban on the sale of cigarettes and find that such a ban, if effective, would be justified. As with many policy decisions, the argument for such a ban requires a weighing of the pros and cons (...) and how they impact on different individuals, both current and future. The weightiest factor supporting a ban, we argue, is the often substantial well-being losses many individuals suffer because of smoking. These harms, moreover, disproportionally affect the disadvantaged. The potential gains in well-being and equality, we argue, outweigh the limits a ban places on individuals’ freedom, its failure to respect some individuals’ autonomous choice and the likelihood that it may, in individual cases, reduce well-being. (shrink)

Until recently, the problem of traumatic brain injury in sports and the problem of performance enhancement via hormone replacement have not been seen as related issues. However, recent evidence suggests that these two problems may actually interact in complex and previously underappreciated ways. A body of recent research has shown that traumatic brain injuries, at all ranges of severity, have a negative effect upon pituitary function, which results in diminished levels of several endogenous hormones, such as growth hormone and gonadotropin. (...) This is a cause for concern for many popular sports that have high rates of concussion, a mild form of TBI. Emerging research suggests that hormone replacement therapy is an effective treatment for TBI-related hormone deficiency. However, many athletic organizations ban or severely limit the use of hormone replacing substances because many athletes seek to use them solely for the purposes of performance enhancement. Nevertheless, in the light of the research linking traumatic brain injury to hypopituitarism, this paper argues that athletic organizations’ policies and attitudes towards hormone replacement therapy should change. We defend two claims. First, because of the connection between TBI and pituitary function, it is likely many more athletes than previously acknowledged suffer from hormone deficiency and thus could benefit from hormone replacement therapy. Second, athletes’ hormone levels should be tested more rigorously and frequently with an emphasis on monitoring TBI and TBI-related issues, rather than simply monitoring policy violations. (shrink)

In a recent discussion, Walter Glannon discusses a number of ways we might try to minimize harm to patients who experience intraoperative awareness. In this response I direct attention to a possibility that deserves further attention. It might be that a kind of psychological intervention – namely, informing patients of the possibility of intraoperative awareness and of what to expect in such a case – would constitute a unique way to respect patient autonomy, as well as minimize the harm that (...) typically follows intraoperative awareness events. (shrink)

I review six bad arguments for banning performance-enhancing drugs from sports--and a seventh good one.

Savulescu et al have argued that the risk to athletes' welfare provides the only legitimate ground for restricting the use of performance enhancing drugs in sport. In this paper, it is argued that the idea of `sport', properly understood, provides further reason to impose such restrictions. A `balance of excellences' argument is proposed whereby doping is considered objectionable on account of its disrupting the relation between the excellences around which sporting competition is organised. We have reason to restrict the use (...) of performance enhancing drugs in sport not only because of the threat they pose to athletes' health but also because of the threat they pose to athletes' displaying the relevant types of sporting excellence. (shrink)

Homeopathy has been the subject of intense academic, media and public debate in recent months. Those opposed to the practice, which treats like with like by using ultra-dilute remedies, argue that it is an ineffective non-treatment that is not supported by evidence and should not be funded on the National Health Service. Its proponents claim that it is effective (although they disagree about whether it is more effective than placebo) and argue its use is appropriate for certain conditions. This paper (...) examines homeopathy from the perspective of the four principal principles of medical ethics and two example cases. It transpires that homeopathic practice is in contravention of all four of these principles, and is by its very nature unethical. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Subjective Knowledge, Mental Disorders, and MedsHow to Parse the EquationMark D. Rego (bio)Keywordspsychopathology, antidepressants, suicidality, subjective experience, pre-reflectiveA few weeks, ago I was walking down the hall to my office when I spotted my brother-in-law coming the other way. This was odd on two accounts. First, he lives in Kentucky (I am in Connecticut) and second, he is at least a foot taller than the man in my hallway. (...) Nonetheless, I struggled to figure out why he was there. The resemblance was so striking it took me a minute or two to convince myself it was not him. Even after such convincing, the feeling that it was him remained.Later, I imagined that had I just returned from a crack cocaine den I would have been hypervigilant, if not paranoid, and consequently would be certain that my brother-in-law had arrived unannounced. Furthermore, I would probably assume that he was up to no good.How did I retain a strong feeling of recognition, the feeling that maybe it was really him, when I already concluded otherwise? And why, were I on crack cocaine, would the obvious facts be useless in rendering a decision about the identity of the man in the hall? Last, why would the post-cocaine man in the hall become a nefarious brother-in-law rather than a benign one?If I just computed some symbols to figure this out, wouldn't the feeling have gone away? If I activated a brother-in-law neural network, how did I come to acquire an evil brother-in-law neural network? And why wouldn't that go away either?In his article in this issue of Philosophy, Psychiatry, & Psychology, Hadreas looks at questions like these through the prism of before and after effects of people treated with selective serotonin reuptake inhibitors (SSRIs). Hadreas investigates the implications of a straightforward recomputation of self-awareness when treated with these medicines and finds such approaches unsatisfying and incomplete in their explanatory power. (My example looks at a type of awareness, but not specifically self-awareness, as does Hadreas. Furthermore, my paradigm asks about computational conclusions using language more common in psychiatric literature, whereas Hadreas uses standard philosophical terms. Although not isomorphic, I believe the interchange of the two remains true to the issues Hadreas is addressing). [End Page 57]In my example, there is clearly something else going on than the incorrect arrangement of symbols or the misfiring of nodes in a network that influences how I feel and what I think. Neither reason nor empiricism seem to serve me well here. Hadreas utilizes Husserl to begin to unpeel the layers of self-awareness and self-states that intermix to form the shifts and contradictions which are so common in psychiatric treatment (and in common experience as I describe).This is a welcome reckoning; the psychiatric literature is overflowing with unquestioned premises about the neuropsychiatric correlates of reason and empirical approaches (described more as computation and neural networks in the literature—again, not strictly analogous, but the same criticisms apply) Hadreas is critical of. Unfortunately, Hadreas has navigated through a sea of highly questionable assumptions about the psychopharmacology of depression to illustrate his points. This is due in large part to the common practice of consulting literary narratives and critics rather than one of immersion in the literature as a whole and the daily life of patients and active clinicians. He arrived at his destination despite this, because many of these details did not affect his particular analysis. However, to look forward to a continuation of this work and clarify some important issues I devote most of my commentary to these issues. The points I raise are more extensively discussed in a previous edition of this journal (Rego 2005).Affect to Reason ShiftLet's begin with the idea that SSRIs work by dampening emotions. An extension of this idea is that they dampen negative emotions and strengthen positive ones like assertiveness, confidence, and optimism. An even further development in this direction is that, by dampening strong emotions, cognitive enhancement takes place with SSRI treatment. A summary observation then is that SSRIs facilitate... (shrink)

Over the past decades, mood enhancement effects of various drugs and neuromodulation technologies have been proclaimed. If one day highly effective methods for significantly altering and elevating one’s mood are available, it is conceivable that the demand for them will be considerable. One urgent concern will then be what role physicians should play in providing such services. The concern can be extended from literature on controversial demands for aesthetic surgery. According to Margaret Little, physicians should be aware that certain aesthetic (...) enhancement requests reflect immoral social norms and ideals. By granting such requests, she argues, doctors render themselves complicit to a collective ‘evil’. In this paper, we wish to question the extent to which physicians, psychiatrists and/or neurosurgeons should play a role as ‘moral gatekeepers’ in dealing with suspect demands and norms underlying potential desires to alter one’s mood or character. We investigate and discuss the nature and limits of physician responsibilities in reference to various hypothetical and intuitively problematic mood enhancement requests. (shrink)

Kihlbom has recently argued that a system of seeking negatively informed consent might be preferable in some cases to the ubiquitous informed consent model. Although this theory is perhaps not powerful enough to supplant informed consent in most settings, it lends strength to Evans’ and Hungin’s proposal that it can be ethical to prescribe placebos rather than "active" drugs. This paper presents an argument for using negatively informed consent for the specific purpose of authorising the use of placebos in clinical (...) contexts. (shrink)

Most agree that, if all else is equal, patients should be provided with enough information about proposed medical therapies to allow them to make an informed decision about what, if anything, they wish to receive. This is the principle of informed choice; it is closely related to the notion of informed consent. Contemporary clinical trials are analysed according to classical statistics. This paper puts forward the argument that classical statistics does not provide the right sort of information for informing choice. (...) The notion of probability used by classical statistics is complex and difficult to communicate. Therapeutic decisions are best informed by statistical approaches that assign probabilities to hypotheses about the benefits and harms of therapies. Bayesian approaches to statistical inference provide such probabilities. (shrink)

Herbert, Michael Several children are experiencing behavioural and psychological problems at a younger age, due to the harms inflicted by illicit drug use. Professor Patrick McGorry of Orygen Youth Health, an organisation helping teenagers with mental health problems, believes that many young people experiment with drugs recreationally and for fun, but the situation gets worse once it becomes necessary as a relief from their problems.

The appearance of a critical biography of the sociologist Alfred Lindesmith is timely, as initiatives to reform American drug laws gain adherents and visibility. Lindesmith is best known as a longtime critic of American drug policy and one of the first scholars to study heroin addiction as a social phenomenon. The object of a sustained campaign of harassment by Harry Anslinger and the Bureau of Narcotics over several decades, Lindesmith has assumed heroic stature in drug reform circles. Within the discipline (...) of sociology, he exerted more influence than might be expected of a scholar who completed only one piece of fieldwork in his career. By deeming a despised population group worthy of sympathetic study and by insisting on absolute rigor in qualitative methods, he helped set the stage for the emergence of deviance studies and symbolic interactionism in the 1940s.Lindesmith earned his doctorate at the University of Chicago in 1937 under the tutelage of Herbert Blumer. Based on interviews with some 70 heroin addicts, his dissertation argued that addiction occurred only when the addict recognized that the distresses of the withdrawal syndrome were caused by the absence of the accustomed drug and that a new dose would quickly relieve the pain, nausea, and shakes of withdrawal. He stressed the role of experienced addicts in cuing the novice to the meanings of the withdrawal experience. For Lindesmith, addiction was both an alteration in the body's physiological steady state and a social identity. This position was the foundation of his lifelong criticism of the criminalization of addiction and of the psychiatric view that addiction resulted from underlying personality defects.Keys and Galliher have provided an uneven and problematic biography. They deeply appreciate Lindesmith , portraying him as a highly principled scholar who unflaggingly criticized federal drug policy, which he saw as cruel and misguided. They chart his opposition to the repeated stiffening of drug law penalties during the Cold War, when the Bureau of Narcotics connected the drug trade to Chinese Communist attempts to enslave the American people. They also describe his influence on succeeding generations of sociologists through his coauthorship, with Anselm Strauss, of the multiedition textbook Social Psychology. At the same time, they note the limitations of his research and acknowledge Lindesmith's indebtedness to his fellow graduate student Bingham Dai, who was working on a similar project.The account of Lindesmith as a “public intellectual” is more successful than the account of him as a theorist of addiction. Keys and Galliher expend considerable energy arguing that Lindesmith's ideas have been foundational for the addiction treatment industry that has emerged over recent decades and defending him against a few critics who have taken issue with specific aspects of his theory. However, their understanding of addiction, from either a theoretical or a clinical perspective, is weak, and their citations from the addiction literature, even the sociological literature on addiction, are narrow. By overreaching to praise, they undermine their own purpose.As a scholar, Lindesmith can better be appreciated as helping to give rise to a tradition of drug studies in sociology that continued in the work of Howard Becker and, a generation later, in the profusion of ethnographic studies of drug use from the late 1960s to the present day. Lindesmith insisted that addicts' own interpretation of their experience was a critical input into any meaningful theory of addiction. In doing so, he helped create a disciplinary base for challenging a deeply entrenched orthodoxy and for arguing that addicts have a right to humane, nonpunitive health care.The books suffers from sloppy production; citation errors are so pervasive that one should check any reference against another source to be sure of accuracy, and the index fails to note numerous text passages relating to specific entries. (shrink)