We all know that doctors accept gifts from drug companies, ranging from pens and coffee mugs to free vacations at luxurious resorts. But as the former Editor-in-Chief of The New England Journal of Medicine reveals in this shocking expose, these innocuous-seeming gifts are just the tip of an iceberg that is distorting the practice of medicine and jeopardizing the health of millions of Americans today. In On the Take, Dr. Jerome Kassirer offers an unsettling look at the pervasive (...) payoffs that physicians take from big drug companies and other medical suppliers, arguing that the billion-dollar onslaught of industry money has deflected many physicians' moral compasses and directly impacted the everyday care we receive from the doctors and institutions we trust most. Underscored by countless chilling untold stories, the book illuminates the financial connections between the wealthy companies that make drugs and the doctors who prescribe them. Kassirer details the shocking extent of these financial enticements and explains how they encourage bias, promote dangerously misleading medical information, raise the cost of medical care, and breed distrust. Among the questionable practices he describes are: the disturbing number of senior academic physicians who have financial arrangements with drug companies; the unregulated "front" organizations that advocate certain drugs; the creation of biased medical education materials by the drug companies themselves; and the use of financially conflicted physicians to write clinical practice guidelines or to testify before the FDA in support of a particular drug. A brilliant diagnosis of an epidemic of greed, On the Take offers insight into how we can cure the medical profession and restore our trust in doctors and hospitals. (shrink)

After a 50-page outline of the principles of clinical reasoning, over 60 actual cases are detailed that illustrate (and are keyed to) the principles, presenting case records, analysis, and references to literature. For medical students and interns, and their instructors. Annotation copyright Book Ne.

There is something embarrassing about money. Everybody is seeking it but at the same time they are reluctant to talk about their bank balances and stock holdings. As a society we have so much of it that we can install 7000 saffron curtains all over Central Park, send tourists into outer space, and analyze the gas on the surface of Titan, yet we fail to spend it on millions of poverty-stricken people who die of disease or starvation each year. We (...) do open our pocketbooks sometimes, but only when television images of massive destruction overwhelm our sensibilities. Money often dominates our consciousness and bombards us in the headlines: Our national debt is 7.7 trillion dollars and it's increasing by more than 2 billion dollars a day; corporate executives of Enron walk away with millions while their employees lose their jobs and their pensions; and we had an endless fascination with Martha Stewart, who is worth millions, but went to jail trying to save a few thousand. (shrink)

How do people make difficult decisions in situations involving substantial risk and uncertainty? In this study, we presented a difficult medical decision to three expert physicians in a combined “thinking aloud” and “cross examination” experiment. Verbatim transcripts were analyzed using script analysis to observe the process of constructing and making the decision, and using referring phrase analysis to determine the representation of knowledge of likelihoods. These analyses are compared with a formal decision analysis of the same problem to highlight similarities (...) and differences. The process of making the decision resembles an incremental, sequential‐refinement planning algorithm, where a complex decision is broken into a sequence of choices to be made with a simplified description of the alternatives. This strategy results in certain kinds of relevant information being underweighted in the final decision. Knowledge of likelihood appears to be represented as symbolic descriptions capturing categorical and ordinal relations with “landrhark” likelihoods, only some of which are described numerically. Numerical probabilities, capable of being combined and compared arithmetically, were not observed. These observations suggest an explanation for the heuristics and biases in human decision making under uncertainty in terms of the processes that manipulate symbolic descriptions of likelihoods and construct plans of action for situations involving risk and uncertainty. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:just Men and Just Acts in Plato's Republic JEROME SCHILLER I. Introduction Too MUCHhas already been written about Plato's Republic. But this, strangely enough, is why a little more needs to be written. For the book has been worked over so often that an obvious sign of fatigue has set in: critics are beginning to find such elementary flaws in the Republic that one wonders why he should (...) waste time on such a philosophically embarrassing work at all. It is to counter one of these recent criticisms and thus, hopefully, to help offset the fatigue, that this study is written. It purports not only to show the criticism mistaken, but also to sketch a way of looking at the Republic which should send the reader back for a further look at this incredibly rich work. The richness of the Republic is, indeed, a source of embarrassment for anyone writing on it. For because of its structure it is at least misleading to isolate one topic from the myriad others treated there, and because of its complexity, impossible to document interpretations of more than a few topics. I shall follow the time-honored practices here of merely expressing my bias on some topics (such as my non-political interpretation) and leaving it up to the reader to follow up hints of my interpretations of other topics (such as that of the Sun, Line, and Cave). II. Plato's Alleged Fallacy in the Republic David Sachs and A. W. H. Adkins have recently claimed that Plato commits the fallacy of equivocation in the Republic, not in the course of some minor argument, but in answering what is probably the central problem posed by the work: Why be just?1 Simply put, their objection goes like this: In the first book of the Republic, Socrates attempts to prove to Thrasymachus why justice is preferable to injustice. But even Socrates is dissatisfied with this answer and early in the second book, after a brilliantly fashioned defense of the Thrasymachean position by Glaucon and Adeimantus, the brothers ask for a more convincing demonstration from "You, [who have] passed your entire life in the consideration of this very matter." e Socrates seems to accept the challenge and proceeds to a search for the concept of justice writ large in the state. Now, claim Adkins and Sachs, Plato never does answer Glaucon's and AdeiDavid Sachs, A Fallacy in Plato s Republic, Philosophical Review, LX(XII (1963),141158 ;A. W. H. Adkins, Merit and Responsibility, A Study in Greek Values (Oxford,1960),p. 289. Adkins,in developingapolitical interpretation ofthe Republic, doesnot elaborate the criticism as does Sachs; hence I refer in this study primarily to the latter's article. sPlato, Republic 376e 2-3,trans. P. Shorey (2 vols.; Cambridge, Mass.: Loeb Classical Library, 1937-42).All subsequent quotations are from this translation. [1] HISTORY OF PHILOSOPHY mantus' request. For though he does eventually purport to show that justice is preferable to injustice, the justice he attempts to prove this of is not at all the same justice that Glaucon and Adeimantus have in mind. Plato has simply equivocated on the term "iustice," meaning at one time the set of acts generally considered just,s but at another time a certain order in the individual's soul. He has purported to show that an individual with a well-ordered soul reaps advantages, but unless he can show a clear relation between this "Platonic" notion of justice and the "vulgar" notion of justice, the notion which Cephalus, Polemarchus, Thrasymachus, Glaucon and Adeimantus have in mind, he will not have answered the brothers' question, and will thus have avoided the central problem of the Republic. The relation he has to establish is, Sachs claims, that Platonic justice is a necessary and a sufficient condition for vulgar justice. Then he could argue that since he has shown that a man reaps advantages just to the extent that he is Platonically just, (1) a vulgarly unjust individual will not reap more advantages than a vulgarly just one (on the grounds that Platonic justice entails vulgar justice), and (2) a vulgarly just man will reap more advantages than a vulgarly... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:just Men and Just Acts in Plato's Republic JEROME SCHILLER I. Introduction Too MUCHhas already been written about Plato's Republic. But this, strangely enough, is why a little more needs to be written. For the book has been worked over so often that an obvious sign of fatigue has set in: critics are beginning to find such elementary flaws in the Republic that one wonders why he should (...) waste time on such a philosophically embarrassing work at all. It is to counter one of these recent criticisms and thus, hopefully, to help offset the fatigue, that this study is written. It purports not only to show the criticism mistaken, but also to sketch a way of looking at the Republic which should send the reader back for a further look at this incredibly rich work. The richness of the Republic is, indeed, a source of embarrassment for anyone writing on it. For because of its structure it is at least misleading to isolate one topic from the myriad others treated there, and because of its complexity, impossible to document interpretations of more than a few topics. I shall follow the time-honored practices here of merely expressing my bias on some topics (such as my non-political interpretation) and leaving it up to the reader to follow up hints of my interpretations of other topics (such as that of the Sun, Line, and Cave). II. Plato's Alleged Fallacy in the Republic David Sachs and A. W. H. Adkins have recently claimed that Plato commits the fallacy of equivocation in the Republic, not in the course of some minor argument, but in answering what is probably the central problem posed by the work: Why be just?1 Simply put, their objection goes like this: In the first book of the Republic, Socrates attempts to prove to Thrasymachus why justice is preferable to injustice. But even Socrates is dissatisfied with this answer and early in the second book, after a brilliantly fashioned defense of the Thrasymachean position by Glaucon and Adeimantus, the brothers ask for a more convincing demonstration from "You, [who have] passed your entire life in the consideration of this very matter." e Socrates seems to accept the challenge and proceeds to a search for the concept of justice writ large in the state. Now, claim Adkins and Sachs, Plato never does answer Glaucon's and AdeiDavid Sachs, A Fallacy in Plato s Republic, Philosophical Review, LX(XII (1963),141158 ;A. W. H. Adkins, Merit and Responsibility, A Study in Greek Values (Oxford,1960),p. 289. Adkins,in developingapolitical interpretation ofthe Republic, doesnot elaborate the criticism as does Sachs; hence I refer in this study primarily to the latter's article. sPlato, Republic 376e 2-3,trans. P. Shorey (2 vols.; Cambridge, Mass.: Loeb Classical Library, 1937-42).All subsequent quotations are from this translation. [1] HISTORY OF PHILOSOPHY mantus' request. For though he does eventually purport to show that justice is preferable to injustice, the justice he attempts to prove this of is not at all the same justice that Glaucon and Adeimantus have in mind. Plato has simply equivocated on the term "iustice," meaning at one time the set of acts generally considered just,s but at another time a certain order in the individual's soul. He has purported to show that an individual with a well-ordered soul reaps advantages, but unless he can show a clear relation between this "Platonic" notion of justice and the "vulgar" notion of justice, the notion which Cephalus, Polemarchus, Thrasymachus, Glaucon and Adeimantus have in mind, he will not have answered the brothers' question, and will thus have avoided the central problem of the Republic. The relation he has to establish is, Sachs claims, that Platonic justice is a necessary and a sufficient condition for vulgar justice. Then he could argue that since he has shown that a man reaps advantages just to the extent that he is Platonically just, (1) a vulgarly unjust individual will not reap more advantages than a vulgarly just one (on the grounds that Platonic justice entails vulgar justice), and (2) a vulgarly just man will reap more advantages than a vulgarly... (shrink)

The violence of 9/11 and its aftermath have raised in a new way the question of the role of religion in the contemporary world. It has given urgent meaning to the “new atheists,” such as Richard Dawkins, Daniel Dennett, Sam Harris, and Christopher Hitchens, all of whom have argued flatly, as Hitchens put it, that “religion poisons everything.” Some of the power of their position comes from their deep commitment to science, as practiced in the university, and the sharp contrast (...) they make between the methods and knowledge of science and the absolute and dogmatic perspectives of religious traditions which generate intolerance, fanaticism, and violence. As they accurately point out, 9/11 is only the most recent event .. (shrink)

I argue that the most significant contribution and legacy of Gordon Kaufman's work rests in his theological method. I limit my discussion to his methodological starting point, his concept of human nature, as he develops it in his book, In Face of Mystery. I show the relevance of this starting point for cultural and theological criticism by arguing two points: first, that this starting point embraces religious and cultural pluralism at its center, providing a framework for intercultural and interreligious discussion (...) and cooperation, and second, that Kaufman's interpretation of religion that emerges out of this starting point embodies pragmatic criteria for evaluating and reconstructing alternative cultural and religious worldviews, so that they may function more adequately within the changing contexts of life. (shrink)

The violation of editorial independence by the CMA seriously damaged trust in CMAJ and raises questions whether the CMA can operate a truly independent journalOn February 20, 2006, John Hoey and Anne Marie Todkill, the two most senior editors of the Canadian Medical Association Journal were fired by the journal’s publisher, Graham Morris. At first, CMA spokespersons said that the firing had been planned for some time based on a desire to “refresh” the journal. Later they refused to offer any (...) explanation, and weeks later they declared that there had been “irreconcilable differences,” without specifying anything more. After the journal’s editorial board tried fruitlessly to convince the Canadian Medical Association to reinstate the dismissed editors, I resigned from the editorial board. I had been a member since 1999. My letter of resignation to the CMA’s president made these points:" “By interfering with the editorial autonomy of two outstanding editors and firing them without explanation, you have provoked a scandal that will be long remembered as a blot on Canadian Medicine. … Despite the acknowledged success of the CMAJ, you gave no cause for the editors’ dismissals. … You caused the editors to be fired without consultation with major members of the Journal Oversight Committee. … In your public comments, you were even disingenuous about whether the editors were fired. … In answering to the issue of the editors’ departure, you have hidden behind a veil of bureaucratic legalisms, and by arguing that the Editorial Board knows only “one side,” you have left the impression that the editors have done something nefarious. Thereby, you have besmirched the good names and reputations of the editors. … You have mounted a PR campaign to “spin” public opinion at the expense of honest, respectable and hard working … ". (shrink)

Les décisions politiques sur les risques environnementaux complexes font fréquemment intervenir des éléments scientifiques contestés. Il n’y a généralement pas de « faits » qui conduisent à une politique correcte unique. Les éléments de preuve qui sont intégrés dans les avis scientifiques destinés à une décision politique nécessitent une évaluation de leur qualité. En 2003, l’Agence néerlandaise d’évaluation environnementale a adopté une méthode standardisée, désignée sous le nom de « guide », dans le cadre de laquelle les principaux aspects de (...) la production et de l’utilisation des connaissances sont présentés grâce à une liste de contrôle visant à l’évaluation et à la communication des incertitudes. Dans cet article, nous présentons des résultats de l’application de ce guide à la controverse sur les risques des particules en suspension. La délibération active sur l’incertitude dans un contexte d’expertise entraîne un processus d’apprentissage commun entre les experts et les décideurs politiques, ce qui conduit à une meilleure prise de conscience du phénomène d’incertitude et de ses implications politiques.Policy decisions on complex environmental risks often involve disputed science. Typically, there are no “ facts” to support a single unequivocally correct policy. The evidence provided in scientific studies for policy-making decisions requires high-quality assessment. In 2003, the Netherlands Environmental Assessment Agency adopted a standardized method, referred to as “guidelines”, whereby key quality aspects of knowledge production and use are presented in the form of a checklist for uncertainty assessments and communication. In this article, we present the outcomes of applying the guidelines in controversies on the risks of ambient particulate matter. In the policy–advisory context, active deliberation on uncertainty produces a common learning process for advisors and policy makers, which leads to a deeper understanding and increased awareness of the phenomenon of uncertainty and its policy implications. (shrink)

A crisis looms over the scientific enterprise. Not a day passes without news of retractions, failed replications, fraudulent peer reviews, or misinformed science-based policies. The social implications are enormous, yet this crisis has remained largely uncharted-until now. In Science on the Verge, luminaries in the field of post-normal science and scientific governance focus attention on worrying fault-lines in the use of science for policymaking, and the dramatic crisis within science itself. This provocative new volume in The Rightful Place of Science (...) also explores the concepts that need to be unlearned, and the skills that must be relearned and enhanced, if we are to restore the legitimacy and integrity of science. (shrink)

Mgr Félix Hedde (1879-1960), o.p., est un personnage-clé de la mission des dominicains de Lyon dans le Haut-Tonkin. Son long ministère au Việt Nam (1926-1960) en fit un témoin privilégié d’une période dramatique de l’histoire du pays. Il a connu les années prospères de la colonisation française jusqu’en 1940, les souffrances de ses compatriotes pendant la Seconde Guerre mondiale et la guerre d’Indochine, leur humiliation face à la décolonisation forcée, et enfin la persécution ouverte ou larvée des chrétiens sous le (...) régime communiste. Chez Félix Hedde, l’amour pour la mission du Tonkin, le désir d’y implanter l’Église, se conjuguait à sa volonté d’honorer ses traditions familiales et nationales. L’épreuve de l’occupation japonaise, de la guerre d’Indochine, des défaites de l’armée française, autant que le réconfort de la fidélité des chrétiens vietnamiens de la mission dans une situation de plus en plus critique, détachant Mgr Hedde de ses rêves patriotiques, le conduisirent à l’accomplissement de sa vocation missionnaire. Les conditions particulières de son territoire de mission, où les ethnies montagnardes sont très largement majoritaires, l’amenèrent cependant à proposer pour lui succéder le Français André Jacq, privant ainsi d’évêque les chrétiens du lieu, de 1958 à 1990. (shrink)

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

© 2017. The American Astronomical Society. All rights reserved.We present new observations of the low-mass companion to HD 984 taken with the Gemini Planet Imager as a part of the GPI Exoplanet Survey campaign. Images of HD 984 B were obtained in the J and H bands. Combined with archival epochs from 2012 and 2014, we fit the first orbit to the companion to find an 18 au orbit with a 68% confidence interval between 14 and 28 au, an eccentricity (...) of 0.18 with a 68% confidence interval between 0.05 and 0.47, and an inclination of 119°with a 68% confidence interval between 114°and 125°. To address the considerable spectral covariance in both spectra, we present a method of splitting the spectra into low and high frequencies to analyze the spectral structure at different spatial frequencies with the proper spectral noise correlation. Using the split spectra, we compare them to known spectral types using field brown dwarf and low-mass star spectra and find a best-fit match of a field gravity M6.5 ±1.5 spectral type with a corresponding temperature of K. Photometry of the companion yields a luminosity of log=2.88 ± 0.07 dex with DUSTY models. Mass estimates, again from DUSTY models, find an age-dependent mass of 34 ±1 to 95 ±4 M Jup. These results are consistent with previous measurements of the object. (shrink)

What is the significance of that loose collective enterprise, sprung up in the aftermath of the sixties, known as L=A=N=G=U=A=G=E Writing? To answer this question I will be taking, initially, a somewhat oblique route. And I shall assume an agreement on several important social and political matters: first, that the United States, following the Second World War, assumed definitive leadership of a capitalist empire; second, that its position of leadership generated a network of internal social contradictions which persist to this (...) day ; third, that this postwar period has been characterized, at the international level, by an extended cold war shadowed by the threat of a global catastrophe, whether deliberate or accidental. Whatever one’s political allegiances, these truths, surely, we hold as self-evident.Postwar American poetry is deployed within that general arena, and to the degree that it is “political” at all, it reflects and responds to that set of overriding circumstances.1 In my view the period ought to be seen as falling into two phases. The first phase stretches from about 1946 to 1973 . This period is dominated by a conflict between various lines of traditional poetry, on one hand, and the countering urgencies of the “New American Poetry” on the other. In the diversity of this last group Donald Allen argued for a unifying “characteristic”: “a total rejection of all those qualities typical of academic verse.”2Of course, this representation of the conflict between “tradition” and “innovation” obscures nearly as much as it clarifies. The New American poets were, in general, must moe inclined to experimentalism than were writers like Richard Wilbur, Anthony Hecht, Louis Simpson, or Donald Justice. But Allen’s declaration can easily conceal the academic and literary characteristics of the innovators. Robert Duncan and Charles Olson, for example, key figures in the New American Poetry, can hardly not be called “literary” or even “academic” poets. If they opened certain new areas in the field of poetic style, no less could and has been said of Lowell, even in his early work. And if Frank O’Hara seems the antithesis of academic work, John Ashbery is, in his own way, its epitome. Yet both appear in Allen’s New American Poetry anthology. Moreover, who can say, between O’Hara and Ashbery, which is the more innovative of the two—so different are their styles of experimentation? 1. Black and feminist writing in the United States often confines the focus of the political engagement to a more restricted national theater. Nevertheless, even in these cases engagement is necessarily carried out within the global framework I have sketched above.2. The New American Poetry: 1945-1960, ed. Donald M. Allen , p. xi. Jerome J. McGann is Commonwealth Professor of English, University of Virginia. His most recent critical work, Buildings of Loss: The Knowledge of Imaginative Texts, will appear in 1987. “Some Forms of Critics Discourse” and “The Religious Poetry of Christina Rosetti” are among his previous contributions to Critical Inquiry. (shrink)