In their Target Article, “Promoting Ethical Payment in Human Infection Challenge Studies,” Lynch et al. propose a framework for ethical payment to research participants and apply it to the c...

Hospital systems commonly face the challenge of determining just ways to allocate scarce drugs during national shortages. There is no standardised approach of how this should be instituted, but principles of distributive justice are commonly used so that patients who are most likely to benefit from the drug receive it. As a result, clinical indications, in which the evidence for the drug is assumed to be established, are often prioritised over research use. In this manuscript, we present a case of (...) a phase II investigational trial of intravenous thiamine for delirium prevention in patients undergoing haematopoietic stem cell transplantation to emphasise several shortcomings in the overarching prioritisation of clinical over research uses of scarce drugs. Specifically, we present the following considerations: clinical use may not have stronger evidence than research use; a strong scientific rationale for research use may outweigh the claim for clinical indications in which there is weak evidence; treatment within the context of a clinical trial may be the standard of care; and research use may not only benefit patients receiving the treatment but also offers the prospect of improving future clinical care. In summary, we argue against allocation schemes that prohibit all research uses of scarce drugs and instead recommend that allocation schemes include a balanced approach that weighs risks and benefits of access to scarce drugs irrespective of the research versus clinical use designation. (shrink)

In this article, I focus on two problematic aspects of British health-promotion campaigns regarding feeding children, particularly regarding breastfeeding and obesity. The first of these is that health-promotion campaigns around “lifestyle” issues dehumanize mothers with their imagery or text, stemming from the ongoing undervaluing and objectification of mothers and women. Public health-promotion instrumentalizes mothers as necessary components in achieving its aims, while at the same time undermining their agency as persons and interlocutors by tying “mother” to particular images. This has (...) a double effect: first, it excludes mothers who do not fit the campaign picture of a mother; second, it encloses those who do fit the picture into an objectified image of motherhood that is defined by and subject to the dominant white, heteropatriarchal gaze. The second problem is that campaigns place unjustified demands on mothers, which stem from a misinterpretation of the maternal duty to benefit. I argue that nutrition-related health concerns regarding children are improperly framed as individual failures of maternal duty, rather than as failures of a system to function correctly. These arguments ultimately support shifting the focus of responsibility for issues around childhood nutrition away from mothers and back toward policymakers. (shrink)

In the case discussion, ‘Equity in Public Health Ethics: The Case of Menu Labelling Policy at the Local Level’ , Mah and Timming state that menu labelling would ‘place requirements for information disclosure on private sector food businesses, which, as a policy instrument, is arguably less intrusive than related activities such as requiring changes to the food content’. In this commentary on Mah and Timming’s case study, I focus on discussing how menu-labelling policy permits governments to avoid addressing the heart (...) of the problem, which is high-calorie, high-sodium restaurant food. Menu labelling policy does not address food content in a way that is meaningful for change, instead relying on individuals to change their behaviour given new information. Besides having questionable efficacy, this raises concerns about moralizing food choices. (shrink)

Elizabeth A. McGibbon and Josephine B. Etowa, Anti-racist health care practice, Toronto: Canadian Scholars’ Press, 2009, reviewed by Kathryn L. Mackay.

The concept of projection from one space to another, with a consequent loss of information, can be seen in the relationships of gene to protein and language description to real situation. Such a transformation can only be reversed if extra external information is re-supplied. The genetic algorithm embodying this idea is now used in applied mathematics for exploring a configuration space. Such a dialectic – transformation back and forth between two kinds of description – extends the traditional Hegelian concept used (...) by Engels and others of change as resulting from a resolution of the conflict of two opposing tendencies and provides for evolution of the joint system. (shrink)

Elizabeth A. McGibbon and Josephine B. Etowa’s co-authored book Anti-racist Health Care Practice exposes and addresses systemic racism in the Canadian health-care system. McGibbon and Etowa directly confront racism in health provision and Canadian society, and provide a discussion of racism and related issues (gender, class) that does not hold back criticisms. The system of racial oppression and its sustenance by white privilege is presented to the reader in a clear and straightforward way, making it impossible for the reader to (...) deny or misunderstand his or her role in the power structures of Canadian (or American) society. The book is directed primarily at medical practitioners, as well as educators and policy .. (shrink)

Bundle theory takes objects to be bundles of properties. Some bundle theorists take objects to be bundles of instantiated universals, and some take objects to be bundles of tropes. Tropes are instances of properties: some take instantiated universals to be tropes, while others deny the existence of universals and take tropes to be ontologically fundamental. Historically, the bundling relation has been taken to be a primitive relation, not analyzable in terms of or ontologically reducible to some other relation, and has (...) been variously characterized as, e.g., “compresence,” “concurrence,” or “consubstantiation.” Bertrand Russell (1940) defends compresence of universals, and Hector-Neri Castañeda (1974) defends consubstantiation of universals. John Bacon (1995) defends concurrent tropes and Keith Campbell (1990) defends compresent tropes. Jonathan Schaffer (2001) bucks this trend, endorsing compresence understood as co-location in spacetime, but this brings with it undesireable consequences such as the impossibility of distinguishing between objects (such as electrons or other microentities) with the same location. Mereological bundle theory improves upon traditional bundle theory by taking the primitive relation of bundling to be the more familiar relation of fusing or composing, such that objects are fusions of properties or fusions of property instances. Hence, mereological bundle theorists endorse a property mereology: a mereology where properties or property instances can be parts of objects. An advantage of the approach derives from the fact that standard mereologies take composition to be primitive or define it using a different primitive mereological notion (such as primitive parthood). Thus, taking the basic primitive of bundle theory to be composition can reduce the need for.. (shrink)

Involuntary autobiographical memories are typically discussed in the context of negative memories such as trauma ‘flashbacks’. However, IAMs occur frequently in everyday life and are predominantly positive. In spite of this, surprisingly little is known about how such positive IAMs arise. The trauma film paradigm is often used to generate negative IAMs. Recently an equivalent positive film was developed inducing positive IAMs . The current study is the first to investigate which variables would best predict the frequency of positive IAMs. (...) Higher levels of positive mood change to the film were significantly associated with the number of positive IAMs recorded in the subsequent week. Results demonstrate the importance of positive emotional reaction at the time of an event for subsequent positive IAMs. (shrink)

Policy-makers must allocate scarce resources to support constituents’ health needs. This requires policy-makers to be able to evaluate health states and allocate resources according to some principle of allocation. The most prominent approach to evaluating health states is to appeal to the strength of people’s preferences to avoid occupying them, which we refer to as decision utility metrics. Another approach, experienced utility metrics, evaluates health states based on their hedonic quality. In this article, we argue that although decision utility metrics (...) face a number of significant problems, the appropriate response to these problems is not to replace them with experienced utility metrics. Rather, decision utility metrics should be employed in conjunction with experienced utility metrics. Specifically, respondents to decision utility surveys should be provided with the results of experienced utility metrics in an effort to make their decisions better informed and more robust to the deficiencies of decision utility metrics. Ultimately, this approach would improve quality-adjusted life year calculations and enhance the decision-making of policy-makers in allocating resources to support constituents’ health needs. (shrink)

The sports world has historically rejected the practice of tanking. I argue that this attitude is unwarranted. To do so, I introduce a concept called strategic suboptimal play (SSP), which is the practice of incurring the risk of a short-term competitive disadvantage to increase the chances of gaining a longer-term competitive advantage. Tanking is just an instance of SSP employed in higher-order games, i.e. games that are at least partially played by other games, like tournaments or seasons. Since SSP is (...) integral to every sport, there are currently no easy grounds for rejecting it outright. As such, the same is true of tanking. I will explore some possible reasons why tanking is wrongly thought objectionable, as well as some objections to and implications of my argument for competitive sports more broadly. (shrink)

The term fuzzy logic is used in this paper to describe an imprecise logical system, FL, in which the truth-values are fuzzy subsets of the unit interval with linguistic labels such as true, false, not true, very true, quite true, not very true and not very false, etc. The truth-value set, , of FL is assumed to be generated by a context-free grammar, with a semantic rule providing a means of computing the meaning of each linguistic truth-value in as a (...) fuzzy subset of [0, 1].Since is not closed under the operations of negation, conjunction, disjunction and implication, the result of an operation on truth-values in requires, in general, a linguistic approximation by a truth-value in . As a consequence, the truth tables and the rules of inference in fuzzy logic are (i) inexact and (ii) dependent on the meaning associated with the primary truth-value true as well as the modifiers very, quite, more or less, etc. (shrink)

Causation is at once familiar and mysterious. Neither common sense nor extensive philosophical debate has led us to anything like agreement on the correct analysis of the concept of causation, or an account of the metaphysical nature of the causal relation. Causation: A User's Guide cuts a clear path through this confusing but vital landscape. L. A. Paul and Ned Hall guide the reader through the most important philosophical treatments of causation, negotiating the terrain by taking a set of examples (...) as landmarks. They clarify the central themes of the debate about causation, and cover questions about causation involving omissions or absences, preemption and other species of redundant causation, and the possibility that causation is not transitive. Along the way, Paul and Hall examine several contemporary proposals for analyzing the nature of causation and assess their merits and overall methodological cogency.The book is designed to be of value both to trained specialists and those coming to the problem of causation for the first time. It provides the reader with a broad and sophisticated view of the metaphysics of the causal relation. (shrink)

Causation is a deeply intuitive and familiar relation, gripped powerfully by common sense. Or so it seems. As is typical in philosophy, however, that deep intuitive familiarity has not led to any philosophical account of causation that is at once clean, precise, and widely agreed upon. Not for lack of trying: the last thirty years or so have seen dozens of attempts to provide such an account, and the pace of development is, if anything, accelerating. (See Collins et al. [2003a] (...) for a comprehensive sampling of the latest work.). (shrink)

I explore some of the ways that assumptions about the nature of substance shape metaphysical debates about the structure of Reality. Assumptions about the priority of substance play a role in an argument for monism, are embedded in certain pluralist metaphysical treatments of laws of nature, and are central to discussions of substantivalism and relationalism. I will then argue that we should reject such assumptions and collapse the categorical distinction between substance and property.

It seems natural to choose whether to have a child by reflecting on what it would be like to actually have a child. I argue that this natural approach fails. If you choose to become a parent, and your choice is based on projections about what you think it would be like for you to have a child, your choice is not rational. If you choose to remain childless, and your choice is based upon projections about what you think it (...) would be like for you to have a child, your choice is not rational. This suggests we should reject our ordinary conception of how to make this life-changing decision, and raises general questions about how to rationally approach important life choices. (shrink)

I defend a one category ontology: an ontology that denies that we need more than one fundamental category to support the ontological structure of the world. Categorical fundamentality is understood in terms of the metaphysically prior, as that in which everything else in the world consists. One category ontologies are deeply appealing, because their ontological simplicity gives them an unmatched elegance and spareness. I’m a fan of a one category ontology that collapses the distinction between particular and property, replacing it (...) with a single fundamental category of intrinsic characters or qualities. We may describe the qualities as qualitative charactersor as modes, perhaps on the model of Aristotelian qualitative (nonsubstantial) kinds, and I will use the term “properties” interchangeably with “qualities”. The qualities are repeatable and reasonably sparse, although, as I discuss in section 2.6, there are empirical reasons that may suggest, depending on one’s preferred fundamental physical theory, that they include irreducibly intensive qualities. There are no uninstantiated qualities. I also assume that the fundamental qualitative natures are intrinsic, although physics may ultimately suggest that some of them are extrinsic. On my view, matter, concrete objects, abstract objects, and perhaps even spacetime are constructed from mereological fusions of qualities, so the world is simply a vast mixture of qualities, including polyadic properties (i.e., relations). This means that everything there is, including concrete objects like persons or stars, is a quality, a qualitative fusion, or a portion of the extended qualitative fusion that is the worldwhole. I call my view mereological bundle theory. (shrink)

The question I want to explore is whether experience supports an antireductionist ontology of time, that is, whether we should take it to support an ontology that includes a primitive, monadic property of nowness responsible for the special feel of events in the present, and a relation of passage that events instantiate in virtue of literally passing from the future, to the present, and then into the past.

Critics of contemporary metaphysics argue that it attempts to do the hard work of science from the ease of the armchair. Physics, not metaphysics, tells us about the fundamental facts of the world, and empirical psychology is best placed to reveal the content of our concepts about the world. Exploring and understanding the world through metaphysical reflection is obsolete. In this paper, I will show why this critique of metaphysics fails, arguing that metaphysical methods used to make claims about the (...) world are similar to scientific methods used to make claims about the world, but that the subjects of metaphysics are not the subjects of science. Those who argue that metaphysics uses a problematic methodology to make claims about subjects better covered by natural science get the situation exactly the wrong way around: metaphysics has a distinctive subject matter, not a distinctive methodology. The questions metaphysicians address are different from those of scientists, but the methods employed to develop and select theories are similar. In the first section of the paper, I will describe the sort of subject matter that metaphysics tends to engage with. In the second section of the paper, I will show how metaphysical theories are classes of models and discuss the roles of experience, common sense and thought experiments in the construction and evaluation of such models. Finally, in the last section I will discuss the way these methodological points help us to understand the metaphysical project. Getting the right account of the metaphysical method allows us to better understand the relationship between science and metaphysics, to explain why doing metaphysics successfully involves having a range of different theories, to understand the role of thought experiments involving fictional worlds, and to situate metaphysical realism in a scientifically realist context. (shrink)