The use of transcranial Electrical Stimulation in the modulation of cognitive brain functions to improve neuropsychiatric conditions has extensively increased over the decades. tES techniques have also raised new challenges associated with study design, stimulation protocol, functional specificity, and dose-response relationship. In this paper, we addressed challenges through the emerging methodology to investigate the dose-response relationship of High Definition-transcranial Direct Current Stimulation, identifying the role of negative valence in tinnitus perception. In light of the neurofunctional testable framework (...) and tES application, hypotheses were formulated to measure clinical and surrogate endpoints. We posited that conscious pairing adequately pleasant stimuli with tinnitus perception results in correction of the loudness misperception and would be reinforced by concurrent active HD-tDCS on the left Dorsolateral Prefrontal Cortex. The dose-response relationship between HD-tDCS specificity and the loudness perception is also modeled. We conducted a double-blind, randomized crossover pilot study with six recruited tinnitus patients. Accrued data was utilized to design a well-controlled adaptive seamless Bayesian dose-response study. The sample size and optimum interims were anticipated for adaptive decision-making about efficacy, safety, and single session dose parameters. Furthermore, preliminary pilot study results were sufficient to show a significant difference within the longitudinally detected self-report tinnitus loudness between before and under positive emotion induction. This study demonstrated a research methodology used to improve emotion regulation in tinnitus patients. In the projected method, positive emotion induction is essential for promoting functional targeting under HD-tDCS anatomical specificity to indicate the efficacy and facilitate the dose-finding process. The continuous updating of prior knowledge about efficacy and dose during the exploratory stage adapts the anticipated dose-response model. Consequently, the effective dose range to make superiority neuromodulation in correcting loudness misperception of tinnitus will be redefined. Highly effective dose adapts the study to a standard randomized trial and transforms it into the confirmatory stage in which active HD-tDCS protocol is compared with a sham trial. Establishing the HD-tDCS intervention protocols relying on this novel method provides reliable evidence for regulatory agencies to approve or reject the efficacy and safety. Furthermore, this paper supports a technical report for designing multimodality data-driven complementary investigations in emotion regulation, including EEG-driven neuro markers, Stroop-driven attention biases, and neuroimaging-driven brain network dynamics. (shrink)

Placebos are often used by clinicians, usually deceptively and with little rationale or evidence of benefit, making their use ethically problematic. In contrast with their typical current use, a provocative line of research suggests that placebos can be intentionally exploited to extend analgesic therapeutic effects. Is it possible to extend the effects of drug treatments by interspersing placebos? We reviewed a database of placebo studies, searching for studies that indicate that placebos given after repeated administration of active treatments acquire (...) medication-like effects. We found a total of 22studies in both animals and humans hinting of evidence that placebos may work as a sort of dose extender of active painkillers. Wherever effective in relieving clinical pain, such placebo use would offer several advantages. First, extending the effects of a painkiller through the use of placebos may reduce total drug intake and side effects. Second, dose-extending placebos may decrease patient dependence. Third, using placebos along with active medication, for part of the course of treatment, should limit dose escalation and lower costs. Importantly, provided that nondisclosure is pre-authorized in the informed consent process and that robust evidence indicates therapeutic benefit comparable to that of standard full-dose therapeutic regimens, introducing dose-extending placebos into the clinical arsenal should be considered. This novel prospect of placebo use has the potential to change our general thinking about painkiller treatments, the typical regimens of painkiller applications, and the ways in which treatments are evaluated. (shrink)

Many people argue that uncertain science—or controversial policies based on science—can be clarified primarily by greater attention to social/political values influencing the science and by greater attention to the vested interests involved. This paper argues that while such clarification is necessary, it is not a sufficient condition for achieving better science and policy; indeed its importance may be overemphasized. Using a case study involving the current, highly politicized controversy over the shape of dose‐response curves for biological effects of (...) ionizing radiation, the paper argues that the conflict could be significantly resolved through specific methodological improvements in the areas of metascience and philosophy of science. These improvements focus on taking account, respectively, of scale, data trimming, aggregation, measurability, and simplicity. (shrink)

This article traces disagreements about the genetic effects of low-dose radiation exposure as waged by James Neel, a central figure in radiation studies of Japanese populations after World War II, and Yuri Dubrova, who analyzed the 1986 Chernobyl nuclear power plant accident. In a 1996 article in Nature, Dubrova reported a statistically significant increase in the minisatellite DNA mutation rate in the children of parents who received a high dose of radiation from the Chernobyl accident, contradicting studies that (...) found no significant inherited genetic effects among offspring of Japanese A-bomb survivors. Neel’s subsequent defense of his large-scale longitudinal studies of the genetic effects of ionizing radiation consolidated current scientific understandings of low-dose ionizing radiation. The article seeks to explain how the Hiroshima/nagasaki data remain hegemonic in radiation studies, contextualizing the debate with attention to the perceived inferiority of Soviet genetic science during the Cold War. (shrink)

BackgroundConventionally, transcranial direct current stimulation (tDCS) aims to focalize the current reaching the target region-of-interest (ROI). The focality can be quantified by the dose-target-determination-index (DTDI). Despite having a uniform tDCS setup, some individuals receive focal stimulation (high DTDI) while others show reduced focality (“non-focal”). The volume of cerebrospinal fluid (CSF), gray matter (GM), and white matter (WM) underlying each ROI govern the tDCS current distribution inside the brain, thereby regulating focality.AimTo determine the regional volume parameters that (...) differentiate the focal and non-focal groups.MethodsT1-weighted images of the brain from 300 age-sex matched adults were divided into three equal groups- (a) Young (20 ≤ × < 40 years), (b) Middle (40 ≤ × < 60 years), and (c) Older (60 ≤ × < 80 years). For each group, inter and intra-hemispheric montages with electrodes at (1) F3 and right supraorbital region (F3-RSO), and (2) CP5 and Cz (CP5-Cz) were simulated, targeting the left- Dorsolateral Prefrontal Cortex (DLPFC) and -Inferior Parietal Lobule (IPL), respectively. Both montages were simulated for two current doses (1 and 2 mA). For each individual head simulated for a tDCS configuration (montage and dose), the current density at each region-of-interest (ROI) and their DTDI were calculated. The individuals were categorized into two groups- (1) Focal (DTDI ≥ 0.75), and (2) Non-focal (DTDI < 0.75). The regional volume of CSF, GM, and WM of all the ROIs was determined. For each tDCS configuration and ROI, three 3-way analysis of variance was performed considering- (i) GM, (ii) WM, and (iii) CSF as the dependent variable (DV). The age group, sex, and focality group were the between-subject factors. For a given ROI, if any of the 3 DV’s showed a significant main effect or interaction involving the focality group, then that ROI was classified as a “focal ROI.”ResultsRegional CSF was the principal determinant of focality. For interhemispheric F3-RSO montage, interaction effect (p < 0.05) of age and focality was observed at Left Caudate Nucleus, with the focal group exhibiting higher CSF volume. The CSF volume of focal ROI correlated positively (r ∼ 0.16, p < 0.05) with the current density at the target ROI (DLPFC). For intrahemispheric CP5-Cz montage, a significant (p < 0.05) main effect was observed at the left pre- and post-central gyrus, with the focal group showing lower CSF volume. The CSF volume correlated negatively (r ∼ –0.16, p < 0.05) with current density at left IPL. The results were consistent for both current doses.ConclusionThe CSF channels the flow of tDCS current between electrodes with focal ROIs acting like reservoirs of current. The position of focal ROI in the channel determines the stimulation intensity at the target ROI. For focal stimulation in interhemispheric F3-RSO, the proximity of focal ROI reserves the current density at the target ROI (DLPFC). In contrast, for intrahemispheric montage (CP5-Cz), the far-end location of focal ROI reduces the current density at the target (IPL). (shrink)

Wardrope argues against my proposed non-consequentialist policy for the distribution of scarce influenza vaccine in the face of a pandemic. According to him, even if one accepts what he calls my deontological ethical theory, it does not follow that we are required to agree with my proposed randomised allocation of doses of vaccine by means of a lottery. He argues in particular that I fail to consider fully the prophylactic role of vaccination whereby it serves to protect from infection more (...) people than are vaccinated. He concludes that: ‘The benefits and burdens of vaccination are provided impartially and far more effectively by targeted vaccination than impartial lotteries.’ He has shown convincingly that this conclusion can be established in the case of his particular envisaged scenario. However, Wardrope gives no reason to suppose that, in the circumstances that we actually face, targeted vaccination would constitute impartial treatment of citizens in the UK. I readily agree with Wardrope that if it should treat its citizens justly and impartially, it does not necessarily follow that the state should distribute vaccinations of the basis of a lottery. That will be a reasonable thing to do only if certain assumptions are made. These assumptions will not always be reasonable. However, they are reasonable ones to make in the actual circumstances that currently apply. (shrink)

Understanding of the human genome and its functional significance has increased exponentially since the completion of the Human Genome Project in 2003. The HGP fueled the discovery of more than 1,800 disease genes and paved the way for researchers to identify and test for genes suspected of causing inherited diseases. Currently, there are more than 1000 genetic tests for human diseases and conditions on the market. These tests can play an integral role in the delivery of health care by providing (...) information that could potentially form the basis for profound life decisions, such as whether to undergo a prophylactic mastectomy, whether to terminate a pregnancy, or whether to take a particular drug or medication dose. (shrink)

Understanding of the human genome and its functional significance has increased exponentially since the completion of the Human Genome Project in 2003. The HGP fueled the discovery of more than 1,800 disease genes and paved the way for researchers to identify and test for genes suspected of causing inherited diseases. Currently, there are more than 1000 genetic tests for human diseases and conditions on the market. These tests can play an integral role in the delivery of health care by providing (...) information that could potentially form the basis for profound life decisions, such as whether to undergo a prophylactic mastectomy, whether to terminate a pregnancy, or whether to take a particular drug or medication dose. (shrink)

Understanding of the human genome and its functional significance has increased exponentially since the completion of the Human Genome Project in 2003. The HGP fueled the discovery of more than 1,800 disease genes and paved the way for researchers to identify and test for genes suspected of causing inherited diseases. Currently, there are more than 1000 genetic tests for human diseases and conditions on the market. These tests can play an integral role in the delivery of health care by providing (...) information that could potentially form the basis for profound life decisions, such as whether to undergo a prophylactic mastectomy, whether to terminate a pregnancy, or whether to take a particular drug or medication dose. (shrink)

The biological effects of low doses of toxic and carcinogenic chemicals are currently a matter of significant scientific controversy. This paper argues that philosophers of science can contribute to alleviating this controversy by examining it with the aid of a novel account of scientific anomaly. Specifically, analysis of contemporary research on chemical hormesis (i.e., alleged beneficial biological effects produced by low doses of substances that are harmful at higher doses) suggests that scientists may initially describe anomalous phenomena in terms of (...) multiple distinct "characterizations," each of which is compatible with current empirical evidence. By focusing attention on this feature of scientific anomalies, philosophers of science can alleviate the controversy over low-dose chemical effects in at least two ways: (1) they can pinpoint the significant ways in which particular characterizations frame the controversy, and (2) they can identify the methodological value judgments at stake in researchers' choice of characterizations. (shrink)

Thin slices are used across a wide array of research domains to observe, measure, and predict human behavior. This article reviews the thin-slice method as a measurement technique and summarizes current comparative thin-slice research regarding the reliability and validity of thin slices to represent behavior or social constructs. We outline decision factors in using thin-slice behavioral coding and detail three avenues of thin-slice comparative research: (1) assessing whether thin slices can adequately approximate the total of the recorded behavior or (...) be interchangeable with each other (representativeness); (2) assessing how well thin slices can predict variables that are different from the behavior measured in the slice (predictive validity), and (3) assessing how interpersonal judgment accuracy can depend on the length of the slice (accuracy-length validity). The aim of the review is to provide information researchers may use when designing and evaluating thin-slice behavioral measurement. (shrink)

A number of common and generally noncontroversial practices in the care of patients at the end of life lead to their deaths. For example, physicians honor a patient's refusal of medical intervention even when doing so leads to the patient's death. Similarly, with a patient's or surrogate's consent, physicians administer sedatives in order to relieve pain and distress at the end of life, even when it is known that doing so will cause the patient's death. In contemporary U.S. public policy, (...) these practices are accepted as ethical and legal while physician-assisted suicide (PAS) isrejected in current U.S. law and public policy. Some think, however, that if one accepts practices that are known to lead to a patient's death, then one cannot reasonably reject a patient's request for a lethal dose of medication so that she may kill herself (PAS). (shrink)

Many people argue that uncertain science -- or controversial policies based on science -- can be clarified primarily by greater attention to the social and ethical values influencing the science and the policy and by greater attention to the vested, economic interests involved. This paper argues that while such clarification is necessary, it is neither a sufficient condition, nor even the primary means, by which to achieve better science and better policy. Using a case study involving the current, highly (...) politicized controversy over the shape of dose-response curves for biological effects of ionizing radiation in both the protective action levels (PALS) and the International Commission on Radiological Protection (ICRP) environmental proposals, the paper argues that the conflict could be resolved largely through five specific methodological improvements in the areas of metascience and philosophy of science. (shrink)

It is increasingly acknowledged that cognitive impairment can play an important role in depression vulnerability. Therefore, cognitive remediation strategies, and cognitive control training procedures have gained attention in recent years as possible interventions for depression. Recent studies suggest a small to medium effect on indicators of depression vulnerability. Despite initial evidence for the efficacy and effectiveness of CCT, several central questions remain. In this paper we consider the key challenges for the clinical implementation of CCT, including exploration of potential working (...) mechanisms and related to this, moderators of training effects, necessary conditions under which CCT could be optimally administered, such as dose requirements and training schedules, and how CCT could interact with or augment existing treatments of depression. Revisiting the CCT literature, we also reflect upon the possibilities to evolve toward a stratified medicine approach, in which individual differences could be taken into account and used to optimize prevention of depression. (shrink)

The study of human cognition and the study of artificial intelligence (AI) have a symbiotic relationship, with advancements in one field often informing or creating new work in the other. Human cognition has many capabilities modern AI systems cannot compete with. One such capability is the detection, identification, and resolution of knowledge gaps (KGs). Using these capabilities as inspiration, we examine how to incorporate detection, identification, and resolution of KGs in artificial agents. We present a paradigm that enables research on (...) the understanding of KGs for visual-linguistic communication. We leverage and enhance and existing KG taxonomy to identify possible KGs that can occur for visual question answer (VQA) tasks and use these findings to develop a classifier to identify questions that could be engineered to contain specific KG types for other VQA datasets. Additionally, we examine the performance of different VQA models through the lens of KGs. (shrink)

The study of human cognition and the study of artificial intelligence (AI) have a symbiotic relationship, with advancements in one field often informing or creating new work in the other. Human cognition has many capabilities modern AI systems cannot compete with. One such capability is the detection, identification, and resolution of knowledge gaps (KGs). Using these capabilities as inspiration, we examine how to incorporate detection, identification, and resolution of KGs in artificial agents. We present a paradigm that enables research on (...) the understanding of KGs for visual-linguistic communication. We leverage and enhance and existing KG taxonomy to identify possible KGs that can occur for visual question answer (VQA) tasks and use these findings to develop a classifier to identify questions that could be engineered to contain specific KG types for other VQA datasets. Additionally, we examine the performance of different VQA models through the lens of KGs. (shrink)

In the described case, the consult requester, nurse Gloria, wants help with the question: “is it ethically justifiable to compel tube feeding over the objection of a young adult with anorexia nervo...

Are philosophers of science limited to conducting autopsies on dead scientific theories, or might they also help resolve contemporary methodological disputes in science? This essay (1) gives an overview of thought experiments, especially in mathematics; (2) outlines three major positions on the current dose-response controversy for ionizing radiation; and (3) sketches an original mathematical thought experiment that might help resolve the low-dose radiation conflict. This thought experiment relies on the assumptions that radiation "hits'' are Poisson distributed and (...) that background conditions cause many more radiation-induced cancers than human activities. The essay closes by responding to several key objections to the position defended here. (shrink)

Are philosophers of science limited to conducting autopsies on dead scientific theories, or might they also help resolve contemporary methodological disputes in science? This essay (1) gives an overview of thought experiments, especially in mathematics; (2) outlines three major positions on the current dose-response controversy for ionizing radiation; and (3) sketches an original mathematical thought experiment that might help resolve the low-dose radiation conflict. This thought experiment relies on the assumptions that radiation "hits'' are Poisson distributed and (...) that background conditions cause many more radiation-induced cancers than human activities. The essay closes by responding to several key objections to the position defended here. (shrink)

The DNA hypomethylating agents (HMA) azacitidine (AZA) and decitabine (DAC) improve survival and transfusion independence in myelodysplastic syndrome (MDS) and enable a low intensity cytotoxic treatment for aged AML patients unsuitable for intensive chemotherapy, particularly in combination with novel agents. The proposed mechanism of AZA and DAC relies on active DNA replication and therefore patient responses are only observed after multiple cycles of treatment. Although extended dosing may provide the optimal scheduling, the reliance of injectable formulation of the drug limits (...) it to intermittent treatment. Recently, an oral formulation of AZA demonstrated significantly improved patient relapse free survival (RFS) and overall survival (OS) when used as maintenance after chemotherapy for AML. In addition, both DAC and AZA were found to be highly effective to improve survival in elderly patients with AML through combination with other drugs. These recent exciting results have changed the therapeutic paradigm for elderly patients with AML. In light of this, we review current knowledge on HMA mechanism of action, clinical trials exploring dosing and scheduling, and recent HMA combination therapies to enhance efficacy. (shrink)

The current UK policy for the distribution of scarce vaccination in an influenza pandemic is ethically dubious. It is based on the planned outcome of the maximum health benefit in terms of the saving of lives and the reduction of illness. To that end, the population is classified in terms of particular priority groups. An alternative policy with a non-consequentialist rationale is proposed in the present work. The state should give the vaccination, in the first instance, to those who (...) are at risk of catching the pandemic flu in the line of their duties of public employment. Thereafter, if there is not sufficient vaccine to give all citizens equally an effective dose, the state should give all citizens an equal chance of receiving an effective dose. This would be the just thing to do because the state has a duty to treat each and all of its citizens impartially and they have a corresponding right to such impartial treatment. Although this article specifically refers to the UK, it is considered that the suggested alternative policy would be applicable generally. The duty to act justly is not merely a local one. (shrink)

Current research on the neural basis of consciousness is based mainly on neuroimaging, physiology and psychophysics. This target article reviews what is known about biochemical factors that may contribute to the development of consciousness, based on loss of consciousness (i.e., coma). There are two theories of the biochemical mode of action of general anaesthetics. One is that anaesthesia is a direct (i.e., not receptor-mediated) effect of the anaesthetic on cellular neurophysiological function; the other is that some alteration of receptor (...) function occurs. General anaesthetics are mainly GABA agonists but some (such as ketamine) are glutamate antagonists. They also affect other systems, particularly cholinergic ones. There are various comas of metabolic origin. For example, a combination of small doses of the iron chelators desferrioxamine and prochlorperazine induce a profound and long lasting coma in humans. The mechanisms that might mediate this include redox mechanisms at the glutamate synapse, post-synaptic endocytosis of dopamine and iron, and intracellular iron-dopamine complexes, which are powerful dismuters of the superoxide anion. New findings in cell biology relating to endocytosis and recycling of receptors are discussed in a wider context. These biochemical events may induce coma by two mechanisms: (i) Consciousness may depend on widespread cortical (or cortico-thalamic) activation. (ii) Whereas these biochemical changes are widespread, only the changes in a subset of consciousness' neurons may count. An experimental program to distinguish between these two alternatives is proposed. (shrink)

In the last several months, several major disciplines have started their initial reckoning with what ChatGPT and other Large Language Models (LLMs) mean for them – law, medicine, business among other professions. With a heavy dose of humility, given how fast the technology is moving and how uncertain its social implications are, this article attempts to give some early tentative thoughts on what ChatGPT might mean for bioethics. I will first argue that many bioethics issues raised by ChatGPT are (...) similar to those raised by current medical AI – built into devices, decision support tools, data analytics, etc. These include issues of data ownership, consent for data use, data representativeness and bias, and privacy. I describe how these familiar issues appear somewhat differently in the ChatGPT context, but much of the existing bioethical thinking on these issues provides a strong starting point. There are, however, a few “new-ish” issues I highlight – by new-ish I mean issues that while perhaps not truly new seem much more important for it than other forms of medical AI. These include issues about informed consent and the right to know we are dealing with an AI, the problem of medical deepfakes, the risk of oligopoly and inequitable access related to foundational models, environmental effects, and on the positive side opportunities for the democratization of knowledge and empowering patients. I also discuss how races towards dominance (between large companies and between the U.S. and geopolitical rivals like China) risk sidelining ethics. (shrink)

Many supporters of ‘moral bioenhancement’, the use of biomedical interventions for moral improvement, have been criticised for having unrealistic proposals. The interventions they suggest have often been called infeasible and their implementation plans vague or unethical. I dispute these criticisms by showing that various interventions to implement MBE are practically and ethically feasible enough to warrant serious consideration. Such interventions include transcranial direct current stimulation over the medial and dorsolateral prefrontal cortex, as well as supplementation with lithium and omega-3. (...) Considering their efficacy and feasibility, it is strange that these interventions have rarely been proposed or discussed as MBE. I review evidence that each of those interventions can reduce antisocial behaviour, reduce racial bias, increase executive function or increase prosocial traits like fairness and altruism. I then specify and defend realistic, ethically permissible ways to implement these interventions, especially for violent offenders and public servants—the former as rehabilitation and the latter to meet the high standards of their occupations. These interventions could be given to violent offenders in exchange for a reduced sentence or compulsorily in some cases. Potential intervention methods for non-prisoners include increasing the USDA-recommended dose of omega-3, encouraging food companies to supplement their products with omega-3 or trace lithium, requiring MBE for employment as a police officer or political leader, and insurance companies providing discounts for undergoing MBE. In some reasonably limited form, using these interventions may be a good first step to implement the project of MBE. (shrink)

Applying the Roman Catholic Church's set of moral principles on social concerns called Catholic social teaching (CST) on charity, distributive justice, private property and the common good, and utilising some secondary data and scientific literature, this article argues that establishing distributive justice for the global distribution of the COVID-19 vaccines must be a priority than donating millions of doses in the name of charity to address vaccine scarcity. Catholic social teaching teaches that the right to private property is a basic (...) right but has moral limits and is subordinated to the moral principles on the universal destination of earth's goods and the common good. CONTRIBUTION: The current COVID-19 vaccines are developed by people and organisations outside the pharmaceutical companies and largely funded using taxpayers' money. Thus, by virtue of justice, these vaccines must belong to all nations as global public health goods. Patents are to be suspended to allow poor countries to reproduce the popular vaccines and address the current vaccine shortage. (shrink)

Finishing this essay exactly one year after the official arrival of the SARS-COV-2 virus in Belgium and the Netherlands—where the cartographers of this essay are currently located—it is safe to say that the COVID-19 pandemic has immensely impacted our day-to-day lives. The pandemic has not only forced us to question various taken-for-granted existential certainties and luxuries provided by a capitalist system out to destroy the earth but has also re-spotlighted post-Enlightenment critiques of the human subject. If these pandemic times are (...) indeed more-than-human, then the clock is ticking for the discipline of philosophical anthropology to face these post-anthropological facts and receive what feminist science studies scholar Donna J. Haraway has aptly called a thorough dose of “epistemological electroshock therapy” (1988, p. 578). Taking Haraway’s foregoing call and the idea of thinking-with the (end of the) Anthropocene seriously, we construct a critical cartography of Emmanuel Levinas’ take on philosophical anthropology in dialogue with other major philosophical anthropologists and feminist new materialists while arguing for a post-anthropology for the Chthulucene. (shrink)

Gilbertson et al should be commended for their insightful exploration of expanded terminal sedation (ETS)1; however, there are a number of concerns that I will address in this response. I will first better characterise the currently accepted and commonplace ‘standard’ TS (STS), and then argue that the advocated forms of ETS draw very close to—and at times clearly constitute a subtype of—euthanasia, as opposed to representing a similar but separate practice. I will then conclude with concerns regarding the inappropriate application (...) of ETS, particularly in the non-voluntary context. Gilbertson et al distinguish ‘gradual’ TS, which they state is the currently accepted form of TS, from ‘rapid’ TS, which is then argued to be a justifiable form of ETS. However, in my experience working in multiple large public teaching hospitals in New South Wales, Australia and consistent with local clinical practice guidelines,2 3 STS falls somewhere in the middle between ‘gradual’ and ‘rapid’ TS. STS explicitly aims to achieve permanent unconsciousness so as to eliminate the potential for (and therefore relieve) suffering; conversely, lighter or more intermittent forms of sedation, or administering sedatives with aims other than to achieve unconsciousness (eg, anxiolysis), do not constitute TS proper. STS uses doses proportionate to the extent of symptoms so as to avoid ‘overshooting’ and inadvertently administering excessive doses which actually hasten/cause death, in order to distinguish STS from euthanasia in this respect. This is achieved by gradually uptitrating doses when the patient appears distressed, and is therefore by definition …. (shrink)

The concept of “public participation” is currently one of great interest to researchers and policy makers. In response to a perceived need for greater public involvement in decision making and policy formation processes on the part of both policymakers and the general public, a variety of novel mechanisms have been developed, such as the consensus conference and citizens jury, to complement traditional mechanisms, such as the public meeting. However, the relative effectiveness of the various mechanisms is unclear, as efforts at (...) evaluation have been sparse. In this article, the authors describe an evaluation of a two-day “deliberative conference” on the topic of radiation dose assessment. The authors detail the evaluation framework that they adopt and describe the instruments that they have developed to determine the attainment of the evaluationcriteria stipulated in that framework. They then describe the participation exercise that they have evaluated. Finally, they apply the instruments to assess the effectiveness of the exercise, and discuss the results and their implications for the conduct of evaluations and the use of this particular participation mechanism. (shrink)

In June 2020, Gilead agreed to provide the USA with 500 000 doses of remdesivir—an antiviral drug which at that time was percieved to show promise in reducing the recovery time for patients with COVID-19. This quantity represented Gilead’s then full production capacity for July and 90% of its capacity for August and September. Similar deals are evident around access to proposed vaccines for COVID-19, and such deals are only likely to increase. These attempts to secure preferential access to medicines (...) and vaccines, so-called vaccine/treatment nationalism, jeopardise supplies of life-saving treatments and vaccines available elsewhere, and jeopardise global equitable distribution of such vaccines/treatments more generally. Much of the focus to date has been on States’ role in negotiating such deals. However, such developments also demonstrate the power patent holders have in controlling access to life-saving healthcare, determining who obtains access first and at what price. This article argues that the extent of control currently given to patent holders for COVID-19 must be questioned. This article demonstrates that patents have significant implications for healthcare acting as private governance tools over patented inventions. It is only by greater probing of patent holders’ role in delivering access to medicines, diagnostics and vaccines for COVID-19 that equitable global equitable access can be achieved. (shrink)

Contact between culturally distinct human groups in the contemporary ‘glocal’ -global and local- world is much greater than at any point in history. The challenge we face is the identification of the most convenient ways to organise the coexistence of different human language groups in order that we might promote their solidarity as members of the same culturally developed biological species. Processes of economic and political integration currently in motion are seeing increasing numbers of people seeking to become polyglots. Thus, (...) English is establishing itself as the usual world supra-language, although it coexists with other lingua francas that are widely used in certain parts of the globe. All this communicative reorganization of the human species may very well pose new problems and aggravate existing tensions as regards language and identity. It would seem that these processes comprise at least four major conceptual dimensions which must be taken into account above all else, as they are both widespread and, left unaddressed, may lead to significant social instability. These dimensions concern linguistic recognition, communicability, sustainability and integration. While accepting the utility of having an inter-national language, the keystone of the system is clearly that it must ensure the linguistic sustainability of each group. The basic principle is likely to be functional subsidiarity, i.e., whatever can be done by the local language should not be done by another one which is more global. As in the quote from Paracelsus --“the dose alone makes the poison”-- contact between languages is not ‘poisonous’ per se, but when the correct dose is exceeded it can prove harmful to the language whose position is weaker. A multilingual and communicated humanity is possible. (shrink)

In England, Wales and Scotland, the vast majority of abortions take place in the first trimester of pregnancy. In 2009, for example, 91% of abortions were carried out at under 13 weeks gestation for women resident in England and Wales. 1 Early abortion opens up the opportunity for a woman to have a medical abortion rather than a surgical abortion. Medical abortion is considered to be less invasive and less expensive than surgical abortion, and is increasingly becoming the preferred method. (...) 1 The proportion of medical abortions to surgical abortions has doubled in the last five years with 52% of abortions being medical abortions under 9 weeks gestation in 2009. A medical abortion typically involves taking mifepristone to block the hormones that help a pregnancy to continue, and then later on misoprostol, which makes the womb expel the embryo/fetus, usually within 4–6 h. Current legislation requires that both sets of drugs are administered in an NHS hospital or approved place, but women can go home after taking the second dose of drugs to complete the abortion. There has long been disagreement between the Department of Health and the British Pregnancy Advisory Services about what constitutes ‘any treatment for the termination of pregnancy’ under the Abortion Act 1967, specifically whether a woman taking the second set of drugs is considered to be undergoing the ‘treatment’ and is therefore required to be present in premises permitted under the Act. At the end of 2010, BPAS went to the High Court to challenge the Department of Health's view that the legislation requires women to take both sets of drugs in an approved place. BPAS argued that ‘treatment’ stops at the point of prescription and women should be able to go home, …. (shrink)

Stem cells are likely to be used as an alternate source of biological material for neural transplantation to treat Parkinson’s disease in the not too distant future. Among the several ethical criteria that must be fulfilled before proceeding with clinical research, a favourable benefit to risk ratio must be obtained. The potential benefits to the participant and to society are evaluated relative to the risks in an attempt to offer the participants a reasonable choice. Through examination of preclinical studies transplanting (...) stem cells in animals and the transplantation of fetal tissue in patients with Parkinson’s disease, a current set of potential benefits and risks for neural transplantation of stem cells in clinical research of Parkinson’s disease are derived. The potential benefits to research participants undergoing stem cell transplantation are relief of parkinsonian symptoms and decreasing doses of parkinsonian drugs. Transplantation of stem cells as a treatment for Parkinson’s disease may benefit society by providing knowledge that can be used to help determine better treatments in the future. The risks to research participants undergoing stem cell transplantation include tumour formation, inappropriate stem cell migration, immune rejection of transplanted stem cells, haemorrhage during neurosurgery and postoperative infection. Although some of these risks are general to neurosurgical transplantation and may not be reduced for participants, the potential risk of tumour formation and inappropriate stem cell migration must be minimised before obtaining a favourable potential benefit to risk calculus and to provide participants with a reasonable choice before they enrol in clinical studies. (shrink)

The promises of nanotechnology have been framed by a variety of metaphors, that not only channel the attention of the public, orient the questions asked by researchers, and convey epistemic choices closely linked to ethical preferences. In particular, the image of the ‘therapeutic missile’ commonly used to present targeted drug delivery devices emphasizes precision, control, surveillance and efficiency. Such values are highly praised in the current context of crisis of pharmaceutical innovation where military metaphors foster a general mobilization of (...) resources from multiple fields of cutting-edge research. The missile metaphor, reminiscent of Paul Ehrlich’s ‘magic bullet’, has framed the problem in simple terms: how to deliver the right dose in the right place at the right moment? Chemists, physicists and engineers who design multi-functional devices operating in vitro can think in such terms, as long as the devices are not actually operating through the messy environment of the body. A close look at what has been done and what remains to be done suggests that the metaphor of the “therapeutic missile” is neither sufficient, nor even necessary. Recent developments in nanomedicine suggest that therapeutic efficacy cannot be obtained without negotiating with the biological milieu and taking advantage of what it affords. An ‘oikological’ approach seems more appropriate, more heuristic and more promising than the popular missile. It is based on the view of organism as an oikos that has to be carefully managed. The dispositions of nanocapsules have to be coupled with the affordances of the environment. As it requires dealing with nanoparticles as relational entities (defined by their potential for interactions) rather than as stable substances (defined by intrinsic properties) this metaphor eventually might well change research priorities in nanotechnology in general. (shrink)

This thesis is intended t0 help develop the theory 0f coalgebras by, Hrst, taking classic theorems in the theory 0f universal algebras amd dualizing them and, second, developing an interna] 10gic for categories 0f coalgebras. We begin with an introduction t0 the categorical approach t0 algebras and the dual 110tion 0f coalgebras. Following this, we discuss (c0)a,lg€bra.s for 2. (c0)monad and develop 2. theory 0f regular subcoalgebras which will be used in the interna] logic. We also prove that categories 0f (...) coalgebras are completc, under reasonably weak conditions, and simultaneously prove the wellknown dual result for categories 0f algebras. We dose the second chapter with 2. discussion 0f bisimulations in which we introduce a weaker 110tion 0f bisimulaticn than is current in the literature, but which is w€H—b€ha.v€d and reduces t0 the standard defmition under the assumption 0f choice. (shrink)

Recent mutagenesis studies have demonstrated that the chemotherapeutic agent, chlorambucll (CHL), is highly mutagenic in male germ cells of the mouse. Post‐melotic germ cells, and especially early spermatids, are the most sensitive to the cytotoxic and mutagenic effects of this agent. Genetic, cytogenetic and molecular analyses of many induced mutations have shown that, in these germ‐cell stages, CHL induces predominantly chromosomal rearrangements (deletions and translocations), and mutation‐rate studies show that, in terms of tolerated doses, CHL is perhaps five to ten (...) times more efficient in inducing rearrangements than is radiation exposure. Appropriate breeding protocols, along with knowledge of the advantages and limitations associated with the use of CHL, can be used to expand the current resource of chromosomal rearrangements in the mouse and to provide new phenotype‐associated mutations amenable to positional‐cloning techniques. The analysis of CHL‐induced mutations has also contributed to understanding the factors that affect the yield and nature of chemically induced germline mutations in mammals. (shrink)

This paper examines the culture, the dynamics and the financial underpinnings that determine how medical research is being conducted on children in the United States. Children have increasingly become the subject of experiments that offer them no potential direct benefit but expose them to risks of harm and pain. A wide range of such experiments will be examined, including a lethal heartburn drug test, the experimental insertion of a pacemaker, an invasive insulin infusion experiment, and a fenfluramine "violence prediction" experiment. (...) Emphasis, however, is given to psychoactive drug tests because of the inherent ethical and diagnostic problems involved in the absence of any objective, verifiable diagnostic tool. Effort is made to provide readers comprehensive reference sources to evidence-based reports about the serious risks these drugs pose for adults and children so that the reader may judge whether the benefits (if any) outweigh the risks for children. The first ethical issue raised by these experiments is: did the severity of illness in these children justify their exposure to short and long-term risks? The ethics of the experiments will be evaluated by referring to existing codes of medical research ethics-the Nuremberg Code, the Declaration of Helsinki, and the federal Code of Regulations. The thirteen cases presented will demonstrate that children are being used in ever more speculative experiments, often in the absence of a therapeutic intent, but a significant chance for causing harm and / or discomfort. Some of the experiments were designed to explore the mechanisms of pathology and pharmacological interventions, or the response of neurological brain receptors to chemical provocation ("challenge"). Others were designed to test the safety or efficacy of new drugs, even to test these drugs on healthy children who were hypothesized to be "at risk." Children and adolescents have been subjected to "forced dose titration" experiments that induced a spectrum of severe adverse effects, including insomnia, extreme restlessness, agitation, (akathisia) and self-injurious behavior. FDA reports show that suicide is a significant issue in psychotropic drug trials-in pediatric trials the problem is even greater. The paper aims to demonstrate how the enactment of the Better Pharmaceuticals for Children Act (incorporated into the Food and Drug Administration Modernization Act, FDAMA), set in motion a radical shift in public policy by providing huge financial incentives to pharmaceutical companies to test new or patented drugs in children. Federal policy shifted from one aimed at protecting children by setting limits on permissible research risks, to a policy aimed at broadening the inclusion of children as test subjects. It will be shown how the FDA and the Department of Health and Human Services lifted regulatory restrictions to permit research involving greater than minimal risk to be conducted on healthy children, claiming that all children are potentially "at risk" of a future condition. Children were in this way deprived of regulatory protections. An argument will be made that the approval of nontherapeutic, harmful experiments-such as exposure of toddlers to lead poison-under the current gate keeping system raises serious doubts about the sustainability of institutional review boards (IRBs) as protectors of human research subjects. Children, who are precluded from exercising the adult human's right to informed consent, are being exploited as commodities for commercial ends. It is the position of the author that nothing less than the enactment of a federal law mandating a radical overhaul of the current research review system, with independent checks and balances, will provide children the legal protections they need. Ten specific recommendations are offered to protect children from harmful experiments. (shrink)

This is a response to an article by Wade Allison in which he argues that we should accept drastically higher doses of ionizing radiation than what we currently do. He employs four arguments in defence of his position: comparisons with background radiation, the positive experiences of radiotherapy, the presence of biological defence mechanisms against radiation, and a concession by Swedish authorities that their approach to reindeer meat after the Chernobyl fallout was unnecessarily strict. It is shown that each of the (...) four arguments is fallacious. In conclusion, the traditional weighing of risks against benefits in radiation protection is defended. (shrink)

The U.S. FDA has issued emergency use authorizations for monoclonal antibodies for non-hospitalized patients with mild or moderate COVID-19 disease and for individuals exposed to COVID-19 as post-exposure prophylaxis. One EUA for an oral antiviral drug, molnupiravir, has also been recommended by FDA’s Antimicrobial Drugs Advisory Committee, and others appear likely in the near future. Due to increased demand because of the Delta variant, the federal government resumed control over the supply and asked states to ration doses. As future variants (...) with increased infectivity and/or severity emerge, further rationing may be required. We identify relevant ethical principles and priority groups for access to therapies based on an integrated approach to population health and medical factors. Using priority categories to allocate scarce therapies effectively operationalizes important ethical values. This strategy is preferable to the current approach of categorical rules based on vaccination, immunocompromise status, or older age, or the ad hoc consideration of clinical risk factors. (shrink)

Recent developments in the scientific realism debate have resulted in a form of ‘exemplar driven’ realism that eschews general ‘recipes’ and instead focuses on the specific, ‘local’ reasons for adopting a realist stance in particular theoretical contexts. Here I suggest that such a move highlights even more sharply the need for the realist to incorporate a health dose of metaphysics in her position, particularly when it comes to the theories associated with modern physics. Turning to another set of recent (...) developments, having to do with the relationship between metaphysics and science, I argue that the exemplar driven realist can appropriate certain current metaphysical devices to help make concrete her commitments. Specifically I focus on a kind of exemplar based structural realism and examine the adequacy of, first, the determinables-determinate relationship as presented by Wilson and, second, Paul’s ‘one category ontology, as such devices within this framework. (shrink)

This paper provides a critique of the contemporary notion of intellectual property based on the consequences of Wittgenstein's “private language argument”. The reticence commonly felt toward recent applications of patent law, e.g., sports moves, is held to expose erroneous metaphysical assumptions inherent in the spirit of current IP legislation. It is argued that the modern conception of intellectual property as a kind of natural right, stems from the mistaken internalist or Augustinian picture of language that Wittgenstein attempted to diffuse. (...) This view becomes persuasive once it is shown that a complete understanding of the argument against private language must include Wittgenstein's investigation of the role of the will in the creative process. It is argued that original thought is not born by decree of the will, but engendered by a public context of meaning and value. What marks a person as a genius is, therefore, according to Wittgenstein, not some sovereign capacity of conceptual world-making, but merely a propitious dose of intellectual courage. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Aesthetics, Education, the Critical Autonomous Self, and the Culture IndustryMarianna Papastephanou (bio)IntroductionE Lucevan le Stelle disconnected both from Tosca and Puccini becomes incidental music and brings strong recollections of the detergent advertisement it once coated. Last Year in Marienbad has caused some of the deepest yawn relief to many hopefuls for the title of the sophisticated who wished to cash out the film's cultural and social capital. A painting (...) by a well-known artist in the living room of a middle-upper-class residence often matches the colors of the carpet, and a piece of African art in the corner testifies to the hosts' cosmopolitan respect for otherness and the proper dose of hybridity in their selfhood. The young of the family are said to search for freedom from the puritan lifestyle in Ecstasis. Or, they rebel against the oppressive order of the system through idolizing music bands of an unconventional style and, as a matter of fact, of "unconventional" wealth accumulated precisely through the systemic exploitation of their idolization. The whole family, including the discontented young, will unite in the enjoyment of a new movie in which, just as in hundreds before it, police detectives can solve cases only after their suspension from duty and foreigners prefer to converse in perfect English when they are alone. What all members of the family are sure of by the end of the day, some of them through the prism of heavy drinking and others in the sober appreciation of the latest reality show, is that they exercised once again their free will in all instances. For they oriented their desires, treated as natural and self-posited, to objects they initially lacked but "autonomously" and "critically" found and selected from a rich and all-encompassing marketplace of culture. [End Page 75]How are art, its education, and its educational ideals of autonomy and critique related to this particular cultural reality that I have highlighted? Pseudo-individualism, escapism, Ersatzbefriedigung, fetishization, reification, and educationalization are some of the terms Adorno employed to approach the reality of artistic production and reception in capitalist times while preserving the distance that art offers for critiquing reality.1 In contrast with the above-sketched reality, in Adorno's ultimate aesthetic vision through art the self is not supposed to "forget in dreams the present world, but to change it by the strength of an image."2 Adorno attacks the drive toward a "totally administered" society—that of late capitalism—which "reduces every aspect of present-day life to the dead level of conformist popular 'taste' as dictated by a wholesale culture industry given over to the purposes of mass indoctrination."3 Fundamentally, the culture industry hinders the formation of autonomous, critical, and independent individuals.4I shall argue that such a theoretical framework gives us additional insight through which to combat what has already been perceived in pedagogical discourse as educational inability to cultivate reflective and critical subjectivities. Instead of autonomy, education nurtures narcissism. and instead of critique, it promotes appeasement5 —all the more so when education succumbs to the culture industry or fails to encourage students' critical stance to its imperatives.My position here is that by reclaiming their own valuable connection to reflective artistic experience and reception, aesthetic theory and art education can contribute to a reconceptualization of autonomy and critique and, perhaps more importantly, to a reorientation of educational practice.6 Adorno's aesthetics is exceptionally relevant to this aim because his work exemplifies in a unique way the necessary awareness of the antinomic qualities of autonomy and critique, their ineluctable dependence on society and culture, and their secret culpability in domination. Moreover, Adorno's cultural criticism comprises an unsurpassable diagnosis of those social pathologies that leads away from critical and reflective subjectivity and offers conceptual means for setting a critical eye on some current impoverished practices of teaching art. Above all, Adorno's aesthetic theory displays a remarkable topicality regarding contemporary positions on purely artistic concerns and contentions. Thus, the current neglect of his work in aesthetic educational theory7 must be dealt with since accommodation of such aesthetics within art educational discourse will serve significantly the latter's... (shrink)

One of the most striking phenomena of our time is the climate of uncertainty and confusion about fundamental norms and values. It has even been observed that the movement of modern science and technology has eroded the foundations from which norms could be derived. Meanwhile, in this time of confusion ethics is observed to be blossoming as never before in our universities. This paper addresses the question how assured we can be that a hefty dose of ethics in science (...) and the university is an appropriate medicine for the problems of the modern age. A roundabout route is taken. Our analysis begins not with the current problem of norms and values but with another characteristic feature of our century, namely the spiraling course of science and technology. Some initial critical reflections on the widespread view of the autonomy of science and technology suggest that in the technological society we face problems our theoretical toolkit is not outfitted to deal with. Traditionally, ethics has been concerned with the regulation of human action between individual human subjects. The need and possibilities for an ethics for collective human action or for an ethics on a systems level is indicated. It is concluded that today perhaps more than ever, science and the university have an important task to fulfill. (shrink)

Selective serotonin reuptake inhibitors’ wide use, combined with the blurry limit between health and psychological illness, have led neuroscientists, clinicians and ethicists to envision the possibility of these medications’ use in non-clinical populations. This prospect has evoked ethical debates, which have often ignored the findings of the empirical literature. In this context, an evaluation of the empirical evidence for SSRIs’ personality enhancing effects is needed. The present paper examines SSRIs’ effects on healthy personality, including the Five Factor Model traits Neuroticism (...) and Extraversion, as well as some of their facets: Angry Hostility, Impulsiveness, Vulnerability, Warmth, Gregariousness and Assertiveness. The review encompasses investigations in healthy humans, human clinical populations, as well as relevant animal studies. Emerging data raise the possibility that SSRIs, when used by people without a currently diagnosable mental disorder, may reduce some facets of Neuroticism, especially Angry Hostility. On the other hand, very limited support exists for an SSRI-driven change in other Neuroticism facets, such as Impulsiveness, in healthy humans. An increase in Extraversion is possible, but currently available evidence is only indirect. Future research is needed, both to clarify methodological ambiguities in existing studies, and to answer unaddressed questions, such as ones of the stability, predictors, moderators, dose- and context-dependency of the effects. (shrink)

Half of the 33.2 million people living with HIV today are women. Yet, responses to the epidemic are not adequately meeting the needs of women. This article critically evaluates how prevention of mother-to-child transmission (PMTCT) programs, the principal framework under which women's health is currently addressed in the global response to AIDS, have tended to focus on the prevention of HIV transmission from HIV-positive women to their infants. This paper concludes that more than ten years after their inception, PMTCT programs (...) still do not successfully ensure the adequate treatment, care and support of HIV-infected women. Of particular concern is the continued widespread use of single-dose nevirapine despite World Health Organization recommendations to employ more effective combination therapies that do not potentially jeopardize women's future treatment outcomes. In response, the article calls for a more comprehensive approach that places women's health needs at the centre of AIDS responses. This is critical in settings where the pandemic is generalized and there is a push to greatly expand PMTCT programs, as a more effective and equitable way of meeting the needs of women in the context of HIV. Without such a comprehensive approach, women will continue to be impacted disproportionately by the pandemic, and current strategies for prevention, including PMTCT, and treatment will not be as effective and responsive as they need to be. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Criminal Law, Pain Relief, and Physician Aid in DyingFaye Girsh, Ed.D., Executive DirectorMadam:The article by Cantor and Thomas on “Pain Relief, Acceleration of Death, and Criminal Law” (KIEJ, June 1996) was a tortured attempt to develop criteria for the humane and compassionate physician who tries to serve the needs of a patient in unremitting pain. There are three areas that merit comment.The authors dealt with pain medications that might (...) have the undesirable side effect of causing death. They did not mention tolerance, which usually occurs in a patient with chronic pain and which would require exceedingly high doses to be effective. They did not mention barbiturates, which are preferable to opiates in causing death and which are used increasingly by compassionate physicians to answer the pleas of their suffering patients, but for which there is no excuse about alleviating pain. Would the criminal law just call the prescription of a lethal dose of barbiturates a reckless act and require conviction? Fortunately, juries, as the authors point out, do not balance these formulas on the head of a pin. When they see the circumstances under which these doctors do help their patients, they choose to nullify the law and would ignore the suggestions made in this article.The authors refer to the “consent” of the patient. They do not mention that these doctors are operating with more than consent; they are administering these medications because suffering patients are begging them to put them out of their pain and the indignities of the dying process. The article discusses the process as though it were the same as consent to elective surgery. These patients—with AIDS, cancer, and hopeless neurological degeneration—are not simply agreeing to a procedure; they are desperately seeking a way out. If the criminal law were to develop criteria for physician aid in dying, certainly one of them should be the active, witnessed, repeated request of such a patient for a certain, quick, painless, gentle death.The third point is that physicians do not face prosecution when administering no treatment to a patient whose life could be saved with treatment but who chooses not to receive it. This has been upheld by the U.S. Supreme Court; no criteria for suffering, alternatives, terminality, justifiability, or unbearability are required. The doctor can stand by while the patient dies what may be a protracted, difficult death, but it is within the law. What matters in this situation is the decision of the patient to refuse treatment, and that is absolute. How ironic that the patient who cannot refuse treatment must, with his or her doctor, jump through all these hoops to achieve a peaceful death.One worries that the physician who must balance the risk of “risky pain relief” against the accusation of recklessness will err in the direction of allowing [End Page 103] the patient to bear the pain rather than help with a dose of analgesics that might be considered beyond the stipulated “risk.”Why don’t we just be honest about it? Allow dying or hopelessly ill patients to make the decision about what they want by passing a carefully defined law allowing euthanasia rather than balancing the risk and trying to determine the “purpose” of the physician’s ministrations. We protect some patients from themselves while allowing others almost complete autonomy to make the choice of ending their lives. The authors were right in saying that proponents of rational laws consider this sheer hypocrisy.Faye Girsh, Executive DirectorHemlock Society U.S.A. Denver, COFaye Girsh misconceives our article’s objective as an “attempt to develop criteria” for the humane physician. Our goal in writing the paper was to analyze the current criminal law framework in the hope of sharpening debate and engendering normative critiques. We readily acknowledge tensions in the current legal framework and would support changes in that framework.Copyright © 1997 The Johns Hopkins University Press... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Living with Blindness and Fibromyalgia while Occupying AgingKatherine SchneiderI’m blind from birth and in middle age developed fibromyalgia. I’ve retired from a thirty year career as a clinical psychologist and am working on my third book tentatively titled “Occupying Aging: Delights, Disabilities and Daily Life.” My relationship with medical professionals includes gratitude (without good care I would not be alive) and also frustration for assumptions often made about my (...) abilities. I write from the perspectives of an impatient patient, woman living in the United States, former provider of mental health services, person with both invisible and visible disabilities, and boomer moving into the world of the aged. My stories are mine of course, but when I swap medical stories with blind friends, similar happenings abound.When my mom fell down the stairs at a friend’s house, five months pregnant with me, she was told to go to bed for the next four months to save the pregnancy. Thus began the impact of health care professionals on me. I was born a month premature and spent my first month in an incubator. In 1949 it wasn’t known that the enriched oxygen atmosphere in an incubator would cause blindness. At least one lawsuit was filed against physicians and a hospital by a person blinded in this way. A large out–of–court settlement was received. The way I look at it, the health care community did the best they knew and without enough oxygen, I would have died.Early in my life, my parents took me to several ophthalmologists to see what could be done for my vision. Family folklore has it that I could smell a hospital as we entered and would begin howling. These early traumatic experiences may have led to my current healthy lifestyle so I don’t have to go to doctors much now. By about age five, it was clear that nothing could be done about my vision. For the next twenty years my forays into the health care system were for tonsillitis, sprains, and the usual childhood ills.In my early twenties, I developed acute glaucoma in one eye—caused, I’m convinced, by birth control pills. In seeking treatment for this condition, I encountered the first truly insensitive physician I’d met, who said, “Your eyes aren’t doing you any good; let’s take them out.” I was horrified! They were my eyes. I was attached to them, psychologically as well as physically. It turned out that a simple operation relieved the pressure and allowed me to keep my eyes. True, they are not the best looking big brown eyes around, but they did come with the package.Life with blindness seemed quite straightforward until my early forties, when I developed extreme fatigue and pain all over. I was worried. I knew a blind woman who had developed multiple sclerosis and I admired her, but I did not want to walk in her brave footsteps. Then a college student came to see me with the same symptoms and said that she had recently been diagnosed with fibromyalgia. I am often very empathetic with people’s concerns, but this time she complimented me by saying, “You’re great! You seem to know just how I feel.” I sagely counseled her about portioning out her energy carefully, prioritizing, using short cuts, and taking elevators when possible. Being an adult [End Page 216] student used to overachieving, she did not like what I was saying, but said she’d try to follow my advice because she could no longer do it all.What finally broke through my own denial was the day coiling up a hose and dragging it to the basement for the winter took me an hour. It left me totally exhausted and I figured that even being middle aged couldn’t account for feeling that awful.After a thorough physical and plenty of blood work to rule out Lyme disease and multiple sclerosis, I was diagnosed with fibromyalgia and placed on low doses of antidepressants to help me sleep through the night. The medication worked and I began to feel like myself again. My battle to accept that... (shrink)

This article proposes the adoption of a multi-modal system for allocating vaccine doses during large transnational outbreaks of infectious diseases. The chosen allocative criteria (public health need; country-income level; qualification through funding; and, subsidiarily, a modified lottery system) are adapted from a current embodiment of allocative multi-modality outside the context of public health: the New York City Marathon.