BackgroundThe pharmaceutical market in Bangladesh is highly concentrated. Due to high competition aggressive marketing strategies are adopted for greater market share, which sometimes cross limit. There is lack of data on this aspect in Bangladesh. This exploratory study aimed to fill this gap by investigating current promotional practices of the pharmaceutical companies including the role of their medical representatives.MethodsThis qualitative study was conducted as part of a larger study to explore the status of governance in health (...) sector in 2009. Data were collected from Dhaka, Chittagong and Bogra districts through in-depth interview, observation, and round table discussion.ResultsFindings reveal a highly structured system geared to generate prescriptions and ensure market share instituted by the pharmaceuticals. A comprehensive training curriculum for the MRs prepares the newly recruited science graduates for generating enough prescriptions by catering to the identified needs and demands of the physicians expressed or otherwise, and thus grab higher market-share for the companies they represent. Approaches such as inducements, persuasion, emotional blackmail, serving family members, etc. are used. The type, quantity and quality of inducements offered to the physicians depend upon his/her capacity to produce prescriptions. The popular physicians are cultivated meticulously by the MRs to establish brand loyalty and fulfill individual and company targets. The physicians, willingly or unwillingly, become part of the system with few exceptions. Neither the regulatory authority nor the professional or consumer rights bodies has any role to control or ractify the process.ConclusionsThe aggressive marketing of the pharmaceutical companies compel their MRs, programmed to maximize market share, to adopt unethical means if and when necessary. When medicines are prescribed and dispensed more for financial interests than for needs of the patients, it reflects system’s failed ability to hold individuals and entities accountable for adhering to basic professional ethics, code of conduct, and statutory laws. (shrink)

Pharmaceutical promotion is a negative influencing force for prescribing. However, very few regulatory initiatives are taken to overcome this unwarranted influence. The present research was conducted in such context with an attempt to review the regulatory documents related to pharmaceutical promotion in Bangladesh including Code of Pharmaceutical Marketing Practices (CPMP), and to compare CPMP with different global guidelines. The studied guidelines demonstrate effort to regulate promotion, though that varies to a great extent, particularly in (...) enforcement aspects. Clearly defined ethical and legal prohibitions, provisions of punishment for violations and entrusted agency with defined authority are crucial. (shrink)

This paper explains how the current architecture of the pharmaceutical markets has created a misalignment of financial incentives and public health that is a central cause of harmful practices. It explores three possible solutions to address that misalignment: taxes, increased financial penalties, and drug pricing based on value. Each proposal could help to partly realign financial incentives and public health. However, because of the limits of each proposal, there is no easy solution to fixing the problem of financial (...) incentives. (shrink)

This article argues that the misalignment of private profit-maximizing objectives with public health needs causes institutional corruption in the pharmaceutical sector and systematically leads firms to act contrary to public heath. The article analyzes how financial incentives generate a business model promoting harmful practices and explores several means of realigning financial incentives in order to foster therapeutic innovation and promote the rational use of medicines.

In a perfect world, physicians and drug producers would have only one goal: to advance the health of their patients. Unfortunately, ours is not a perfect world. While every physician’s prime responsibility—by oath and by law—is to the patient, every pharmaceutical producer’s first and foremost obligation, by design, is to shareholders and employees. Their ultimate objectives are diagonally diverse. This situation calls for a code of ethics to govern the marketing and prescription of pharmaceuticals. This paper attempts (...) to identifythe business practices prevailing in the Indian pharmaceutical industry, in order to provide a basis for constructing an appropriate code of ethics. The research is based on surveys or in-depth interviews of physicians, patients, retail pharmacists, and drug manufacturers. (shrink)

With the passage of the Physician Payment Sunshine Act as part of the federal health care reform law, pharmaceutical manufacturers are now required to disclose a wide range of payments made by manufacturers to physicians. We review current state regulation of pharmaceutical marketing and consider how the federal sunshine provision will affect existing marketing regulation. We analyze the legal and practical implications of the Physician Payment Sunshine Act.

In 2008 pharmaceutical companies spent over $12 billion on product promotion and detailing aimed at U.S. health care practitioners. Drug and device manufacturers rely on a workforce of detailers and physician speakers to reach health care practitioners and nudge their prescribing habits. To prevent undue influence and protect the public fisc, a number of states began regulating these marketing practices, requiring companies to disclose all gifts to practitioners, prohibiting the commercialized sale of prescription data, and prohibiting certain (...) gifts altogether. The 2010 enactment of the Physician Payment Sunshine Act marks the first Congressional involvement in the regulation of disclosure related to pharmaceutical marketing. Overall, the Act improves transparency in pharmaceutical marketing to physicians and expands the regulation of disclosure of pharmaceutical marketing activities in important substantive ways. (shrink)

BackgroundThe International Committee of Medical Journal Editors Recommendations set ethical and editorial standards for article publication in most leading medical journals. Here, I examine the strengths and weaknesses of the Recommendations in the prevention of commercial bias in industry-financed journal literature, on three levels – scholarly discourse, article content, and article attribution.DiscussionWith respect to overall discourse, the most important measures in the ICMJE Recommendations are for enforcing clinical trial registration and controlling duplicate publication. With respect to article content, the ICMJE (...) promotes stringent author accountability and adherence to established reporting standards. However, the ICMJE accepts the use of commercial editorial teams to produce manuscripts, which is a potential source of bias, and accepts private company ownership and analysis of clinical trial data. New ICMJE guidance on data sharing will address but not eliminate problems of commercial data access. With respect to attribution, the Recommendations oppose guest authorship and encourage clear documentation of author contributions. However, they exclude writers from coauthorship; provide no specific advice on the attribution of commercial literature, for instance with respect to company authorship, author sequence or prominent commercial labeling; and endorse the use of fine print and euphemism. The ICMJE requires detailed author interest disclosures, but overlooks the interests of non-authors and companies, and does not recommend that interests most salient to the publication are highlighted. Together, these weaknesses facilitate “advocacy”-based marketing, in which literature planned, financed and produced by companies is fronted by academics, enabling commercial messages to be presented to customers by their respected clinical peers rather than companies themselves.ConclusionsThe ICMJE Recommendations set important research and reporting standards, without which commercial bias would likely be a significantly greater problem than it is today. However, they also support practices of commercial data control, content development and attribution that run counter to science’s values of openness, objectivity and truthfulness. These weaknesses could be addressed with appropriate modifications to the Recommendations. The ICMJE should also disclose its own commercial interests and funding – not least because publishing organizations that finance it and pay the salaries of some member editors derive substantial revenues from industry. (shrink)

Post-industrial societies confront common problems in pharmaceutical industry-physician relations. In order to promote sales, drug firms create financial relationships that influence physicians' prescriptions and sometimes even reward physicians for prescribing drugs. Three main types exist: kickbacks, gifts, and financial support for professional activities. The prevalence of these practices has evolved over time in response to changes in professional codes, law, and markets. There are certainly differences among these types of ties, but all of them can compromise physicians' independent (...) judgment and rational prescribing.Drug firms have paid kickbacks for prescribing drugs, purchasing drugs, switching brands prescribed, adding a drug to a hospital formulary, enrolling patients in post-marketing clinical trials, and writing practice guidelines that encourage the use of certain drugs. (shrink)

This article is a response to the public consultation on the draft Code of Practice issued by the Human Tissue Authority on the import and export of human bodies, body parts and tissue. The question is whether the Draft Code and the Human Tissue Act go far enough to prevent the unethical acquisition and movement of human tissue. I conclude that the answer to this question is ‘no’ and go on to demonstrate how the identified deficiencies can be (...) remedied. (shrink)

Direct-to-consumer advertising of healthcare products refers to a variety of marketing practices based on a combination of information and promotion strategies directed at consumers through different media such as radio and television broadcasts, newspaper and magazine ads, and, more recently, through the Internet. The principal form of marketing used by the pharmaceutical industry is the distribution of free samples to physicians but DTCA is an increasing part of global promotional spending for prescription drugs. Latest estimates suggest (...) that DTCA now represents an annual $3.2 billion enterprise for the U.S. pharmaceutical industry. Findings from the literature show that these substantial efforts are geared toward the newer pharmaceuticals for chronic conditions with huge market potentials. The lion's share is going to the 20 most prescribed pharmaceuticals. (shrink)

The pressure on companies to practice corporate social responsibility (CSR) has gained momentum in recent times as a means of sustaining competitive advantage in business. The pharmaceutical industry has been acutely affected by this trend. While pharmaceutical product recalls have become rampant and increased dramatically in recent years, no comprehensive study has been conducted to study the effects of announcements of recalls on the shareholder returns of pharmaceutical companies. As product recalls could significantly damage a company's reputation, (...) profitability and brand integrity, this paper investigates the effect on shareholder wealth and the extent to which the adoption of CSR practices by pharmaceutical companies in the United Kingdom (U.K.) and the United States (U.S.), the two largest markets for pharmaceutical products in the world, affected market reactions surrounding product recall announcements. The analysis of product recall announcements from 1998 to 2004 compiled from The Pharmaceutical Journal and U.S. Food and Drug Administration enforcement reports revealed marked differences in the way market participants in the two countries responded to news of product recalls. U.S. investors penalised firms according to the severity of product defects while U.K. investors were indifferent. While U.K. investors rewarded product recalls by firms which were not usually CSR-active, U.S. investors punished non-CSR active firms that performed recalls. These observations could pose strategic challenges to pharmaceutical firms operating in both countries. (shrink)

The best studies on the relationship between pharmaceutical corporations and medicine have recognized that it is an ambiguous one. Yet most scholarship has pursued a simpler, more saleable narrative in which pharma is a scheming villain and medicine its maidenly victim. In this article, I argue that such crude moral framing blunts understanding of the murky realities of medicine's relationship with pharma and, in consequence, holds back reform. My goal is to put matters right in respect to one critical (...) area of scholarly interest, the medical journal publication.Pharma relies on peer advocacy to sell its wares to prescribing doctors. This is an arrangement in which clinicians’ qualified colleagues, including “key opinion leaders,” are recruited by pharmaceutical corporations and marketing agencies to deliver commercially expedient content to their professional fellows. Precisely how this practice works in the setting of publications is not well understood because ethicists studying the problem have made too much of the narrative of corporate villainy and medical victimhood. Accordingly, criticism of industry publications has been preoccupied with the crudely dishonest practices of ghostwriting, ghost authorship, and “ghost management,” vices condemned as “dirty little secrets” perpetrated from “behind the scenes” with the connivance of academic “shills” or “guest authors,” in contempt of standards set by the International Committee of Medical Journal Editors. This account is appealing, and yet it is wrong or, at the very least, seriously incomplete, with only limited relevance to the actualities of contemporary industry practices. In truth, many commercial publications are not developed in secret but fashioned within a culture of open collaboration, where academic authors make substantial, independent contributions; pharmaceutical companies are showcased rather than hidden; and medicine's editorial standards assist rather than impede the workings of commerce. (shrink)

This study investigated effects of codes of ethics on perceptions of ethical behavior. Respondents from companies with codes of ethics (n = 465) rated role set members (top management, supervisors, peers, subordinates, self) as more ethical and felt more encouraged and supported for ethical behavior than respondents from companies without codes (n = 301). Key aspects of the organizational climate, such as supportiveness for ethical behavior, freedom to act ethically, and satisfaction with the outcome of ethical problems were impacted by (...) the presence of an ethics code. The mere presence of a code of ethics appears to have a positive impact on perceptions of ethical behavior in organizations, even when respondents cannot recall specific content of the code. (shrink)

Arguing that ecological thinking can animate an epistemology capable of addressing feminist, multicultural, and other post-colonial concerns, this book critiques the instrumental rationality, hyperbolized autonomy, abstract individualism, and exploitation of people and places that western epistemologies of mastery have legitimated. It proposes a politics of epistemic location, sensitive to the interplay of particularity and diversity, and focused on responsible epistemic practices. Starting from an epistemological approach implicit in Rachel Carson’s scientific projects, the book draws, constructively and critically, on ecological (...) theory and practice, on (post-Quinean) naturalized epistemology, and on feminist and post-colonial theory. Analyzing extended examples from developmental psychology, from medicine and law, and from circumstances where vulnerability, credibility, and public trust are at issue, the argument addresses the constitutive part played by an instituted social imaginary in shaping and regulating human lives. The practices and examples discussed invoke the responsibility requirements central to this text’s larger purpose of imagining, crafting, articulating a creative, innovative, instituting social imaginary, committed to interrogating entrenched hierarchical social structures, en route to enacting principles of ideal cohabitation. (shrink)

The main purpose of this article is to analyse one aspect of Spanish business ethics: the role of the transparency and quality of the economic and financial information given to meet the demands and requirements of shareholders. To that end we concentrate firstly on analysing the Spanish capital market and the situation of shareholders prior to the publication in February 1988 of the Code of Best Practice for Spanish Companies, drawn up by a Special Committee created at the request (...) of the Ministry of Economy and Finance. We analyse the importance of the behaviour and actions of three groups which are fundamental to assuring quality and transparency of information: those who prepare financial statements, the Board of Directors (particularly the Audit Committee) and the external auditors. Finally, we look at the possible consequences of the Code of Best Practice on Spanish business ethics. (shrink)

The essays in Rhetorical Spaces grow out of Lorraine Code's ongoing commitment to engaging philosophical issues as they figure in people's everyday lives. The arguements in this book are informed at once by the moral-political implications of how knowledge is produced and circulated and by issues of gendered subjectivity. In their critical dimension, these lucid essays engage with the incapacity of the philosophical mainstream's dominant epistemologies to offer regulative principles that guide people in the epistemic projects that figure centrally (...) in their lives. In its constructive dimension, Rhetorical Spaces focuses on developing productive, case-by-case analyses of knowing other people in situations where social-political inequalities create asymmetrical patterns of epistemic power and privilege. Framing all of the essays is the conception of rhetorical spaces which shows that prevailing intellectual-political climates can work to enhance or to thwart possibilities of establishing cognitive authority for the members of a society who belong to groups other than the dominant ones. Finally, bridging the gap between theory and practice, Lorraine Code shows how the issue of reconfiguring structures of authority and expertise are not just matters of individual responsibility, but require a radical restructuring of the communities and social orders in which people know and act. (shrink)

The rapid and dynamic nature of digital transformation challenges companies that wish to develop and deploy novel digital technologies. Like other actors faced with this transformation, companies need to find robust ways to ethically guide their innovations and business decisions. Digital ethics has recently featured in a plethora of both practical corporate guidelines and compilations of high-level principles, but there remains a gap concerning the development of sound ethical guidance in specific business contexts. As a multinational science and technology company (...) faced with a broad range of digital ventures and associated ethical challenges, Merck KGaA has laid the foundations for bridging this gap by developing a Code of Digital Ethics (CoDE) tailored for this context. Following a comprehensive analysis of existing digital ethics guidelines, we used a reconstructive social research approach to identify 20 relevant principles and derive a code designed as a multi-purpose tool. Versatility was prioritised by defining non-prescriptive guidelines that are open to different perspectives and thus well-suited for operationalisation for varied business purposes. We also chose a clear nested structure that highlights the relationships between five core and fifteen subsidiary principles as well as the different levels of reference—data and algorithmic systems—to which they apply. The CoDE will serve Merck KGaA and its new Digital Ethics Advisory Panel to guide ethical reflection, evaluation and decision-making across the full spectrum of digital developments encountered and undertaken by the company whilst also offering an opportunity to increase transparency for external partners, and thus trust. (shrink)

Naturalized moral epistemology eschews practices of assuming to know a priori the nature of situations and experiences that require moral deliberation. Thus it promises to close a gap between formal ethical theories and circumstances where people need guidelines for action. Yet according experience so central a place in inquiry risks "naturalizing" it, treating it as incontestable, separating its moral and political dimensions. This essay discusses these issues with reference to Margaret Walker's Moral understandings.

What does unethical behavior look like in everyday professional practice, and how might it become the accepted norm? Examinations of unethical behavior often focus on failures of individual morality or on psychological blind spots, yet unethical behaviors are generated and performed through social interactions across professional practices rather than by individual actors alone. This shifts the focus of behavioral ethics research beyond the laboratory exploring motivation and cognition and into the organizations and professions where unethical behavior is motivated, justified, (...) enabled and supported in specific social contexts. For instance, when pharmaceutical firms fund academic research, how do the funding arrangements intersect with individual behaviors that are typical in academic research? In turn, how do academic-industry interactions affect scientific norms, particularly those involving compliance with rules, regulations, and ethical codes of conduct? A social organization approach to ethics allows us not only to examine ethics in practice, but also to tease apart unethical behaviors that might operate on an unreflective level and become accepted as “just the way it is.”. (shrink)

I evaluate post-Quinean naturalized epistemology as a resource for postcolonial and feminist epistemology. I argue that naturalistic inquiry into material conditions and institutions of knowledge production has most to offer epistemologists committed to maintaining continuity with the knowledge production of specifically located knowers. Yet naturalistic denigrations of folk epistemic practices and stereotyped, hence often oppressive, readings of human nature challenge the naturalness of the nature they claim to study. I outline an ecologically modelled epistemology that focuses on questions of (...) epistemic responsibility and community, while refusing the reductivism of totalizing theory, and producing realistic moral-epistemic analyses of specific, local epistemic resources to ground its normative injunctions. (shrink)

I offer an examination of trust relations in scientific inquiry as they seem to contrast with a lack of trust in an example of knowledge imposed from above by an unaccountable institutional power structure. On this basis I argue for a re-reading of John Hardwig's account of the place of trust in knowledge, and suggest that it translates less well than social epistemologists and others have assumed into a model for democratic epistemic practice.

The federal government indirectly subsidizes the pharmaceutical industry by funding basic research, various tax credits and deductions, patent rules, grants of market exclusivity, and other means, in order to spur drug development, promote public health, and improve medical care. But today, the pharmaceutical industry often neglects these goals and sometimes even undermines them, due to what Lawrence Lessig refers to as institutional corruption — that is, widespread or systemic practices, usually legal, that undermine an institution’s objectives or (...) integrity. A key source of institutional corruption is improper dependence by the institution or its key actors on the actions of third parties that have fundamentally different interests. It is the health care system’s improper dependency on pharmaceutical firms that allows them to displace some public policy goals and to compromise the attainment of others. (shrink)

Images of and references to women are so rare in the vast corpus of his published work that there seems to be no "woman question" for Hans-Georg Gadamer. Yet the authors of the fifteen essays included in this volume show that it is possible to read past Gadamer's silences about women and other Others to find rich resources for feminist theory and practice in his views of science, language, history, knowledge, medicine, and literature. While the essayists find much of value (...) in Gadamer's work, he emerges from their discussion as a controversial figure. Some contributors see him as promoting genuine respect for and engagement with Otherness: others claim that in a Gadamerian conversation the Other has no voice. For some, Gadamer's immersion in tradition is an impediment to feminist inquiry; for others, cognizant of the need to understand tradition well in order to contest its intransigence or benefit from its insights, his way of engaging tradition is especially productive. Some contributors take issue with the separation he maintains between philosophy and politics; others find problems in his relative silence on matters of embodiment; still others maintain that a "fusion of horizons" amounts to a colonizing of difference. But a common aim of each of these controversies is to discern what feminists can learn from Gadamer as well as what limitations feminist reinterpretations of his work must inevitably encounter. Contributors are Linda Martín Alcoff, William Cowling, Gemma Corradi Fiumara, Marie Fleming, Silja Freudenberger, Susan Hekman, Susan-Judith Hoffmann, Grace M. Jantzen, Patricia Altenbernd Johnson, Laura Kaplan, Robin Pappas, Robin May Schott, Meili Steele, Veronica Vasterling, Georgia Warnke, and Kathleen Roberts Wright. (shrink)

: Naturalized moral epistemology eschews practices of assuming to know a priori the nature of situations and experiences that require moral deliberation. Thus it promises to close a gap between formal ethical theories and circumstances where people need guidelines for action. Yet according experience so central a place in inquiry risks "naturalizing" it, treating it as incontestable, separating its moral and political dimensions. This essay discusses these issues with reference to Margaret Walker's Moral understandings.

Departing from an epistemological tradition for which knowledge properly achieved must be objective, especially in eschewing affect and/or special interests; and against a backdrop of my thinking about epistemic responsibility, I focus on two situations where care informs and enables good knowing. The implicit purpose of this reclamation of care as epistemically vital is to show emphatically that standard alignments of care with femininity—the female—are simply misguided. Proposing that the efficacy of epistemic practices is often enhanced when would-be knowers (...) care about the outcomes of investigation, I suggest that epistemic responsibility need not be compromised when caring motivates and animates research. Indeed, the background inspiration comes from the thought, integral to feminist and post-colonial theory and practice that, despite often-justified condemnations of research that serves "special interests," particularities do matter, epistemically. Such thoughts, variously articulated, are integral to enacting a shift in epistemology away from formal abstraction and toward engaging with the specificities of real-world, situated knowledge projects. They are not unequivocally benign, for villains too care about the outcomes of their projects. Hence multi-faceted engagements with epistemic practices and processes are urgently required across the social-political world. (shrink)

I offer an examination of trust relations in scientific inquiry as they seem to contrast with a lack of trust in an example of knowledge imposed from above by an unaccountable institutional power structure. On this basis I argue for a re-reading of John Hardwig's account of the place of trust in knowledge, and suggest that it translates less well than social epistemologists and others have assumed into a model for democratic epistemic practice.

This paper begins to develop a conception of ecological subjectivity and hence of social-political practice that can promote social justice across diverse populations and situations. It urges a provocative posing of the question “who do we think we are?” to direct attention to often unspoken assumptions about subjectivity and agency that tend silently to inform current philosophical inquiry. Drawing attention to the often-unconscious processes of “we-saying.” it aims to highlight and to prompt contestation of the silent assumptions that tend to (...) inform that “we.” In so doing, it appeals to humility as an epistemic and moral virtue. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Loopholes, Gaps, and What Is Held Fast”Lorraine Code (bio)Keywordsepistemology, incredulity, knowing other people, memory, testimonyNancy Potter’s compelling essay points to some of the limitations of the theoretical apparatus that the post-positivist empiricist epistemologies of the Anglo-American mainstream make available for evaluating experiential memory claims in general, and “false memory syndrome” in particular. The loopholes and gaps in these theories of knowledge push urgent questions about testimony, (...) trust, and the politics of knowledge into a prominent place on the agendas of successor epistemology projects. These politics are enacted in societies whose dominant rhetoric privileges eye-witness evidence and “knowledge by acquaintance” as sources of objective knowledge, yet whose practices of incredulity—of granting and withholding acknowledgement to testimonial knowledge claims—expose power-saturated structures of dominance and subordination and of arbitrarily uneven distributions of epistemic authority. 1For classical empiricists and their successors, perception, memory and testimony, hierarchically ordered with perception on top, count as the principal sources of empirical knowledge. This ordering maps the relative reliability of the processes, with perception ranking as most stable, reliable and secure, memory coming second on all of these scores, and testimony ranking a poor third, closer to opinion, hearsay and rumor than to the other more respectable sources. Perception, for these theories, is “immediate” in that it is direct, bare, uncontaminated either by the particularities of the perceiving subject or of the perceptual event: from its presumed (but contestable) immediacy, all the rest follows. Memory counts as perception at one remove, its reliability a function of the relative “vividness” of the perceptions it commemorates. The esteem commonly claimed for eye-witness testimony derives from this conception of memory, which is believed to ground the testimony because of its presumed proximity to “immediate” perception. Yet testimony, even in its restricted “knowledge by description” form, tends by contrast with perception and memory to be a shaky affair; and as the temporal distance between event and testimony increases, so knowledge of matters unavailable to direct observation fares less and less well in classical and post-positivist epistemologies. A distrust of testimony is at once understandable and odd, because so small a proportion both of communal and of “individual” knowledge indeed derives from first-hand observations and experiences: most of it comes from testimony in an extended sense that encompasses books, teachings, media reports, all of the sources and resources on which both secular and scholarly knowledge relies for much of its substance. This expanded construction of the term runs alongside [End Page 255] the first-personal “testimonial” sense that is more plainly operative in discussions of false memory syndrome which, despite its experiential source, is often likewise contested on grounds that discredit the “privileged access” status that these same epistemologies claim for experience at first hand.Epistemologists commonly assimilate testimony to monologic, observational knowledge, deriving its constitutive features from instances where a testimonial utterance can pose as another perception—this time an auditory one—in a personal set of knowledge-producing observations (e.g., Fricker 1987). Because the speaker may be lying or mistaken, the process may fail to transmit knowledge; but this failure can be read as a simple perceptual error or a misremembering. Such approaches ignore the constitutive function of an interpreter/listener in fostering or thwarting testimonial knowledge to subsume it, too, much under an observational model. Indeed, not only do they separate the knower from the known and the process of knowing, as Potter observes, they also separate the knower from other knowers to guard against their influencing (= contaminating) the knowledge-production process. Experiences where an interlocutor actually enables the production of knowledge do not figure in such analyses, 2 whose effect is to suggest that giving or hearing testimony invokes no more significant moral-political issues than do acts of perceiving tables and chairs: that hearing, like seeing, is believing. (Norman Malcolm’s analysis of memory, which Potter cites, would also underwrite such a view of testimony.) Yet standard empiricist and post-positivist epistemologies generate an inquisitorial model of eliciting testimony in which the more generalized “testimony” in the knowledge that people acquire from books, media reports, conversation, reference sources recedes from... (shrink)

Naturalized moral epistemology eschews practices of assuming to know a priori the nature of situations and experiences that require moral deliberation. Thus it promises to close a gap between formal ethical theories and circumstances where people need guidelines for action. Yet according experience so central a place in inquiry risks “naturalizing” it, treating it as incontestable, separating its moral and political dimensions. This essay discusses these issues with reference to Margaret Walker's Moral understandings.

The phrase “statements of fact” has a clear, unequivocal ring. It speaks of a stable place untouchable by contests in epistemology and in more secular places, around questions of constructivism, subjectivism, and the politics of knowledge. It offers fixity, a locus of constancy in a shifting landscape where traditional certainties have ceased to hold, maintains a vantage point outside the fray, where knowledge-seekers can continue to believe in some degree of “correspondence” between items of knowledge and events in the world. (...) Within the social institutions and practices where knowledge is an issue, it designates a secure starting place for deliberation, a way of ensuring that processes of decision-making remain cognizant of the “realities” they have to address.In the institutions of knowledge production and knowledgeable practice that generate the examples I appeal to in this essay – medicine and law – “statements of fact” appear to comprise an incontestable core around which interpretive strategies may indeed have to be enlisted, but which itself functions as a kind of interpretation-exempt zone. There are good reasons for its retaining that status, for resisting the instabilities and sheer whimsicalities that would follow from dislodging it. (shrink)

In a remarkable development, I have constructed a new definition for a self-delimiting universal Turing machine (UTM) that is easy to program and runs very quickly. This provides a new foundation for algorithmic information theory (AIT), which is the theory of the size in bits of programs for selfdelimiting UTM's. Previously, AIT had an abstract mathematical quality. Now it is possible to write down executable programs that embody the constructions in the proofs of theorems. So AIT goes from dealing with (...) remote idealized mythical objects to being a theory about practical down-to-earth gadgets that one can actually play with and use. (shrink)

Increasing pharmaceutical industry presence in health care research and practice has evoked critical social, political, economic, and ethical questions and concern among health care providers, ethicists, economists, and the general citizenry. The case example presented of the ‘marketization’ of nursing practice not only reveals the magnitude of the purview of the pharmaceutical industry, it demonstrates how that industry imparts effect upon the organization of nursing work, an area of health care professional practice where the ethical polemic of (...) class='Hi'>pharmaceutical industry involvement and influence has been largely ignored, and the profession of nursing conspicuously silent. Drawing on a Foucauldian dispositive analysis that troubled the complex apparatus responsible for the production of knowledge and action in the neurology subspecialty of multiple sclerosis (MS), the case discloses how the pharmaceutical industry has created compliance and adherence as clinical imperatives in the practice of MS nursing. The case makes explicit the conscious transformative self‐action undertaken by MS nurses as a result of their subjectivation (marketization) and demonstrates how MS nurses have become pawns in pharmaceutical industry strategic games of power, truth, identity, and wealth creation by turning their clinical practice settings into heterodiscursive spaces of surveillance and persuasion. MS nurses have become instruments of the pharmaceutical industry, and their clinical practices ordered, organized, limited, constrained, and marketized as a result. (shrink)

The international pharmaceutical industry has made significant efforts towards ensuring compliant and ethical communication and interaction with physicians and patients. This article presents the current status of the worldwide governance of communication practices by pharmaceutical companies, concentrating on prescription-only medicines. It analyzes legislative, regulatory, and code-based compliance control mechanisms and highlights significant developments, including the 2006 and 2012 revisions of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) Code of Practice.

Prisoner's dilemmas can lead rational people to interact in ways that lead to persistent inefficiencies. These dilemmas create a problem for institutional designers to solve: devise institutions that realign individual incentives to achieve collectively rational outcomes. I will argue that we do not always want to eliminate misalignments between individual incentives and efficient outcomes. Sometimes we want to preserve prisoner's dilemmas, even when we know that they systematically will lead to inefficiencies. No doubt, prisoner's dilemmas can create problems, but they (...) also create opportunities to practice the cooperative norms that make market institutions possible in the first place. An ethical market culture, I argue, benefits from the presence of prisoner's dilemmas. I first consider standard approaches for solving prisoner's dilemmas. I then argue for the value of prisoner's dilemmas. Finally, I show the significance of this argument for advocating codes of business ethics. (shrink)

Changing Methods is a collection of original essays by feminist practitioners, scholars, and activists. The authors show why "the method question" has moved to the top of many feminist research and interpretive research strategies, and engage in thinking about how ideas and actions have developed within complex social circumstances. The essays in this book challenge the tradition that has allowed abstracted, formalized versions of the ideas and experiences of privileged white men to set standards for how everyone should conduct themselves. (...) The authors use new-found knowledge to displace the dominant ideology constructed around race, class, gender, and heterosexual privilege, and then propose innovative feminist-informed analyses of subjects as diverse as political change, critical linguistics, child care, religious studies, and violence against women. (shrink)

Richard Foley's theory of epistemic rationality specifies what a cognitive agent should believe, whose epistemic goal is now to believe truths and not to believe falsehoods. As the emphasis upon 'now' demonstrates, this is a synchronic, not a diachronic, theory. Foley acknowledges the importance of long-term intellectual goals in human lives--particularly in their practical aspect, and in scientific practice. But such goals are beyond the scope of a purely epistemic theory of rationality.

The medical profession contains five “spheres of morality”: clinical care, clinical research, scientific knowledge, population health, and the market. These distinct sets of normative commitments require physicians to act in different ways depending on the ends of the activity in question. For example, a physician-scientist emphasizes patients’ well-being in clinic, prioritizes the scientific method in lab, and seeks to maximize shareholder returns as a board member of a pharmaceutical firm. Physicians increasingly occupy multiple roles in healthcare and move between (...) them frequently, creating the possibility of conflict between the ethical obligations of their various roles. This paper examines the entire moral landscape of medicine through the lens of role morality. It develops a novel framework that helps physicians recognize how their moral commitments depend on the nature and context of the situation, clarifies ethical conflicts that physicians face, and concludes with ideas for resolving these conflicts. (shrink)

BackgroundIn Pakistan, drug promotion practices, ethical or unethical, have rarely been in the spotlight. We aimed to assess the perception and barriers of medical representatives (MRs) and doctors (MDs) regarding ethical promotion of pharmaceuticals in Pakistan.MethodsA cross sectional survey was conducted in seven major cities of Pakistan for 6-months period. Self-administered questionnaire was used for data collection. Logistic regression and five-point Likert scale scoring was used to estimate the perceptions and barriers.ResultsCompared to national companies (NCs), the medical representatives (MRs) (...) of multinational companies (MNCs) strongly believed that their companies follow World Health Organization (WHO) (OR; 5.31, p = 0.0005), International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) (OR; 6.45, p = 0.0005) and national codes of ethics (OR; 5.84, p = 0.0005). MNCs trained their MRs (OR; 6.68, p = 0.0005), provide accurate and valid scientific data (OR; 4.01, p = 0.007) with adequate system of accountability and controls on product samples (OR; 1.96, p = 0.047), while, NCs sponsor social or entertainment activities, seminars and conferences, and all sort of facilitation in form of gifts of their choice and clinic renovation for medical doctors (MDs). MDs perceptions were similar to MRs mentioned above, yet strongly agreed that companies offer cash payments or equivalents to MDs. The MRs of NCs/mncs and MDs agreed/strongly agreed that no external accountability, profiteering, pressure on sale targets, job insecurity, condoning unethical promotion by high-ups’ and business promotion by junior MDs were the predominant barriers.ConclusionIn conclusion, MRs of MNCs and MDs believed that MNCs follow certain codes of ethics in the promotion of pharmaceuticals, while NCs tend to be more profit oriented and even condone unethical promotion. All stakeholders, MRs, MDs and companies, might pose certain barriers, intentionally or unintentionally, in ethical promotion. (shrink)

Prisoner's dilemmas can lead rational people to interact in ways that lead to persistent inefficiencies. These dilemmas create a problem for institutional designers to solve: devise institutions that realign individual incentives to achieve collectively rational outcomes. I will argue that we do not always want to eliminate misalignments between individual incentives and efficient outcomes. Sometimes we want to preserve prisoner's dilemmas, even when we know that they systematically will lead to inefficiencies. No doubt, prisoner's dilemmas can create problems, but they (...) also create opportunities to practice the cooperative norms that make market institutions possible in the first place. An ethical market culture, I argue, benefits from the presence of prisoner's dilemmas. I first consider standard approaches for solving prisoner's dilemmas. I then argue for the value of prisoner's dilemmas. Finally, I show the significance of this argument for advocating codes of business ethics. (shrink)

Money markets are at the heart of financialized capitalism, as those markets that provide the funding liquidity needed for credit creation and leveraged trading. How have these markets evolved, grown, and become critical for larger financial flows? To answer this question, I distinguish an early period of financial globalization marked by regulatory arbitrage, offshoring, deregulation, and informal trading practices from a period of regime-consolidation marked by formal institutionalization. Concentrating on repo markets as the key funding sources for market-based banking, (...) I demonstrate that new institutional arrangements for these markets were initiated by private sector associations, but supported and authorized by public authorities. Bond trader groups codified new contractual arrangements and these were validated via reforms of bankruptcy codes and changes in central banks’ policy frameworks in the United States and European Union. Through these modifications and re-articulations in institutional conditions, transactions and large exposures on money markets became routine affairs—for shadow banking actors like money market funds as well as for commercial banks. The article concludes by discussing the continuity of regime-consolidation efforts after the transatlantic financial crisis and hypothesizes that they reveal “neo-patrimonial” features. (shrink)

At the 1992 Women in the History of Philosophy Conference at Cambridge, the contestability of the title "philosopher" was a major item of discussion. Historically, it seemed, women could claim the title only if there was no doubt that their work was original, where originality had everything to do with producing writings that did not "merely" derive from, comment upon, contribute to, or critique the works of male philosophers. The requirement is odd in an intellectual discipline shaped and sustained by (...) critical-constructive debate that constitutes both its history and its substance, many of whose canonical participants have directed their major efforts to corroborating, refuting, and/or extending the ideas of their semblables elsewhere or in other times. The "merely derivative" criterion is difficult to credit when it merely confirms fixed assumptions about women's place in a social order where they had no audible public voice and achieved minimal wider acknowledgement for their private utterances. For, although no simple conspiracy theory could account for women's philosophical silence, the original-versus-derivative distinction has often functioned as a double standard, recognizing many men as philosophers because of their engagement with topics that preoccupied other, already established philosophers, denying women recognition because of equivalent engagements. The injustice of these practices prompts Linda McAlister's project of collecting these eighteen articles, which span the time period from the work of Hypatia in the fourth century BC to the late-twentieth-century work of Hannah Arendt and Angela Davis. Many of the essays first appeared in Hypatia: A Journal of Feminist Philosophy, some of them are reprinted from other journals, and five appear here for the first time. In presenting detailed, engaged philosophical analyses of the work of women philosophers, the essays begin to address the belief that women, "denied the opportunity to stand on the shoulders of their foremothers", have frequently had to enter philosophical discourse through the auspices of men. They attest to the contingencies of canon formation in determining who can claim a place in the lineage of the fathers. (shrink)

Drawing from the varieties of capitalism theoretical framework, the study explores the home country influences of multinational corporations on their corporate social responsibility practices when they operate outside their national/regional institutional contexts. The study focusses on a particular CSR practice of seven MNCs from three varieties of capitalism – coordinated, mixed and liberal market economies – operating in the oil and gas sector of the Nigerian economy. The study concludes that the corporate codes of conduct of these MNCs operating (...) in Nigeria, to a large extent, reflect the characteristics of their home countries' model of capitalism, respectively, albeit with certain degree of modifications. The home countries' model of capitalism is also found to have implications for the degree of adaptability of these MNCs' CSR practices to the Nigerian institutional context – with the mixed market economy model of capitalism adapting more flexibly than the liberal and coordinated market economies, respectively. The findings of this study will contribute to the emerging literature on the institutional embeddedness of CSR practices in transnational social spaces, understanding of varieties of capitalism, and CSR in developing economies. (shrink)

A moral core places ethical considerations superior to business interest. This core must include voluntary prescriptions in various forms to “buy higher, sell lower.” International business ethics must somehow address the tradeoff between corporate financial and stakeholder interests. Corporation codes of conduct generally do not define a moral core. Corporate citizenship is typically strategic investment in markets and reputation. There are two practical paths for formulating a moral core. One path is civil lawsuits against multinationals that, successful or not, increase (...) corporate moral sensitivity. The other path is evolution of multilateral codes of conductembedding negotiated norms for guidance of corporate behavior. Four key cases illustrate: (1) World Bank approach for combating corruption in Chad; (2) a lawsuit against Unocal alleging human rights abuses by Myanmar; (3) a lawsuit against ChevronTexaco alleging environmental and community damages in Ecuadorian Amazonia; and (4) demand by developing countries for relaxing intellectual property rights. (shrink)

Here we reconsider teachers’ changing subjectivities as autonomous agents whose practices acknowledge risk as an essential element in intellectual inquiry. We seek alternative descriptions to the limiting language of teachers’ current practices within the primacy of the market. We are convinced by Levinas’s claim that ethics is the first philosophy with its concomitant responsibility for the Other. This provides a valuable point of departure and our understanding of its relevance is expanded by Biesta and Todd. This perspective allows (...) interruption of the global reform ensemble with its reductionist understandings of teachers’ subjectivities within concerns for a ‘visible pedagogy’ and performativity. We illustrate how this global policy imperative is reworked in policies in the Republic of Ireland and share reflexive insights from our tutoring of teachers studying for a Master’s degree in Education. We show that teachers’ autonomy, which we understand as the capacity of teachers to facilitate risk and make ethically informed local judgements, is severely restricted by imposed standards, codes and laws to which there is tightly policed adherence. Instead we describe teachers’ practices occurring within an Invisible Pedagogy, which is not concerned with totalising and limited performativity but instead, explores risks associated with existential possibilities beyond commodification. (shrink)

This article illustrates how a traditional U.S. pharmaceutical industry supply chain operates, beginning with pharmaceutical compounds and ending at patient‐dispensing hospitals or pharmacies. Furthermore, to place the problem of U.S. drug shortages in historical perspective, a review of the annual volume of such shortages over the last decade is undertaken. Following this review of recent drug shortages is an analysis of the market forces and business decisions that drive the creation of a pharmaceutical gray market, its attendant (...) “price gouging” and product integrity issues, and the alterations in the traditional pharmaceutical industry supply chain model. In response to persistent drug shortages, the U.S. Food and Drug Administration (FDA) has recently been empowered by the executive and legislative branches of the U.S. government to actively address this issue. To reflect these FDA challenges, a thorough review of these new agency charges and responsibilities is undertaken. Lastly, an analysis of the results of recent FDA public policy actions on mitigating drug shortages, as well as recommendations tor market‐based solutions to the gray market problem that pharmaceutical manufacturers, hospitals and pharmacies could institute as industry‐wide standards of business practice, are discussed in the conclusion. (shrink)

In an open, unregulated and globalised economy, it is logical that the problem of corporate government not only occupy the time of academics, but also preoccupy both companies and the public administration. Corporate governance varies depending on several factors, such as the culture of a particular country, the economic situation and the organisational structures. Thus, there is no single recipe which can be applied automatically and is universally valid in all contexts. However, it is possible to propose some general principles (...) which have duly stood the test of experience and are recognised as providing valuable guidance for efficient corporate governance. The aim of this article is to present the Spanish " Olivencia Report ", which is an attempt to draft an "ethical code" containing a number of practices and principles, which, if they were to be applied, could improve the governance of the larger Spanish companies listed on the Stock Market. The pages which follow narrate the story of the making of the report, and highlight those features which distinguish this report from other analogous reports published in other countries, and which inspired the Olivencia Report. These reports, which include the "Cadbury Report ", the "Viénot Report " and the "Peters Report " among others will also be dealt with. Once the more outstanding aspects of the Spanish report have been highlighted, the article closes with a brief concluding section, which goes beyond the case in question and stresses the relationship between ethics, corporate governance and the mission of the enterprise. This focus is of some importance as the literature on corporate governance rarely brings the ethical problem to the fore. (shrink)