I trust my lawyer more than I trust my doctor.—Shana Alexander, 1992 [The audience laughed.]1The Hippocratic Oath makes the physician invoke external supervision of her adherence to what she affirm...

In purity and holiness I will guard my life and my art.Every physician-patient encounter is a conflict of interest. Every physician-payer encounter is also a conflict of interest.Wide-spread criticism of the pharmaceutical industry’s extravagant marketing practices and some doctors’ undignified, even appalling eagerness to stuff themselves, their pockets and their offices with the industry’s “stuff,” prompted physician groups, the drug and device industry itself to institute reforms designed better to limit industry influence on physicians.But according to Troyen Brennan and his (...) coauthors, the reforms, while reducing some of the most egregious instances of industry influence peddling and physicians’ self-debasement, were doomed fundamentally, for three reasons. First, they were based on common sense but incorrect assumptions about the mechanism of industry influence and on myths about the efficacy of disclosure as an ethical disinfectant. Second, they relied on voluntary adherence and so failed to pinpoint responsibility for monitoring compliance and enforcement. (shrink)

In the name of restoring professionalism, an influential group of physician-educators have urged academic medical centers to take the lead in purging the house of medicine of the conflicts of interest created by industry's marketing. I argue that this revivalist movement is misguided, uses “conflict of interest” as an epithet, creates counter-productive incentives, and fails the duty to prepare physicians for ethical engagement with their commercial partners in patient care.

“Strict gun control” has no clear meaning,so it is necessary to clarify it.I define SGC as an array of legally sanctioned restrictions designed to impose firearm scarcity on the general population. SGC’s public policy goal, gun scarcity, commonly rests on the predicates that “dangerous criminal control” is not the central problem for reducing the problem of criminal gun violence but rather that it is the social prevalence of the distinctively-lethal instruments by which both supposedly “good citizens” as well as violent (...) criminals inflict a staggeringly high percentage of injury and death.Professor Zimring is one SGC’s most distinguished, prolific and comprehensive theorists. He has advocated for handgun scarcity among the general population since at least 1969. (shrink)

The recent focus on conflict of interest seriously misfires by fixating on monetary payoffs while ignoring all the other things that people care about, things that can bias their judgment and lead to wrongdoing. Wrongdoing should be the focus, not the temptations and motivations that sometimes result in it. This essay explores the evidence in support of strong regulations against conflict of interest, and I conclude that corruption fears have resulted in social-distancing policies of drug reps from physicians and they (...) have given us sharply constrained information markets. There is some evidence that this may be disadvantageous to patients. Information market restrictions do promote powerful political and corporate interests. Whether there are compensating benefits in reduced expenditures on drugs and devices remains to be seen. We can only hope that our institutional policies eventually will be revised in a manner that better respects physicians as sophisticated consumers of product marketing and holds them accountable for their choices not their motivational states. (shrink)

This chapter contains sections titled: Why Gun Control Matters The Initial Entitlement Problem The Regulatory Power Dangerous‐possessor Gun Control Strict Gun Control Guns as Environmental Toxins Gun Prevalence as a Social Cause of the US Homicide Rate How Many Guns? America's Homicide Rate Guns and Social Causation of the Homicide Rate Mechanism in Causal Accounts Mental Causation The Paradox of Gun Control and Reasonable Policies Conclusion Acknowledgments.

A recent New York Times/CBS poll shows that nearly 80 percent of respondents think the American “health care system is headed toward a crisis because of rising costs.” Indeed, the public has become well acquainted with ominous-looking graphs that detail the nation’s health care spending. The increasingly steep slope of the graph showing the percentage of gross domestic product spent on health care invites tongue-in-cheek projections for when health care spending will finally consume it all.High aggregate health care expenditures result (...) from the low prices individuals pay for coverage. On average, patients pay only five cents out-of-pocket for every dollar of hospital charges they generate. The remainder is paid by private or public health insurance. Patients pay slightly more for physicians’ services—nineteen cents on each dollar. For health care of all types, patients pay approximately twenty-four cents on each dollar. With individuals paying what amount to fire sale prices for health care, it should come as no surprise that they purchase a great deal of coverage. (shrink)

Despite the frequent use of the term systems by academicians and management practitioners, there is little agreement as to what the term really means. Experts in different fields talk about accounting systems, production systems, electronic data processing systems, market systems, financial systems, reward and motivation systems, and so on, but the student of management is confused by the nebulous and, at times, seemingly contradictory terms. This article uses the term Systems Approach as a convenient handle to pull together a few (...) basic ideas about the systems concept. Systems Approach organizes one's thinking to understand more clearly the complexity of a real world phenomenon. It consists of two main parts: (1) Systems Thinking (ST), and (2) Information Technology (IT). ST provides the knowledge for developing a Theory of Systems, such as General Systems Theory and Cybernetics, while IT supplies the tools for testing and improving this theory. The relationship between the two parts is a complementary one. Advances in theory lead to the development of better technology, while improvement in technology makes theory development easier and more reliable. (shrink)

… no physician, in so far as he is a physician, considers his own good in what he prescribes, but the good of his patient, for the true physician … is not a mere money-maker.A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.[We] are agents. Our constitution is put in our power. We are charged with it; (...) and therefore are accountable for any disorder or violation of it.Conscience is a sense of duty that inhibits and prompts conduct by threatening distress for noncompliance. Liberty—to live according to the dictates of one's conscience and not to be compelled to live in... (shrink)

“Strict gun control” has no clear meaning,so it is necessary to clarify it.I define SGC as an array of legally sanctioned restrictions designed to impose firearm scarcity on the general population. SGC’s public policy goal, gun scarcity, commonly rests on the predicates that “dangerous criminal control” is not the central problem for reducing the problem of criminal gun violence but rather that it is the social prevalence of the distinctively-lethal instruments by which both supposedly “good citizens” as well as violent (...) criminals inflict a staggeringly high percentage of injury and death.Professor Zimring is one SGC’s most distinguished, prolific and comprehensive theorists. He has advocated for handgun scarcity among the general population since at least 1969. (shrink)

We show how mereotopological notions can be expressed by extending intuitionistic propositional logic with propositional quantification and a strong modal operator. We first prove completeness for the logics wrt Kripke models; then we trace the correspondence between Kripke models and topological spaces that have been enhanced with an explicit notion of expressible region. We show how some qualitative spatial notions can be expressed in topological terms. We use the semantical and topological results in order to show how in some extensions (...) of the logics it is possible to express connectedness, non-emptiness and a set of jointly exhaustive, pairwise disjoint, binary relations that play a significant role in qualitative spatial reasoning. (shrink)

Modern technology (Technik, la technique) has constituted the gears on which the wheels of the modern world keep turning. The later Heidegger devotes sustained reflection to this unprecedented phenomenon in human history. It is notable that, compared with other figures from twentieth-century continental philosophy, Heidegger has served as the most frequent reference point in current philosophy of technology (Technikphilosophie). This field of philosophy came into being after the so-called empirical turn of “Science and Technology Studies.” While relevant scholars focus mainly (...) on “Die Frage nach der Technik” of 1953, “Das Ge-stell” of 1949,1 and some other texts written in that period,2 the time span of Heidegger’s .. (shrink)

Angesichts der enormen Entwicklungen in der Technik zu Beginn des 20. Jahrhunderts, insbesondere angesichts der »totalen Mobilmachung«, die man im Ersten Weltkrieg zu beobachten und zu erfahren glaubte, entstand in den 1920er und 1930er Jahren ein Diskurs über die Technik, in dem das ›Allesumfassende‹ und ›Allesvereinnahmende‹, also ›Totalisierende‹ der Maschinerien zum Thema gemacht wurde. So fragte sich Hans Freyer 1929 wie es sein konnte, dass »ein System von bloßen Mitteln derart schicksalsbestimmend, menschenverwandelnd, geschichtsbildend wirken kann«. Karl Jaspers wiederum beschrieb die (...) »globale« Dimension, die die Technik seiner Einschätzung nach angenommen hatte, und sprach 1931 in seinem Essay Die geistige Situation der Zeit von der »Herrschaft des Apparats« und sogar von einem »Riesenapparat«, der den einzelnen Menschen überformen würde, insbesondere durch eine normierende Massenkultur, die das tägliche Leben der Menschen grundlegend ändern würde. (shrink)

Poetry in lieu of thinking. Reflections on the genesis of song in the third part of Nietzsche’s Zarathustra. The chapter Von der grossen Sehnsucht opens the final section of Nietzscheʼs Also sprach Zarathustra with a speech in which Zarathustra invites his soul to sing and in which he starts to sing himself. Based on Nietzscheʼs own late interpretation in Ecce homo, this article focuses on the narrative coherence and poetic logic of the chapter Von der grossen Sehnsucht. While the address (...) to the soul can be understood as a soliloquy that corresponds to the definition of thinking in Platoʼs Sophistes, the chapter Von der grossen Sehnsucht also allows insight into the relationship between thinking and writing. Von der grossen Sehnsucht, after all, follows the chapter Der Genesende, in which Zarathustraʼs animals talk to him about eternal recurrence. Moreover, the invitation to sing anticipates the Dionysos-Dithyramben: the address to the soul is followed by Das andere Tanzlied and the Ja-und Amen-Lied, which Nietzsche describes as a dithyramb. As such, the chapter Von der grossen Sehnsucht introduces dithyrambic poetry. (shrink)