Background: The research community has a mandate to discover effective treatments for neurodegenerative disorders. The ethics landscape surrounding this mandate is in a constant state of flux, and ongoing challenges place ever greater demands on investigators to be accountable to the public and to answer questions about the implications of their work for health care, society, and policy. Methods: We surveyed US-based investigators involved in neurodegenerative diseases research about how they value ethics-related issues, what motivates them to give consideration to (...) those issues, and the barriers to doing so. Using the NIH CRISP database we identified 1,034 researchers with relevant, active grants and invited them to complete an online questionnaire. We received 193 responses. We used exploratory factor analysis to transform individual survey questions into a smaller set of factors, and linear regression to understand the effect of key variables of interest on the factor scores. Results: Ethics-related issues clustered into two groups: research ethics and external influences. Heads of research groups viewed issues of research ethics to be more important than the other respondents. Concern about external influences was related to overall interest in ethics. Motivators clustered into five groups: ensuring public understanding, external forces, requirements, values, and press and public. Heads of research groups were more motivated to ensure public understanding of research than the other respondents. Barriers clustered into four groups: lack of resources, administrative burden, relevance to the research, and lack of interest. Perceived lack of ethics resources was a particular barrier for investigators working in drug discovery. Conclusions: The data suggest that senior level neuroscientists working in the field of neurodegeneration (ND), and drug discovery specifically, are motivated to consider ethics issues related to their work, but the perceived lack of ethics resources thwarts their efforts. With bioethics centres at more than 50% of the institutions at which these respondents reside, the neuroscience and bioethics communities appear to be disconnected. Dedicated ethical, legal and social implications (ELSI) programs, such as those fully integrated into genetics and regenerative medicine, provide models for achieving meaningful partnerships not yet adequately realized for scholars and trainees interested in drug discovery for ND. (shrink)

This paper criticizes Langton's speech act account of MacKinnon's claim about (the subordinating force of) pornography and offers a different account of how speech might enact harmful norms and thus constitute harm.

This book provides the first comprehensive introduction to Simone de Beauvoir's philosophical thought. Beauvoir has long been recognized as the twentieth century's leading feminist writer, but the full extent of her significance as a philosopher is just coming into focus. This study examines the history of Beauvoir's development into one of the most original and influential thinkers of her era. The Fullbrooks begin with an account of Beauvoir's formation as a philosopher. They then explore her early writing on philosophical method (...) and the ways this shaped her fiction. The book traces the development of Beauvoir's central theories of embodied consciousness and intersubjectivity, and examines her concepts of the "individual" and the "social other". An analysis of Beauvoir's ethics of liberation leads to philosophical readings of her great works of applied ethics, The Second Sex and Old Age. Finally, Beauvoir's contribution to continuing debates about consciousness, the body, the self and the other is reassessed. The publication of this introduction to Beauvoir's philosophy is an important contribution to the current renaissance of Beauvoir studies. Clear, accessible and lively, this book is essential reading not only for students of Beauvoir but for anyone interested in the submerged record of women's impact on philosophy. (shrink)

Supported decision-making has been promoted at a policy level and within international human rights treaties as a way of ensuring that people with disabilities enjoy the right to legal capacity on an equal basis with others. However, little is known about the practical issues associated with implementing supported decision-making, particularly in the context of dementia. This study aimed to understand the experiences of people with dementia and their family members with respect to decision-making and their views on supported decision-making. Thirty-six (...) interviews were undertaken with fifty-seven participants across three states in Australia. Interpretative Phenomenological Analysis was used as the methodological approach, with relational autonomy as a theoretical perspective. We identified two overarching themes relating to participants’ experiences with decision-making: “the person in relationship over time” and “maintaining involvement.” Participant views on the practical issues associated with supported decision-making are addressed under the themes of “facilitating decision-making,” “supported decision-making arrangements,” “constraints on decision-making,” and “safeguarding decision-making.” While participants endorsed the principles of supported decision-making as part of their overarching strategy of “maintaining involvement” in decision-making, they recognized that progressive cognitive impairment meant that there was an inevitable transition toward greater involvement of, and reliance upon, others in decision-making. Social and contextual “constraints on decision-making” also impacted on the ability of people with dementia to maintain involvement. These themes inform our proposal for a “spectrum approach” to decision-making involvement among people living with dementia, along with recommendations for policy and practice to assist in the implementation of supported decision-making within this population. (shrink)

Philosophers of science discuss whether theory selection depends on aesthetic judgments or criteria, and whether these putatively aesthetic features are genuinely extra-epistemic. As examples, judgments involving criteria such as simplicity and symmetry are often cited. However, other theory selection criteria, such as fecundity, coherence, internal consistency, and fertility, more closely match those criteria used in art contexts and by scholars working in aesthetics. Paying closer attention to the way these criteria are used in art contexts allows us to understand some (...) evaluative and developmental practices in scientific theory selection as genuinely aesthetic, enlarging the scope of the goals of science. (shrink)

In a recent article in this journal, Nellie Wieland argues that silencing in the sense put forward by Rae Langton and Jennifer Hornsby has the unpalatable consequence of diminishing a rapist's responsibility for the rape. We argue both that Wieland misidentifies Langton and Hornsby's conception of silencing, and that neither Langton and Hornsby's actual conception, nor the one that Wieland attributes to them, in fact generates this consequence.

Many liberal societies are deeply committed to freedom of speech. This commitment is so entrenched that when it seems to come into conflict with other commitments (e.g., gender equality), it is often argued that the commitment to speech must trump the other commitments. In this paper, we argue that a proper understanding of our commitment to free speech requires being clear about what should count as speech for these purposes. On the approach we defend, should get a special, technical sense, (...) different from its ordinary sense. We offer a partial characterization of this technical sense. Finally, we argue that if certain theorists (e.g., MacKinnon) are right about what (some) pornography does, then it should fall outside the scope of the free-speech principle. If so, then contrary to first appearances, pornography may not be a case in which our commitments to freedom and gender equality come into conflict. (shrink)

Legal judgment writing mobilises a process of story-telling, drawing on existing judicial discourses, precedents and practices to create a narrative relevant to the specific case that is articulated by the presiding judge. In the Feminist Judgments projects feminist scholars and activists have sought to challenge and reinterpret legal judgments that have disadvantaged, discriminated against or denied women’s experiences. This paper reflects on the process of writing as a feminist judge in the Australian Project, in an intimate homicide case, R v (...) Middendorp. Drawing on the work of Judith Butler on intelligibility, iterability and the communality of violence and vulnerability, this article argues that feminist judgments necessarily require some uncomfortable compromises with unjust gendered institutions. While ‘donning the robes’ may be an uncomfortable process, a feminist re-articulation of the law’s carceral power serves to unsettle and challenge some aspects of gendered oppression, even though it cannot unsettle the operation of the institution. The article concludes that effective feminist interventions by members of the judiciary may require donning robes that are not entirely comfortable in order to persuade and advocate for change. (shrink)

Catharine MacKinnon has pioneered a new brand of anti-pornography argument. In particular, MacKinnon claims that pornography silences women in a way that violates their right to free speech. In what follows, we focus on a certain account of silencing put forward by Jennifer Hornsby and Rae Langton, and we defend that account against two important objections. The first objection contends that this account makes a crucial but false assumption about the necessary role of hearer recognition in successful speech acts. In (...) response, we argue that, as silencing primarily concerns communication, Hornsby and Langton are perfectly correct to treat hearer recognition as they do. The second objection contends that their particular account of silencing has the unacceptable result of undermining the responsibility of rapists. We here argue that no such result follows from their account. (shrink)

This article is the author's response to critical essays by Luvell Anderson, Claire Horisk, and Lori Watson. The legal concept of discrimination, the sneaky communicative functioning of joke-telling, and the phenomenon of hepeating are each discussed.

Supportive peer relationships are crucial for mental and physical health. Early adolescence is an especially important period in which peer influence and school environment strongly shape psychological development and maturation of core social-emotional regulatory functions. Yet, there is no integrated evidence based model of SPR in this age group to inform future research and practice. The current meta-analysis synthetizes evidence from 364 studies into an integrated model of potential determinants of SPR in early adolescence. The model encompasses links with 93 (...) variables referring to individual and environmental potential influences on SPR based on cross-sectional correlational data. Findings suggest the central importance of identity and social–emotional skills in SPR. School environment stands out as a compelling setting for future prevention programs. Finally, we underscore an alarming gap of research on the influence of the virtual and online environment on youth's social realm given its unquestionable importance as a globally expanding social interaction setting. Hence, we propose an integrated model that can serve as organizational framework, which may ultimately lead to the adoption of a more structured and integrated approach to understanding peer relationship processes in youth and contribute to overcoming marked fragmentation in the field. (shrink)

This article provides an analysis of the relationships between IVF and therapeutic cloning, as they played out in the UK Human Fertilisation and Embryology Authority consultation of 2006: Donating Eggs for Research: Safeguarding Donors. We develop an account of current developments in IVF and cloning which foregrounds the role of mediation in structuring the discursive context in which they are constituted. We foreground the imperative of choice and the promise of cures as key features of this context. We also argue (...) that the intercorporeal exchanges of IVF are materially restructured in relation to cloning research, despite their represented similitude in the consultation document. The discourse of choice in relation to reproductive technologies has become entrenched over the last twenty years. In relation to therapeutic cloning, it has been coupled with, and strengthened by, the discourse of cures. In examining relations between IVF and cloning with specific attention to both mediating imaginaries, and intercorporeal exchanges, we develop an analysis that displaces the rhetoric of choice and cures. This makes visible the limited subject positions available, and the limited possibilities for responding critically to the consultation. Identifying women as the gendered subjects of this consultation and placing intercorporeality at the centre of our analysis illuminates the interdependency of women undergoing IVF, cloning science and the governance of embryo research in the UK. (shrink)

This paper argues that linguistic oppression is coherent; speech can oppress. Moreover, even though oppression is a structural phenomenon, a single utterance can nevertheless be an act of oppression. This paper also argues that ordinary utterances can oppress. That is, speakers do not need to have and be exercising authority in order for their speech to be oppressive. Furthermore, ordinary speech can oppress even though the speakers do not intend to oppress, even though the hearers do not take it to (...) oppress, even though the oppressed do not hear it, and even though the oppressed are unaware of being oppressed. On the account offered here, linguistic oppression is sneaky, hidden, and surprisingly widespread. (shrink)

Expanding buprenorphine access in the United States requires evidence-based decision-making that considers both the drug's potential dangers and its potential benefits. Risks associated with buprenorphine misuse and diversion highlight the need for careful, ongoing evaluation during each stage of increased access.

Kolbe and de Melo-Martin (2023) raise important concerns about the limited usefulness of measures of moral distress. They propose that moral distress is best measured in terms of “illegitimate inst...

Paediatric research in low-income countries is essential to tackle high childhood mortality. As with all research, consent is an essential part of ethical practice for paediatric studies. Ethics guidelines recommend that parents or another proxy provide legal consent for children to participate, but that children should be involved in the decision through providing assent. However, there remain uncertainties about how to judge when children are ready to give assent and about appropriate assent processes. Malawi does not yet have detailed guidelines (...) on assent. Understanding perspectives among children and their parents can assist in developing contextually-appropriate assent guidance. Qualitative research was conducted with children and parents in three settings in Southern Malawi, to take account of any variations between socioeconomic and cultural contexts. In each setting, interviews were conducted with parents and their children who had participated in paediatric research to understand their experiences of assent and views on appropriate assent practice. Focus groups were also conducted with children and parents, to understand broader social perspectives. We found widespread support for involving children in decisions on research participation. Participants identified a range of factors that affect children’s capacity to give assent, including intellectual capacity, emotional development, life experience and cultural norms. Age was often mentioned as a consideration, but deemed an unreliable sole indicator of capacity to assent. In relation to appropriate assent processes, participants emphasised considerations such as supporting effective understanding and minimizing harms. Views on how to achieve these aims varied; for example, there were different ideas about the appropriate order in which to approach children and parents, and about whose decision to respect in the event of disagreement. Parents and children agreed about the value of involving children in decisions on research, and about the need to promote children’s decision-making capacity while respecting parents’ interests in children’s welfare. Developing practical guidance that meets these principles is challenging, particularly given the need for flexible approaches that suit different study types, children’s capacities and family environments. Further discussion within the Malawi research and ethics community will help develop contextually-appropriate guidelines. (shrink)

Although disgust is recognized as a common and prominent emotion in healthcare, little is known about how healthcare professionals understand, experience and conceptualize disgust. The aim of the study was to gain an in‐depth understanding of how nursing and midwifery students experience, understand and cope with disgust in their clinical work. Interviews were transcribed verbatim and analysed using interpretative phenomenological analysis (IPA). Six participants (all women: two nursing students, four midwifery students) from a university in the South of England were (...) interviewed. Four superordinate themes with eight subthemes were identified. Overall, findings suggest that participants experience both moral and physical disgust; however, they find it difficult to talk about and use other terms to describe their experience. Findings are discussed through the lens of social identity theory, to understand the relevance of professional identity and how this might further maintain the disgust taboo. The strategies participants have developed in order to cope with disgust are explored and understood within the current healthcare climate. Future research should focus on ways of addressing the experience of disgust by healthcare professionals in order to improve the quality of care provided, especially in the climate of the COVID‐19 crisis. (shrink)

This book argues that Christian ethics urgently needs the category of tragic dilemmas. The author argues for a definition of tragic dilemmas that responds to philosophical concerns in a Christian context, using insights from the Protestant and Roman Catholic traditions, and in light of psychological evidence of moral injury after combat. Jackson-Meyer suggests that in a tragic dilemma an agent deliberates on, with sufficient knowledge, an issue that involves non-negotiable moral requirements in line with Christian obligations to protect human life (...) and the vulnerable. The agent is morally responsible for the harm caused and/or the obligation not acted upon. However, culpability is mitigated due to the constraints of the situation as long as the agent acts with, what Aquinas calls, "repugnance of the will." Tragic dilemmas are often the result of sin, a reality to which the Augustinian tradition is keenly attuned. When involvement in a tragic dilemma produces emotional harm, this has the power to undermine character because passions and the moral life are inextricably related. In turn, the agent's life is marred. In light of this harm, it is incumbent on Christian communities to offer opportunities for moral healing after tragic dilemmas. (shrink)

Silencing is a speech-related harm. We here focus on one particular account of silencing offered by Jennifer Hornsby and Rae Langton. According to this account, silencing is systematically generated, illocutionary-communicative failure. We here raise an apparent challenge to that account. In particular, we offer an example—the drowning case—that meets these conditions of silencing but does not intuitively seem to be an instance of it. First, we explore several conditions one might add to the Hornsby-Langton account, but we argue that none (...) are satisfactory. Then, we further explore the systematicity condition, which is insufficiently characterized in the current literature. Although we explore several promising ways to further characterize this condition, we ultimately conclude that more work needs to be done. Consequently, because this systematicity condition is under-specified, the Hornsby-Langton account of silencing is incomplete. (shrink)

There is no cure or vaccine for HIV/AIDS. The only life-prolonging treatment available is antiretroviral (ARV) therapy. WHO estimates, however, that less than 5 percent of those who require treatment in developing countries currently enjoy access to these medicines. In Africa fewer than 50,000 people–less than 2 percent of the people in need–currently receive ARV therapy. These facts have elicited strongly divergent reactions, and views about the appropriate response to this crisis have varied widely.The intensity of the debate concerning access (...) to life-prolonging medicines for the treatment of HIV/AIDS, and the heated rhetoric with which they are often conducted, suggest that these disagreements may be rooted in deeper disagreements of value. It is not obvious, however, what disagreements of value are at stake in this debate. By analyzing the statements of scholars, public officials, activist organizations, and private sector representatives, each of whom may endorse very different policy recommendations on access to HIV/AIDS drugs, we have identified and created a typology of the different sources of disagreement in the debate. We conclude that the central disagreements concerning access to medicines arise from competing understandings of how responsibilities for bringing remedy to hardships should be allocated to different agents and institutions. A central lesson that emerges from our analysis is that thinking about “health equity” must extend beyond the explanation and justification of goals, values, and ideals, and engage more honestly with the difficult question of how responsibilities for bringing remedy to health crises should be allocated in complex social contexts. (shrink)

This a review of Max Waltman's _Pornography: The Politics of Legal Challenges_.

Legal responses to battered women who kill have long animated scholarly debate and law reform activity. In September 2012 after 47 years of alleged abuse, Frenchwoman Jacqueline Sauvage fatally shot her abusive husband three times in the back. The subsequent contested trial, conviction for murder, unsuccessful appeal and later presidential pardon of Sauvage thrust the French law of self-defence into the spotlight. The Sauvage case raises important questions surrounding the adequacy of the French criminal law in this area, the ongoing (...) proliferation of gendered stereotypes in law and the need for reform. In the wake of the Sauvage case, this article provides a timely analysis of the gendered law of self-defence in France. Drawing from an in-depth analysis of the judgments imposed in the Sauvage case, this article examines the adequacy of French legal responses to battered women who kill and ignites an argument for further law reform. (shrink)

Principles of ethics -- Medical research and clinical trials -- Treatment decision making -- Palliative and end-of-life care -- Patient advocacy -- Communication and ethics -- Genetics and genomics -- The impact of ethical conflict and dilemmas on nurses -- Ethics consultation and education.

The Assumption of Agency Theory revisits the Turing Test and€examines what Turing's assessor knew. It asks important questions about how machines vis à vis humans have been characterized since Turing, and seeks to reverse the trend of looking closely at the machine by asking what humans know in interaction and how they know it.€This book€characterizes a non-human agent that shows itself in interaction but is distinct from human agency: an agent acting with us in our ongoing reproduction and transformation of (...) structure. Turing predicted that at the end of the twentieth century, w. (shrink)

This article examines the definitions of literacy in operation in secondary schools, and the relationship between official literacy policy and the practices of the agents responsible for implementing this policy. We trace the history of national 'policy' back to the Language Across the Curriculum movement of the 1970s as it provides an illustrative point of comparison with the first five years of the National Literacy Strategy. Drawing on empirical data which illuminate the views, perceptions and practices of key agents on (...) a number of levels, we critically review the concept of 'school literacy' promoted in government policy, defining it as 'school-centric literacy' and question its ability to facilitate participation in the practices associated with the media and technological literacies which are increasingly a feature of school life. There is evidence of some unplanned effects of the current national policy but also that levels of agency, for literacy teachers in particular, may be rapidly diminishing. (shrink)

In this short response we show that Kevin Smith's moral and ethical rejections of homeopathy1 are fallacious and rest on questionable epistemology. Further, we suggest Smith's presumption of a utilitarian stance is an example of scientism encroaching into medicine.

It is widely recognized that Goodman's grue example demonstrates that the rules for induction, unlike those for deduction, cannot be purely syntactic. Ways in which Goodman's proof generalizes, however, are not widely recognized. Gruesome considerations demonstrate that neither theories of simplicity nor theories of empirical confirmation can be purely syntactic. Moreover, the grue paradox can be seen as an instance of a much more general phenomenon. All empirical investigations require semantic constraints, since purely structural constraints are inadequate. Both Russell's theory (...) of empirical knowledge and Putnam's model-theoretic argument against metaphysical realism illustrate the inadequacy of purely structural constraints. (shrink)

Legal, medical, and public health professionals have been complicit in creating and maintaining systems that drive health inequities. To ameliorate this, current and future leaders in law, medicine, and public health must learn about racism and its impact along the life course trajectory and how to engage in antiracist practice and health equity work.

This article explores the idea that there is a spectrum of individuals who feel compelled to dwell in the past, either due to psychological or social conditions. I analyze both conditions respectively by critically examining two cases: post-traumatic stress disorder and racialized oppression. I propose that individuals with PTSD can feel psychologically compelled to dwell in the past in a dually negative sense: the individual lives in the past but also broods on it, causing them to feel “stuck” in the (...) past. This kind of “dwelling” can cause individuals to suffer disruptions to their sense of self and intersubjectivity. After exploring the psychological case of dwelling in the past, I explore the social sense in which individuals can dwell in the past due to oppressive social structures by examining the case of racialized oppression. The case of racialization is philosophically stimulating because of its intersubjective dimensions—it subverts the idea that dwelling in the past is simply a psychological phenomenon by capturing that others can help or hinder us with maintaining a sense of self and future-directed intentionality. By putting the phenomenological work of Al-Saji into conversation with recent phenomenological research on incarceration, I propose that racialization can be similarly disruptive to one’s sense of self and intersubjectivity. The proposed account is suggestive that traumatic and oppressive experiences may amplify and compound each other in ways not yet well elucidated in the literature. If this account is taken to be persuasive, it is indicative that both psychological and social conditions mediate one’s temporality and well-being. (shrink)

Miley Cyrus has increasingly occupied debates at the centre of feminist engagements with popular culture. Evoking concerns around young women and ‘sexualisation’, Cyrus emerges as a convergent signifier of sexualised media content and the girl-at-risk. As Cyrus is repeatedly invoked in these debates, she comes to function as the bad object of young femininity. Arguing, however, that Cyrus troubles the sexualisation thesis in the provocations of her creative practice, I suggest that this contested media figure exceeds the frames through which (...) she is read. Thus, I ask: what kinds of insights might be possible if we were to transform the terms on which we approach this figure? Considering a selection of the images and performances that constitute the Cyrus archive, this article proposes a reading of Cyrus as performative provocation. Mobilising an existing sensibility of queer feminist struggle, Cyrus emerges as a disruptive, albeit contradictory, figure. Questions of privilege, limit and possibility emerge in this discussion, as well as what constitutes feminist struggle. (shrink)

This paper clarifies the legal right to free speech, identifies ways that speech can be harmful, and discusses pornography hate speech, and lies. It is also written for a non-technical audience.

Biometrics is the science of establishing the identity of an individual based on their physical attributes. Ethical concerns surrounding the appropriate use of biometrics have been raised, especial...

Suppose a diner says, 'Can you pass the salt?' Although her utterance is literally a question (about the physical abilities of the addressee), most would take it as a request (that the addressee pass the salt). In such a case, the request is performed indirectly by way of directly asking a question. Accordingly this utterance is known as an indirect speech act. On the standard account of such speech acts, a single utterance constitutes two distinct speech acts. On this account (...) then, 'Can you pass the salt?' is both a question and a request. In a provocative essay, Rod Bertolet argues that there are no indirect speech acts. According to Bertolet, 'Can you pass the salt?' is only a question. It is a question that merely functions as a request (without also being one). In this paper we respond to Bertolet's skeptical argument. Appealing to Searle's theory of speech acts and to certain features of linguistic communication, we argue that, despite Bertolet's challenge, there is good reason to countenance indirect speech acts. (shrink)

Chemical visualizations and models are special kinds of situated, inductive arguments. In this paper, I examine several historical case studies—an archive of images from museums, special collections, and popular magazines—as examples of emergent practices of physical modeling as theoretical play which became the basis for molecular biology and structural chemistry. Specifically, I trace a legacy of visualization tools that starts with Archibald Scott Cooper and Friedrich Kekulé in the late 1800s, crystallizes as material manipulatives in Kekulé’s student Jacobus Henricus Van’t (...) Hoff and his folded paper “toys,” is legitimized in the California lab of Linus Pauling, and is glorified in the popular imaginary with James Watson and Francis Crick’s model of DNA. My tracing then follows several threads into contemporary modeling practices. I ultimately argue that modeling play, originally outside of the boundary of deductive, positivist science, is now an accepted mode of inductive reasoning in these related chemical fields. (shrink)

This is a summary of the book _Just Words: On Speech and Hidden Harm (OUP 2019)_. We all know that speech can be harmful. But what are the harms and how exactly does the speech in question brings those harms about? Just Words identifies a previously overlooked mechanism by which speech constitutes, rather than merely causes, harm. The author argues that speech constitutes harm when it enacts a norm that prescribes that harm. She illustrates this theory by considering many categories (...) of speech including sexist remarks, racist hate speech, pornography, verbal triggers for stereotype threat, micro-aggressions, political dog whistles, slam poetry, and even the hanging of posters. Just Words explores a variety of harms - such as oppression, subordination, discrimination, domination, harassment, and marginalization - and ways in which these harms can be remedied. (shrink)

The Mental Capacity Act (2005) was designed to protect and empower patients with impaired capacity. Despite an estimated 40% of medical inpatients lacking capacity, it is unclear how many patients undergo capacity assessments and treatment under the Act. We audited the number of capacity assessments on the general medical wards of an English-teaching hospital. A total of 95 sets of case notes were reviewed: the mean age was 78.6 years, 57 were female. The most common presenting complaints were feeling ‘unwell’ (...) (n = 25) and confusion (n = 24). In all, 52 patients had conditions, such as delirium (n = 26) and dementia (n = 15), which often impair capacity. Capacity was assessed in seven (7.4%) patients, all of whom disagreed with the medical team about their treatment. The number of documented assessments fell short of the estimated rate of incapacity, suggesting that some means of improving capacity assessment in busy medical environments is required. (shrink)

More than twenty-five years after the first signs of potential harm, the US remains locked in the grip of an opioid epidemic, with more Americans dying from overdoses than ever before.1 Diversion of prescription opioids plays an important role in opioid-related harms. Much of the scientific and public health focus on diversion has been on end-users, given how commonly non-medical prescription opioid use occurs, as well as the proportion of individuals who report that their source of non-medical opioids was friends (...) or family. However, diversion of opioids, as well as their rampant oversupply, can be discerned higher up the supply chain, including among wholesalers, pharmacies and rogue prescribers whose behavior may trigger well-described “flags” warranting further evaluation and action. (shrink)