Why was Anti-Slavery International (ASI) so effective at changing norms slavery and even mobilizing the support that ended the transatlantic slave trade at the end of the nineteenth century, and why has that success not continued on into subsequent eras? This article claims that ASI's organizational structure is the key to understanding why its accomplishments in earlier eras have yet to be replicated, and why today it struggles to make modern forms of slavery, such as human trafficking, salient political issues. (...) Organizational structure is defined by how an NGO distributes power over agenda-setting (proposal and enforcement power) and its implementation. Those NGOs that centralize agenda-setting and decentralize the implementation of that agenda will be most effective at changing international norms. This paper demonstrates the tractability of that claim with a comparative analysis of ASI past and present to show that changes in organizational structure have led to differences in their effect on international norms, in spite of the fact that slavery in its modern forms persists as a political and social problem. (shrink)

Biomedical innovation and translation are increasingly emphasizing research using “big data.” The hope is that big data methods will both speed up research and make its results more applicable to “real-world” patients and health services. While big data research has been embraced by scientists, politicians, industry, and the public, numerous ethical, organizational, and technical/methodological concerns have also been raised. With respect to technical and methodological concerns, there is a view that these will be resolved through sophisticated information technologies, predictive algorithms, (...) and data analysis techniques. While such advances will likely go some way towards resolving technical and methodological issues, we believe that the epistemological issues raised by big data research have important ethical implications and raise questions about the very possibility of big data research achieving its goals. (shrink)

Maria Morales’s striking and thought-provoking argument in Perfect Equality is that John Stuart Mill’s egalitarianism unifies his practical philosophy and that this element of his thought has been neglected in recent revisionary scholarship. Placing Mill’s arguments for the substantive value of “perfect equality” in The Subjection of Women at the center of her analysis, Morales develops a distinctive interpretation of Mill as an egalitarian liberal. Morales also aims to counter many recent communitarian critiques of liberalism as founded upon a conception (...) of the self as atomistic and individualistic. Like other Mill scholars, Morales sees Mill’s liberalism as an appealing alternative to the dominant Rawlsian theory, and she offers Mill’s approach as a response to “the still popular view that liberalism is structurally incompatible with a rich conception of the human good, particularly with a substantive commitment to equality”. Mill’s theory is not “doggedly individualistic,” and it rejects the model of liberal social life as atomistic and abstract. The well-constituted communities of the title are based upon “sympathetic, cooperative, and egalitarian values”. (shrink)

In this Symposium on the Ethics and Epistemology of Big Data, we present four perspectives on the ways in which the rapid growth in size of research databanks—i.e. their shift into the realm of “big data”—has changed their moral, socio-political, and epistemic status. While there is clearly something different about “big data” databanks, we encourage readers to place the arguments presented in this Symposium in the context of longstanding debates about the ethics, politics, and epistemology of biobank, database, genetic, and (...) epidemiological research. (shrink)

On one hand, Chinese consumers are well known for conspicuous consumption and the adoption of luxury products and named brands. On the other hand, they also have a bad reputation for buying counterfeit products. Their simultaneous preferences for two contrasting types of product present a paradox that has not been addressed in the literature. This study attempts to present an explanation of this paradox by examining the effects of traditional Chinese cultural values and consumer values on consumers’ deontological judgment of (...) pirated CDs and the amount of social benefits they perceive they gain from them. We interviewed 300 Hong Kong Chinese consumers, and found that face consciousness increased materialism and risk aversion, thereby producing a favorable deontological judgment of pirated CDs. Face consciousness also has a direct effect on the amount of social benefits perceived in pirated CDs. Both favorable deontological judgment and perceived social benefits contributed to a strong intention to buy pirated CDs. The results are discussed in a cultural perspective. (shrink)

During the past decade, a new term has entered the medical/legal lexicon : maternal-fetal conflict. Implicit in the terminology is the assumption that a pregnant woman and her fetus have separate and competing rights. This concept has stimulated extensive legal and ethical debate, primarily in the context of medical interventions forced on unwilling pregnant women, and in corporate efforts to bar fertile women from hazardous jobs. On one side of the debate are the proponents of the future child's right to (...) be born of sound mind and body, and society's interest in the delivery of healthy newborns. On the other side, are advocates of a woman's right to reproductive autonomy, bodily integrity, due process, confidential medical treatment, and freedom from gender discrimination. Neither side has challenged the formulation of the problem, or has examined its permeation into public health policy. (shrink)

Ethics training has been highlighted as essential for building and fostering business ethics in organizations. National and international trends show that over 40% of businesses have some form of business ethics training. We use data collected from 199 firms to examine the presence of ethics training in top Canadian companies and found that the presence varied by region and firm size, and that the Canadian average (35%) lags other countries.

Peer review of manuscripts for biomedical journals has become a subject of intense ethical debate. One of the most contentious issues is whether or not peer review should be anonymous. This study aimed to generate a rich, empirically-grounded understanding of the values held by journal editors and peer reviewers with a view to informing journal policy. Qualitative methods were used to carry out an inductive analysis of biomedical reviewers’ and editors’ values. Data was derived from in-depth, open-ended interviews with journal (...) editors and peer reviewers. Data was “read for” themes relevant to reviewer anonymisation and interactions among editors, reviewers, and authors. Editors and peer reviewers provided three arguments that would support a more open and interactive peer-review process. First, a number of participants emphasised the importance of not only ensuring the scientific quality of published research but also nurturing their colleagues and supporting their communities. Second, many spoke about the ongoing moral responsibilities that reviewers and editors felt toward authors. Finally, participants spoke at length about their enjoyment of social interactions and of the value of collective, rather than isolated, reasoning processes. Whether or not journal editors decide to allow anonymous review , the values of editors and reviewers need to be seriously addressed in codes of publication ethics, in the management of biomedical journals, and in the establishment of journal policies. (shrink)

In this Symposium on the Ethics and Epistemology of Big Data, we present four perspectives on the ways in which the rapid growth in size of research databanks—i.e. their shift into the realm of “big data”—has changed their moral, socio-political, and epistemic status. While there is clearly something different about “big data” databanks, we encourage readers to place the arguments presented in this Symposium in the context of longstanding debates about the ethics, politics, and epistemology of biobank, database, genetic, and (...) epidemiological research. (shrink)

During the past decade, a new term has entered the medical/legal lexicon : maternal-fetal conflict. Implicit in the terminology is the assumption that a pregnant woman and her fetus have separate and competing rights. This concept has stimulated extensive legal and ethical debate, primarily in the context of medical interventions forced on unwilling pregnant women, and in corporate efforts to bar fertile women from hazardous jobs. On one side of the debate are the proponents of the future child's right to (...) be born of sound mind and body, and society's interest in the delivery of healthy newborns. On the other side, are advocates of a woman's right to reproductive autonomy, bodily integrity, due process, confidential medical treatment, and freedom from gender discrimination. Neither side has challenged the formulation of the problem, or has examined its permeation into public health policy. (shrink)

In this study, we discuss the colonial project as an eliminatory structure of indigenous ways of knowing and doing that is built into Canadian social and health institutions. We elaborate on the role nursing plays in maintaining systemic racism, marginalization and discrimination of Indigenous Peoples. Based on historical practices and present‐day circumstances, we argue that changing language in research and school curriculums turns decolonization into what Tuck and Yang call a ‘metaphor’. Rather, we propose decolonization as a political project where (...) nurses acknowledge their involvement in colonial harms and disrupt the assumptions that continue to shape how nurses interact with Indigenous people, including knowledge systems that perpetuate colonial interests and privilege. Decolonization requires nurses to understand the colonial practices that led to dispossession of land, erasure of knowledge, culture and identity, while upholding indigenous ways of knowing and doing in health, healing and living. As a political manifesto that liberates indigenous life from oppressive structures of colonialism and capitalism, The Red Deal is presented as a visionary platform for decolonization. The aim of this study is to articulate three dimensions of caretaking within The Red Deal as a framework to decolonize nursing knowledge development and practice. Based on the philosophical dimension embedded in The Red Deal that revoke norms and knowledge assumptions of capitalism that destroy indigenous ways of knowing and doing, we underscore an approach toward decolonizing nursing. Our approach rejects the apolitical nature of nursing as well as the unilateral western scientific knowledge approach to knowledge development and recognition. A critical emancipatory approach that addresses the socio‐political and historical context of health care, recognizes dispossession of land and adopts a ‘multilogical’ vision of knowledge that gives space for representation and voice is needed for true decolonization of nursing. (shrink)

Many countries are experiencing increasing levels of demand for access to assisted reproductive technologies. Policies regarding who can access ART and with what support from a collective purse are highly contested, raising questions about what state responses are justified. Whilst much of this debate has focused on the status of infertility as a disease, we argue that this is something of a distraction, since disease framing does not provide the far-reaching, robust justification for state support that proponents of ART seem (...) to suppose. Instead, we propose that debates about appropriate state responses should consider the various implications for health and broader well-being that may be associated with difficulties starting a family. We argue that the harms and disruption to valued life projects of subfertility-related suffering may provide a stronger basis for justifying state support in this context. Further, we suggest that, whilst ART may alleviate some of the harm resulting from subfertility, population-level considerations can indicate a broader range of interventions aimed at tackling different sources of subfertility-related harm, consistent with broader public health aims. (shrink)

Researchers from diverse disciplines, including organismal and cellular physiology, sports science, human nutrition, evolution and ecology, have sought to understand the causes and consequences of the surprising variation in metabolic rate found among and within individual animals of the same species. Research in this area has been hampered by differences in approach, terminology and methodology, and the context in which measurements are made. Recent advances provide important opportunities to identify and address the key questions in the field. By bringing together (...) researchers from different areas of biology and biomedicine, we describe and evaluate these developments and the insights they could yield, highlighting the need for more standardisation across disciplines. We conclude with a list of important questions that can now be addressed by developing a common conceptual and methodological toolkit for studies on metabolic variation in animals. (shrink)

Our social role/biosocial theory provides a more adequate account of aggression sex differences than does Archer's sexual selection theory. In our theory, these sex differences arise flexibly from sociocultural and ecological forces in interaction with humans' biology, as defined by female and male physical attributes and reproductive activities. Our comments elaborate our theory's explanations for the varied phenomena that Archer presents.

The ultimate causes of sex differences in human aggressive behavior can lie mainly in evolved, inherited mechanisms that differ by sex or mainly in the differing placement of women and men in the social structure. The present commentary contrasts Campbell's evolutionary interpretation of aggression sex differences with a social structural interpretation that encompasses a wider range of phenomena.

Schmitt's findings provide little evidence that sex differences in sociosexuality are explained by evolved dispositions. These sex differences are better explained by an evolutionary account that treats the psychological attributes of women and men as emergent, given the biological attributes of the sexes, especially female reproductive capacity, and the economic and social structural aspects of societies.

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

Insect molting is elicited by a class of polyhydroxylated steroids, ecdysteroids, that originate in the prothoracic glands. Ecdysteroid synthesis in the prothoracic glands is controlled in large measure by a peptide hormone from the brain, prothoracicotropic hormone (PTTH), which exists in two forms and is released into the general circulation as a result of environmental and developmental cues. The means by which PTTH activates the prothoracic glands has been examined at the cellular level and the data reveal the involvement of (...) cAMP, calcium, calmodulin, cAMP‐dependent protein kinase and the ultimate phosphorylation of a 34 kDa protein tentatively identified as ribosomal protein S6. (shrink)

This target article presents a plausible evolutionary scenario for the emergence of the neural preconditions for language in the hominid lineage. In pleistocene primate lineages there was a paired evolutionary expansion of frontal and parietal neocortex (through certain well-documented adaptive changes associated with manipulative behaviors) resulting, in ancestral hominids, in an incipient Broca's region and in a configurationally unique junction of the parietal, occipital, and temporal lobes of the brain (the POT). On our view, the development of the POT in (...) our ancestors resulted in the neuroanatomical substrate consistent with the ability for representations in modality-neutral association cortex and, as a result of structure-imposing interaction with Broca's area, the hierarchically structured Evidence from paleoneurology and comparative primate neuroanatomy is used to argue that Homo habilis (2.5–2 million years ago) was the first hominid to have the appropriate gross neuroanatomical configuration to support conceptual structure. We thus suggest that the neural preconditions for language are met in H. habilis. Finally, we advocate a theory of language acquisition that uses conceptual structure as input to the learning procedures, thus bridging the gap between it and language. (shrink)

Semiotics, in the guise of the limited Saussurean semiology, has been widely used in the humanities and in cultural studies for the past 20 to 30 years at least. With the advent, nearly 20 years ago, of the environmental humanities, including the new field of humanities animal studies, the weaknesses of this mode of analysis became increasingly clear. This essay forms part of a larger attempt to develop a Peirce-informed biosemiotic theory capable of affording conceptual tools for the broad-based study (...) of human and nonhuman natural and cultural developmental ecologies. It is particularly concerned to develop a biosemiotic, and hence non-reductive, account of aesthetic experience in which function consists in the growth of knowledge. Based on the role of chance, and thus creativity, in natural and cultural evolutionary systems, this essay uses poetry and poetic theory in order to argue that chance is a habit-upsetting happenstance whereby something which has the potential to become a sign , or to become a bearer of meaning, actually does become a sign to some living thing. (shrink)

Background Autism self-advocates’ views regarding genetic tests for autism are important, but critical questions about their perspectives arise.Methods We interviewed 11 autism self-advocates, recruited through autism self-advocacy websites, for 1 h each.Results Interviewees viewed genetic testing and its potential pros and cons through the lens of their own indiviudal perceived challenges, needs and struggles, especially concerning stigma and discrimination, lack of accommodations and misunderstandings from society about autism, their particular needs for services, and being blamed by others and by themselves (...) for autistic traits. Their views of genetic testing tended not to be binary, but rather depended on how the genetic test results would be used. Interviewees perceived pros of genetic testing both in general and with regard to themselves (e.g., by providing “scientific proof” of autism as a diagnosis and possibly increasing availability of services). But they also perceived disadvantages and limitations of testing (e.g., possible eugenic applications). Participants distinguished between what they felt would be best for themselves and for the autistic community as a whole. When asked if they would undergo testing for themselves, if offered, interviewees added several considerations (e.g., undergoing testing because they support science in general). Interviewees were divided whether a genetic diagnosis would or should reduce self-blame, and several were wary of testing unless treatment, prevention or societal attitudes changed. Weighing these competing pros and cons could be difficult.Conclusions This study, the first to use in-depth qualitative interviews to assess views of autism self-advocates regarding genetic testing, highlights key complexities. Respondents felt that such testing is neither wholly good or bad in itself, but rather may be acceptable depending on how it is used, and should be employed in beneficial, not harmful ways. These findings have important implications for practice, education of multiple stakeholders, research, and policy. (shrink)

Adults typically take pleasure in the physical dimension of caring for children. Confusingly, much recent theology either condemns adults' physical enjoyment of children as exploitive or accepts it without comment. A convincing, unifying theological moral argument is needed to yoke the two instincts systematically. Although this essay acknowledges sexual abuse's harmful effects on children, its focus is the ordering of adult desire and behavior. Beginning from the premise that all human love is erotic—hoping in, if not expecting, pleasurable reciprocity—I draw (...) upon the work of Wendy Farley and Linda Holler to argue that healthy human love for children combines desires for the other with unpossessive delight, attunement, and realistic responsiveness. I examine the documented examples of female abuse of children and the example of male abuse in Vladimir Nabokov's Lolita to demonstrate the usefulness of this discussion for an analysis of Western accounts of abuse, and I suggest that the approach may be illuminating in other cultures. (shrink)

We describe the structure, operation, and experience of the Massachusetts General Hospital ethics committee, formally called the Edwin H. Cassem Optimum Care Committee, from January 2007 through December 2013. Founded in 1974 as one of the nation’s first hospital ethics committees, this committee has primarily focused on the optimum use of life-sustaining treatments. We outline specific sociodemographic and clinical characteristics of consult patients during this period, demographic differences between the adult inpatient population and patients for whom the ethics committee was (...) consulted, and salient features of the consults themselves. We include three case studies that illustrate important consult themes during this period. Our findings expand knowledge about the structure and workings of hospital ethics committees and illustrate how one ethics committee has developed and utilized policies on end-of-life care. More generally, we model a sociological approach to the study of clinical ethics consultation that could be utilized to contextualize institutional practices over time. (shrink)

Providing the most thorough coverage available in one volume, this comprehensive, broadly based collection offers a wide variety of selections in four major genres, and also includes a section on film. Each of the five sections contains a detailed critical introduction to each form, brief biographies of the authors, and a clear, concise editorial apparatus. Updated and revised throughout, the new Fourth Edition adds essays by Margaret Mead, Russell Baker, Joan Didion, Annie Dillard, and Alice Walker; fiction by Nathaniel Hawthorne, (...) Ursula K. LeGuin, Anton Chekov, James Joyce, Katherine Mansfield, F. Scott Fitzgerald, William Faulkner, Alice Walker, Louise Erdrich, Donald Barthelme, and James McPherson; poems by John Donne, Robert Browning, Walt Whitman, Edwin Arlington Robinson, e.e. cummings, Langston Hughes, W.H. Auden, Philip Levine, and Louise Gluck; and plays by August Wilson, Marsha Norman, Wendy Wasserstein, and Vaclav Havel. The chapter devoted to film examines the relation of film to literature and gives the complete screenplay for Citizen Kane plus close analysis of a scene from the film. With its innovative structure, comprehensive coverage, and insightful and stimulating presentation of all kinds of literature, this is an anthology readers will turn to again and again. (shrink)

Arthur W. H. Adkins's writings have sparked debates among a wide range of scholars over the nature of ancient Greek ethics and its relevance to modern times. Demonstrating the breadth of his influence, the essays in this volume reveal how leading classicists, philosophers, legal theorists, and scholars of religion have incorporated Adkins's thought into their own diverse research. The timely subjects addressed by the contributors include the relation between literature and moral understanding, moral and nonmoral values, and the contemporary meaning (...) of ancient Greek ethics. The volume also includes an essay from the late Adkins himself illustrating his methodology in an analysis of the "Speech of Lysias" in Plato's _Phaedrus_. _The Greeks and Us_ will interest all those concerned with how ancient moral values do or do not differ from our own. Contributors include Arthur W. H. Adkins, Stephanie Nelson, Martha C. Nussbaum, Paul Schollmeier, James Boyd White, Bernard Williams, and Lee Yearley. Commentaries by Wendy Doniger, Charles M. Gray, David Grene, Robert B. Louden, Richard Posner, and Candace Vogler. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Erotic Attunement: Parenthood and the Ethics of Sensuality between Unequals by Cristina L. H. TrainaSandra Sullivan-DunbarErotic Attunement: Parenthood and the Ethics of Sensuality between Unequals CRISTINA L. H. TRAINA Chicago: University of Chicago Press, 2011, 363 pp. $55.00In this ambitious and broadly interdisciplinary work, Cristina Traina begins from an experience that evades contemporary discussion: maternal sensual pleasure in the care of infants and young children. As Traina notes, (...) this experience puts two contemporary dogmas on a “collision course”: the widely accepted norm that sexual pleasure is intrinsically good and the widely accepted norm that sexual pleasure between unequals is intrinsically exploitative. As with other feminist turns toward neglected experience, this one calls for a recalibration of ethical models—in this case, a more complex and nuanced sexual ethic.Traina challenges readers to broaden notions of sexuality beyond androcentric models focused primarily on particular acts and on genital release. Such models are deeply graven in the Christian tradition and reinforced through reductive cultural appropriations of Freudian thought. But all human relations are embodied and involve desire, argues Traina, and are thus in some sense erotic, though most do not involve genital sexuality. Likewise, her readers are challenged to recognize the pervasiveness of relations of inequality in human life, when most Christian sexual ethics limit themselves to relations between equals, or at least understand a sexual ethic to aim at equality and mutuality.The book engages psychological resources demonstrating the human need for appropriate touch as well as the profound damage done by abusive touch. The need is so universal and foundational that Traina casts it as a human right; yet offering such touch appropriately is a subtle and challenging moral task beset with danger and the potential for self-deception.Traina diagnoses the sexual abuser as a fragmented self, one unable to perceive the concrete reality, needs, and experiences of her victim and bent on the doomed project of creating a whole self by appropriating and objectifying the other. Thus, at the heart of her ethic of sensuality between unequals is the notion of “attunement.” The attuned caregiver can acknowledge and fully experience inclinations, joys, and pains with a contemplative and compassionate awareness that allows considered and appropriate responses. The attuned care-giver lives with “unending, acknowledged desire” (177), a desire that glories in the goodness of the child in her care and, in so doing, creatively elicits subjectivity from her rather than manipulating her to meet the needs of the caregiver. [End Page 240]This ethical vision is developed in dialogue with a number of resources from Christian and secular sources. Traina helpfully nuances a Thomistic account of the virtue of temperance as a guideline for appropriate touch. She also develops revisionist accounts of Augustinian desire offered by Wendy Farley and Linda Holler. I found myself wondering whether some more traditional interpretations of Augustine might serve Traina’s project as well as or better than these revisionist understandings, which emphasize desire as a permanent state rather than directed toward final rest in God.Likewise, Traina works her way through the plethora of recent eros theologies, drawing in particular on recent interpretations of Plato’s Symposium that stress the creativity of eros in bringing to birth goodness and beauty as well as its potential for enabling a degree of other-regard. It seems to this reader that a contemporary ethic of sexuality between unequals calls for greater other-regard than the most generous interpretation of Plato’s ladder of love can suggest. However, Plato’s caution about the profound difficulty of directing eros toward the true good resonates with the difficulty of achieving the “erotic attunement” described by Traina.In any case, quibbles about the resources and interpretations that Traina mines to support her ethic do not lessen the originality, power, and importance of this book, which extends beyond sexual ethics to reframe questions about embodiment, (in)equality, and moral agency in profound and necessary ways.Sandra Sullivan-DunbarLoyola University, ChicagoCopyright © 2014 Society of Christian Ethics... (shrink)

In 'Een handvol filosofen' staan de filosofen centraal die sinds de oprichting van de Vrije Universiteit in 1880 aan deze instelling verbonden zijn geweest. Het gaat hierbij niet alleen om de inhoud van hun werk, maar ook om de personen zelf. Er waren filosofiedocenten die zich met de universiteit identificeerden en zich volledig konden ontplooien. Er waren er echter ook voor wie dit niet gold, die geïsoleerd of in gewetensnood raakten. Veel filosofiestudenten waren actief betrokken bij wat er in hun (...) faculteit gebeurde. Zij namen initiatieven, protesteerden soms tegen de gang van zaken en kozen partij in conflictsituaties. Sinds het eind van de jaren zestig van de twintigste eeuw verloor de Vrije Universiteit geleidelijk haar christelijk karakter. Tegenwoordig werken alle stafleden vanuit hun eigen motivatie mee aan een hoofdzakelijk seculier geworden universiteit, die ruimte biedt voor religieuze en levensbeschouwelijke diversiteit. (shrink)

A promise to do some action seems to create a binding obligation to do that action. And yet, paradoxically, an obligation seems not to be a fact that we can create or bring into existence; we can create an obligation only by creating or bringing into existence something else. The only way to avoid the paradox is to show that the act of promising creates something other than an obligation, which nonetheless binds us to perform the action in question. After (...) considering and rejecting various options such as the promisee's expectation and the promisor's resolve, Prichard locates the bindingness of a promise in a prior general promise, which allows the noises we make when promising to generate an obligation to perform the promised action. (shrink)

Overdiagnosis refers to diagnosis that does not benefit patients because the diagnosed condition is not a harmful disease in those individuals. Overdiagnosis has been identified as a problem in cancer screening, diseases such as chronic kidney disease and diabetes, and a range of mental illnesses including depression and attention deficit hyperactivity disorder. In this paper, we describe overdiagnosis, investigate reasons why it occurs, and propose two different types. Misclassification overdiagnosis arises because the diagnostic threshold for the disease in question has (...) been set at a level where many people without harmful disease are nonetheless diagnosed. We illustrate misclassification overdiagnosis using the example of chronic kidney disease. Misclassification occurs in diseases diagnosed using biomarkers or based on patient reported phenomena. Maldetection overdiagnosis arises because, at the time the diagnosis is made and despite the presence of a 'gold standard' diagnostic test, it is not possible to discriminate between harmful and non-harmful cases of the index disease. We illustrate maldetection overdiagnosis using the example of thyroid cancer. While there is some overlap between misclassification and maldetection overdiagnosis, this conceptual analysis helps to clarify the phenomenon of overdiagnosis and is a necessary first step in developing strategies to address the problem. (shrink)