The use of recent research on variations in medical practice to promote competitive market oriented cost containment strategies is critically examined. Research demonstrating widespread variations in physician practices for similar patient populations undermines the medical profession's claims about the scientific objectivity of medical practice and indicates the existence of widespread waste and inappropriate utilization of health care resources. Cost containment programs which rely on market-based care avoidance incentives, such as Medicare prospective payment or cost sharing plans, (...) attempt to impact medical practice variations by creating economic barriers between doctor and patient. An alternative interpretation of research on practice variations is presented, emphasizing containing costs while improving quality of care and achieving greater equity through planning and regulation of medical supply factors. (shrink)

BackgroundObtaining informed consent for intravenous thrombolysis in acute ischemic stroke can be challenging, and little is known about if and how the informed consent procedure is performed by neurologists in clinical practice. This study examines the procedure of informed consent for intravenous thrombolysis in acute ischemic stroke in high-volume stroke centers in the Netherlands.MethodsIn four high volume stroke centers, neurology residents and attending neurologists received an online questionnaire concerning informed consent for thrombolysis with tissue-type plasminogen activator (tPA). The respondents (...) were asked to report their usual informed consent practice for tPA treatment and their considerations on whether informed consent should be obtained.ResultsFrom the 203 invited clinicians, 50% (n = 101) completed the questionnaire. One-third of the neurology residents (n = 21) and 21% of the neurologists (n = 8) reported that they always obtain informed consent for tPA treatment. If a patient is not capable of providing informed consent, 30% of the residents (n = 19) reported that they start tPA treatment without informed consent. In these circumstances, 53% of the neurologists (n = 20) reported that the resident under their supervision would start tPA treatment without informed consent. Most neurologists (n = 21; 55%) and neurology residents (n = 45; 72%) obtained informed consent within one minute. None of the respondents used more than five minutes for informed consent. Important themes regarding obtaining informed consent for treatment were patients’ capacity, and medical, ethical and legal considerations.ConclusionThe current practice of informed consent for thrombolysis in acute ischemic stroke varies among neurologists and neurology residents. If informed consent is obtained, most clinicians stated to obtain informed consent within one minute. In the future, a shortened information provision process may be applied, making a shift from informed consent to informed refusal, while still considering the patient’s capacity, stroke severity, and possible treatment delays. (shrink)

This article explores local variations in scientific practice through the lens of scientists’ international mobility. Its aim is twofold: to explore how the notion of epistemic living spaces may be mobilised as a tool for systematically exploring differences in scientific practice across locations, and to contribute to literature on scientific mobility. Using material from an interview study with scientists with experience of international mobility, and epistemic living spaces as an analytical frame, the paper describes a set of (...) aspects of life in science that interviewees described as being different in different places. These axes of variation were: embodied routines of research; resource levels and salaries; daily or longer-term rhythms of scientific life ; ‘efficiency’ and how work time is used; degree of hierarchy; the nature of social interactions between colleagues; the purposes of research; the social and interpersonal organisation of knowledge production; and the scale or ambition of research. In presenting an exploratory overview of these variations, the article points the way for future comparative investigation of epistemic cultures through studies of international mobility. (shrink)

This paper aims to explore disciplinary variation in valuation practices by comparing the way research groups accumulate credibility across four epistemic cultures. Our analysis is based on case studies of four high-performing research groups representing very different epistemic cultures in humanities, social sciences, geosciences and mathematics. In each case we interviewed about ten researchers, analyzed relevant documents and observed a couple of meetings. In all four cases we found a cyclical process of accumulating credibility. At the same time, we found (...) significant differences in the manifestation of the six main resources that are part of the cycle, the mechanisms of conversion between these resources, the overall structure and the average speed of the credibility cycle. The different ways in which the groups use data and produce arguments affect the whole cycle of accumulating credibility. In some cultures, journal publications are the main source of recognition, but in others one can earn significant amounts of recognition for conference contributions or service to the academic community. Moreover, the collaboration practices in the respective fields strongly influence the connection between arguments and publications. In cultures where teams of researchers collaboratively produce arguments, it is more strongly embedded in the process of writing publications. We conclude that the credibility cycle can only be used as an analytical tool to explain the behavior of researchers or research groups when taking differences across epistemic cultures into account. (shrink)

The entextualization and recontextualization of speech via transcription is a fundamental methodology of discourse analysis. However, particularly for researchers concerned with sociopolitical issues in discourse, transcription is not a straightforward tool but a highly problematic yet necessary form of linguistic representation. Recent commentators have critiqued the inconsistency of researcher transcripts; by contrast, this article seeks to understand rather than remedy such variability, conceptualizing diversity in transcripts as a kind of linguistic variation. Examining four different types of variation in transcription (...) class='Hi'>practice — global format choices based on an analytic focus on content versus form, variation in the details of transcription format in reproducing one's own or others' transcripts, orthographic variation in a single transcript, and variation in translation — the article argues that although reflection about the transcription process cannot overcome the difficulties inherent in this methodology, it can allow scholars to be more attentive to their own transcription choices and their limitations and to make these explicit in their writing. (shrink)

Philosophical theorizing is often, either tacitly or explicitly, guided by intuitions about cases. Theories that accord with our intuitions are generally considered to be prima facie better than those that do not. However, recent empirical work has suggested that philosophically significant intuitions are variable and unstable in a number of ways. This variability of intuitions has led naturalistically inclined philosophers to disparage the practice of relying on intuitions for doing philosophy in general (e.g. Stich & Weinberg 2001) and for (...) doing moral philosophy in particular (Appiah 2008; Doris & Stich 2005; Horowitz 1998; Nadelhoffer & Feltz 2008; Sinnott Armstrong 2008). In this paper, we will draw on naturalistic considerations to offer some solace to philosophers who rely on intuitions. We wouldn’t call this a defense of intuitions, exactly, since we are sympathetic with much of the naturalists’ critique. But we want to introduce into the debate some neglected naturalistic reasons to be optimistic about intuitions, focusing especially on ethical intuitions. (shrink)

This paper aims to clarify the consequences of new scientific and philosophical approaches for the practical-theoretical framework of modern developmental biology. I highlight normal development, and the instructive-permissive distinction, as key parts of this framework which shape how variation is conceptualised and managed. Furthermore, I establish the different dimensions of biological variation: the units, temporality and mode of variation. Using the analytical frame established by this, I interpret a selection of examples as challenges to the instructive-permissive distinction. These examples include (...) the phenomena of developmental plasticity and transdifferentiation, the role of the microbiome in development, and new methodological approaches to standardisation and the assessment of causes. Furthermore, I argue that investigations into organismal development should investigate the effects of a wider range of kinds of variation including variation in the units, modes and temporalities of development. I close by examining various possible opportunities for producing and using normal development free of the assumptions of the instructive-permissive distinction. These opportunities are afforded by recent developments, which include new ways of producing standards incorporating more natural variation and being based on function rather than structure, and the ability to produce, store, and process large quantities of data. (shrink)

Given the enduring debate over what constitutes quality, and therefore appropriate training, in clinical ethics consultation, it is unsurprising that there is variation in the structure and content of clinical ethics fellowship programs. However, this variation raises questions about the value of fellowship training when the ethicists that emerge from these programs might be quite different. The specifics of fellowship programs are largely internal. As such, the extent of variation and whether such variation is problematic remains unclear. In this article, (...) we summarize lessons learned from discussions between fellows, their mentors and program directors at the 2020 Clinical Ethics UnConference, and outline some possible ways to advance the conversation about variation in fellowship programs and training. We argue for the more open sharing of training specifics in order to help break down the siloed nature of fellowship programs. Greater transparency could, firstly, allow for more robust reflection on and refinement of training practices and, secondly, allow us to better balance professionally appropriate consistency with unavoidable or desirable variation based on local norms, culture and leadership. (shrink)

Why do people comply with coronavirus disease 2019 public health guidance? This study considers cultural-psychological foundations of variation in beliefs about motivations for such compliance. Specifically, we focused on beliefs about two sources of prosocial motivation: desire to protect others and obligation to society. Across two studies, we observed that the relative emphasis on the desire to protect others as an explanation for compliance was greater in the United States settings associated with cultural ecologies of abstracted independence than in Chinese (...) settings associated with cultural ecologies of embedded interdependence. We observed these patterns for explanations of psychological experience of both others and self, and for compliance with mandates for both social distancing and face masks. Discussion of results considers both practical implications for motivating compliance with public health guidance and theoretical implications for denaturalizing prevailing accounts of prosocial motivation. (shrink)

Cognitive science has been beset for thirty years by foundational disputes about the nature and extension of cognition—e.g. whether cognition is necessarily representational, whether cognitive processes extend outside the brain or body, and whether plants or microbes have them. Whereas previous philosophical work aimed to settle these disputes, I aim to understand what conception of cognition scientists could share given that they disagree so fundamentally. To this end, I develop a number of variations on traditional conceptual explication, and defend (...) a novel explication of cognition called the sensitive management hypothesis. -/- Since expert judgments about the extension of “cognition” vary so much, I argue that there is value in explication that accurately models the variance in judgments rather than taking sides or treating that variance as noise. I say of explications that accomplish this that they are ecumenically extensionally adequate. Thus, rather than adjudicating whether, say, plants can have cognitive processes like humans, an ecumenically adequate explication should classify these cases differently: human cognitive processes as paradigmatically cognitive, and plant processes as controversially cognitive. -/- I achieve ecumenical adequacy by articulating conceptual explications with parameters, or terms that can be assigned a number of distinct interpretations based on the background commitments of participants in a discourse. For example, an explication might require that cognition cause “behavior,” and imply that plant processes are cognitive or not depending on whether anything plants do can be considered “behavior.” Parameterization provides a unified treatment of embattled concepts by isolating topics of disagreement in a small number of parameters. -/- I incorporate these innovations into an account on which cognition is the “sensitive management of organismal behavior.” The sensitive management hypothesis is ecumenically extensionally adequate, accurately classifying a broad variety of cases as paradigmatically or controversially cognitive phenomena. I also describe an extremely permissive version of the sensitive management hypothesis, arguing that it has the potential to explain several features of cognitive scientific discourse, including various facts about the way cognitive scientists ascribe representations to cognitive systems. (shrink)

The aim of this work is to elucidate John F. W. Herschel’s distinctive contribution to nineteenth-century British inductivism by exploring his understanding of experimental methods. Drawing on both his explicit discussion of experiment in his Preliminary Discourse on Natural Philosophy and his published account of experiments he conducted in the domain of electromagnetism, I argue that the most basic principle underlying Herschel’s epistemology of experiment is that experiment enables a particular kind of lower-level experimental understanding of phenomena. Experimental practices provide (...) knowledge of a particular phenomenon as a genuine effect produced under precise material conditions whose connections with other phenomena can be traced by variations in experimental parameters. The orienting concern of experimental inquiry seems to be the production of a secure understanding of phenomena even if it has no direct theoretical significance. Insofar as one can generate this lower-level understanding, it can function both as a fertile source for explanatory principles about phenomena and as a body of evidence against which one can test the adequacy of an explanatory hypothesis. This project provides evidence of Herschel’s inductivism not merely as a philosophical approach to understanding the sciences but as a methodological commitment in scientific practice. (shrink)

Objectives: Machine learning (ML) has the potential to facilitate “continual learning” in medicine, in which an ML system continues to evolve in response to exposure to new data over time, even after being deployed in a clinical setting. In this article, we provide a tutorial on the range of ethical issues raised by the use of such “adaptive” ML systems in medicine that have, thus far, been neglected in the literature. -/- Target audience: The target audiences for this tutorial are (...) the developers of ML AI systems, healthcare regulators, the broader medical informatics community, and practicing clinicians. -/- Scope: Discussions of adaptive ML systems to date have overlooked the distinction between 2 sorts of variance that such systems may exhibit—diachronic evolution (change over time) and synchronic variation (difference between cotemporaneous instantiations of the algorithm at different sites)—and underestimated the significance of the latter. We highlight the challenges that diachronic evolution and synchronic variation present for the quality of patient care, informed consent, and equity, and discuss the complex ethical trade-offs involved in the design of such systems. (shrink)

ArgumentThis paper analyzes the research strategies of three different cases in the study of human genetics in Mexico – the work of Rubén Lisker in the 1960s, INMEGEN's mapping of Mexican genomic diversity between 2004 and 2009, and the analysis of Native American variation by Andrés Moreno and his colleagues in contemporary research. We make a distinction between an approach that incorporates multiple disciplinary resources into sampling design and interpretation (unpacking), from one that privileges pragmatic considerations over more robust multidisciplinary (...) analysis (flattening). These choices have consequences for social, demographic, and biomedical practices, and also for accounts of genetic variation in human populations. While the former strategyunpacksfine-grained genetic variation – favoring precision and realism, the latter tends toflattenindividual differences and historical depth in lieu of generalization. (shrink)

Chinese negotiators are known to have a negotiation emphasis that differs from their Western counterparts, especially in issues of face and conflict. These values, however, are not monolithic, and can change depending on the negotiation circumstance. This research examines how negotiation tactics changes when Chinese negotiators are faced with counterparts from near and distant cultures. An online conjoint simulation drew 351 respondents in Taiwan to test subjective perceptions of counterparts from the USA and Japan. Chinese respondents exhibited increased cultural accommodation (...) when the counterpart's culture was more distant – paying more attention to sacrificing self-interest and saving face for the other side. Integration in the negotiation was emphasized across both near and distant cultures above that observed for negotiation with Chinese counterparts. Saving face, ignoring conflict, and domination tactics were consistently valued, irrelevant of culture. Masculinity among Chinese respondents was exhibited in a preference for integration with male counterparts, especially for Chinese male negotiators. Results indicate practical considerations when preparing for negotiation with a Chinese counterpart by considering inconsistencies in preferences while also considering consistent values. (shrink)

Chinese negotiators are known to have a negotiation emphasis that differs from their Western counterparts, especially in issues of face and conflict. These values, however, are not monolithic, and can change depending on the negotiation circumstance. This research examines how negotiation tactics changes when Chinese negotiators are faced with counterparts from near and distant cultures. An online conjoint simulation drew 351 respondents in Taiwan to test subjective perceptions of counterparts from the USA and Japan. Chinese respondents exhibited increased cultural accommodation (...) when the counterpart's culture was more distant – paying more attention to sacrificing self-interest and saving face for the other side. Integration in the negotiation was emphasized across both near and distant cultures above that observed for negotiation with Chinese counterparts. Saving face, ignoring conflict, and domination tactics were consistently valued, irrelevant of culture. Masculinity among Chinese respondents was exhibited in a preference for integration with male counterparts, especially for Chinese male negotiators. Results indicate practical considerations when preparing for negotiation with a Chinese counterpart by considering inconsistencies in preferences while also considering consistent values. (shrink)

In her paper, ‘Action and Self-location in Perception’, Susanna Schellenberg argues that perceptual experience of an object's intrinsic spatial properties, such as its size and shape, requires a capacity to act. More specifically, Schellenberg argues that, to have a perceptual experience of an object's intrinsic spatial properties, a subject needs to have a certain practical conception of space, or a spatial know-how. That, in turn, requires self-locating representations, which locate the subject, relative to the perceptual object, as a perceiver and (...) an agent, viz., someone who has a capacity for actions. She also makes two objections, viz., the unification objection and the sentient statue objection, to Alva Noë's sensorimotor view, a different account of how perceptual experience depends on actions. I will argue that her objections jointly render problematic not only Noë's but also her own view. (shrink)

Recent advances in machine learning methods have created opportunities to eliminate unfairness from algorithmic decision making. Multiple computational techniques (i.e., algorithmic fairness criteria) have arisen out of this work. Yet, urgent questions remain about the perceived fairness of these criteria and in which situations organizations should use them. In this paper, we seek to gain insight into these questions by exploring fairness perceptions of five algorithmic criteria. We focus on two key dimensions of fairness evaluations: distributive fairness and procedural fairness. (...) We shed light on variation in the potential for different algorithmic criteria to facilitate distributive fairness. Subsequently, we discuss procedural fairness and provide a framework for understanding how algorithmic criteria relate to essential aspects of this construct, which helps to identify when a specific criterion is suitable. From a practical standpoint, we encourage organizations to recognize that managing fairness in machine learning systems is complex, and that adopting a blind or one-size-fits-all mentality toward algorithmic criteria will surely damage people’s attitudes and trust in automated technology. Instead, firms should carefully consider the subtle yet significant differences between these technical solutions. (shrink)

Lionel Penrose (1898–1972) was an important leader during the mid-20th century decline of eugenics and the development of modern medical genetics. However, historians have paid little attention to his radical theoretical challenges to mainline eugenic concepts of mental disease. Working from a classification system developed with his colleague, E. O. Lewis, Penrose developed a statistically sophisticated and clinically grounded refutation of the popular position that low intelligence is inherently a disease state. In the early 1930s, Penrose advocated dividing “mental defect” (...) (low intelligence) into two categories: “pathological mental defect,” which is a disease state that can be traced to a distinct genetic or environmental cause, and “subcultural mental defect,” which is not an inherent disease state, but rather a statistically necessary manifestation of human variation in intelligence. I explore the historical context and theoretical import of this contribution, discussing its rejection of typological thinking and noting that it preceded Theodosius Dobzhansky’s better-known defense of human diversity. I illustrate the importance of Penrose’s contribution with a discussion of an analogous situation in contemporary medicine, the controversial practice of using human growth hormone injections to treat “idiopathic short stature” (mere diminutive height, with no distinct cause). I show how Penrose’s contributions to understanding human variation make such treatments appear quite misguided. (shrink)

This response picks up on the four key points developed in `Variation in Transcription'. The focus is on how transcription practices are implicated in extended histories of data processing by arguing for a wider take on the `dyad' of researcher and represented voice. The article addresses the relevance of historically specific contexts of `hearing' and interpretative-analytical appropriation, the practical exigencies of publication and how these have shifted over time, the contemporary challenges posed by transcription-in-translation, as well as the affordances and (...) constraints of past and current technologies. (shrink)

In this paper, we examine the period that immediately followed the invention of the Leiden jar. Historians of science have developed narrations that emphasize the role of grounding during the process of charging the jar. In this respect, this episode shows significant aspects that can be used to characterize science, scientific knowledge production, and the nature of science. From our own experimentation, we learned that grounding was not necessary in order to produce the effect. These experiences inspired us to go (...) back to primary sources. In doing so, we came to a new understanding of the early period after Kleist’s and Musschenbroek’s initial creation of the effect. From our analysis, we conclude that it is not the grounding which was perceived as a major innovation during this early period of the discussion but the concept of an electrical circuit. This understanding was fundamental in characterizing the Leiden jar as a new device challenging the then current knowledge of experimental practices in the field of electricity. (shrink)

We describe seven challenges that confront the kind of cross-cultural research currently practiced in experimental philosophy, illustrating them in an example in which intuitions about moral responsibility were studied in participants in four different countries. The seven challenge are (1) defining culture, (2) finding representative samples, (3) defining cognition, (4) task variation, (5) ecological validity, (6) interpreting the results, and (7) conducting ethical research. We suggest that these challenges can be overcome or avoided by attending to the ways cognition arises (...) in everyday life, and briefly describe an approach which regards culture not as an independent variable but as the medium of human action and human life, and which regards cognition as situated in time and place. (shrink)

Concepts and experimental results taken frombehavioral pharmacology, functional brain imaging,brain physiology, and behavioral neuroscience, wereused to develop the hypothesis that behavioraltolerance can, in part, be attributed to cellulartolerance. It is argued that task specific activationof circumscribed neuronal populations gives rise tocorresponding increases in regional cerebral bloodflow such that neurons related to task performance areexposed to higher effective doses of blood-borne drugthan neuronal groups not highly activated by thebehavioral task. Through this cerebral hemodynamicregulatory mechanism cellular tolerance phenomena canat least partially account (...) for behavioral tolerance(i.e., tolerance conferred through drugged practice). (shrink)

This paper will initially explore the assumptions about dissensus and consensus embedded in the values of cultures such as the dimension of individualism/collectivism. This will lead into an examination of how the emerging ideas about cultural forms of argument relate to dissensus and consensus in cultural practices. Finally, the paper will explore the ways that argument as dissensus can bridge the gap between cultural values and practice.

This paper will first introduce the development of professional ethics of counseling and psychotherapy in mainland China. Ethical awareness is often limited due to variations in training experiences. Aligning with ethics codes can also bring challenges due to nuances within Chinese culture. Furthermore, the authors discuss the ethical challenges regarding the principles of multiple relationships, informed consent, and confidentiality in the context of Chinese culture. These ethical issues are often discussed within an individualistic cultural frame and presentation from a (...) collectivist culture offers a unique perspective in the ethics literature. (shrink)

The target article “Thinking Through Other Minds” (TTOM) offered an account of the distinctively human capacity to acquire cultural knowledge, norms, and practices. To this end, we leveraged recent ideas from theoretical neurobiology to understand the human mind in social and cultural contexts. Our aim was bothsynthetic– building an integrative model adequate to account for key features of cultural learning and adaptation; andprescriptive– showing how the tools developed to explain brain dynamics can be applied to the emergence of social and (...) cultural ecologies of mind. In this reply to commentators, we address key issues, including: (1) refining the concept of culture to show how TTOM and the free-energy principle (FEP) can capture essential elements of human adaptation and functioning; (2) addressing cognition as an embodied, enactive, affective process involving cultural affordances; (3) clarifying the significance of the FEP formalism related to entropy minimization, Bayesian inference, Markov blankets, and enactivist views; (4) developing empirical tests and applications of the TTOM model; (5) incorporating cultural diversity and context at the level of intra-cultural variation, individual differences, and the transition to digital niches; and (6) considering some implications for psychiatry. The commentators’ critiques and suggestions point to useful refinements and applications of the model. In ongoing collaborations, we are exploring how to augment the theory with affective valence, take into account individual differences and historicity, and apply the model to specific domains including epistemic bias. (shrink)

Although there is increasing recognition that theory and practice in science are often inseparably intertwined, discussions of scientific controversies often continue to focus on theory, and not practice or methodologies. As a contribution to constructing a framework towards understanding controversies linked to scientific practices, we introduce the notion of borrowed epistemic credibility, to describe the situation in which scientists exploit fallacious similarities between accepted tenets in other fields to garner support for a given position in their own field. (...) Our proposal is based on the analysis of a recent controversy in phylogeography, a biological subdiscipline concerned with the study of the historical causes of variation in genetic diversity within species in concrete biogeographical locations. Through a review of the arguments that support the two conflicting phylogeographic schools, we show that ‘theory’ plays essentially no role as a foundation of the controversy, whereas both sides borrow epistemic credibility from sources such as formal logic, similarity of results to those in other scientific areas, the authority of prominent scientists, or the presumed superiority of quantitative vs. verbal reasoning. Our case study underscores the indivisibility of theory and practice and provide a means to re-examine important philosophical issues such as the meaning of inference, rationality, justification, and objectivity in scientific practice. (shrink)

The dichotomy between the conceptual and the empirical is part of common sense, yet its organizing force also extends to intellectual life more generally, including the disciplinary life of science and technology studies. This article problematizes this dichotomy as it operates in contemporary STS discussions, arguing instead that the conceptual and the empirical form unstable hybrids. Beginning with a discussion of the “discontents” with which the dominant theory methods packages in STS are viewed, it is suggested that STS has entered (...) a phase resembling Kuhnian normal science. Based on a discussion of the making of cognitive dissonance theory, it is then argued conceptual–empirical mixtures are unavoidable in actual research practice. This situation can be taken as an encouragement for more sustained exploration of conceptual–empirical relations and their inventive potentials. Invoking Deleuze and Guattari’s notion of “continuous variation,” the article concludes that STS as a discipline is well served by promoting an ethos of empirical and conceptual experimentation. (shrink)

In this commentary, I consider variability as an ordinary and irremediable feature related to the indexicality not only of transcripts but first of all of transcribing. In this sense, it is not just a characteristic of transcripts as texts, which can be assessed in a kind of philological comparison comparing formal features of autonomous and fixed textual objects, but a characteristic of transcribing as a situated practice. Practices are irremediably indexical, reflexively tied to the context of their production and (...) to the practical purposes of their accomplishment. Thus, a transcript is an evolving flexible object; it changes as the transcriber engages in listening and looking again at the tape, endlessly checking, revising, reformatting it. Transcribing relies in a fundamental way not only on the possibility of fixing the relevant details in a complex multilayered representation but also on the possibility of manipulating them, playing them again and again, at different paces, positions, fragments, while transcribing their finely tuned coordination, their synchronization, the fine articulation between different projections and sequential implicativenesses. These manipulations are one of the ways in which transcribing is accomplished as a situated practice. (shrink)

OBJECTIVES: To compare the practices of local research ethics committees and the time they take to obtain ethical approval for a multi-centre study. DESIGN: A retrospective analysis of outcome of applications for a multi-centre study to local research ethics committees. SETTING: Thirty-six local research ethics committees covering 38 district health authorities in England. MAIN MEASURES: Response of chairmen and women, the time required to obtain approval, and questions asked in application forms. RESULTS: We received replies from all 36 chairmen contacted: (...) four (11%) granted their approval, and 32 (89%) required our proposal to be considered by their local research ethics committee. Three committees asked us to attend their meetings. The application was approved by all 36 local research ethics committees but the time to obtain ethical approval varied between six to 208 days. One third of the committees did not approve the project within three months, and three took longer than six months. There was considerable variation in the issues raised by local research ethics committees and none conformed exactly to the Royal College of Physicians' guidelines. CONCLUSION: Obtaining ethical approval for a multi-centre study is time-consuming. There is much diversity in the practice of local research ethics committees. Our data support the recommendation for a central or regional review body of multi-centre studies which will be acceptable to all local research ethics committees. (shrink)

The purpose of this paper is to contribute to the ongoing analyses that aim to confront the problem of marked variation. Negatively marked differences are those natural variations that are used to cleave human beings into different categories (e.g., of disablement, of medicalized pathology, of subnormalcy, or of deviance). The problem of marked variation is: Why are some rather than other variations marked as epistemically or culturally significant or as a diagnostic of pathology, and What is the epistemic (...) background that makes these—rather than other variations—marked as subnormal? For Wilson (2018a), critical examination of the problem of marked variation is central to understanding the epistemology of medicalized pathology that made the history of eugenics possible. My aim is to explore the role marked variation plays in eugenic and other problematic classifications and the inferences they appear to license. I pay particular attention to the normative valuations of marked variations, how these valuations affect the inferences that are made by others about those possessing the variation, and how those possessing the variation perceive themselves. In the final sections, I illustrate this by critically discussing three putative kinship conceptions of race. I rely on these to extend the scope of the puzzle of marked variation from the context of historic and current markings of an individual’s variation as disability in the eugenics movement to historic and current markings for assigning putative racial ascriptions to individuals and groups. Lastly, I suggest that the problem of marked variation is a problem that looms over any epistemic account that is dependent upon sorting or classifying. (shrink)