The implication is that the majority of universities are inferior. A consequence of this is that whether such pronouncements are accurate or not they will influence decision-making in various quarters in such a way as to attract resources towards a small subset of the organisations, thereby amplifying differences that already exist, or, in some cases introducing real differences in quality where previously the alleged differences were spurious.

A genomic diagnosis for a young child could guide access to developmental care, school services, and social supports; yet these contexts remain understudied. Here we describe (at least) two ways a genomic diagnosis could promote such utility: as a ticket, where the diagnosis qualifies a child for services they weren’t previously able to access, or as a roadmap, where the diagnosis guides which services might be helpful. We explore the implications of a diagnosis that functions as either a ticket or (...) a roadmap, including how either might create additional disparities in the US developmental services system. We argue that fewer inequities would exist in a world where a genomic diagnosis functions more as a roadmap than a ticket. We recommend policy changes (increase early intervention funding, improve family navigation, and incentivize developmental services research) that can avoid the inequities associated with the “ticket” and move us towards a “roadmap” future. (shrink)

Religious healing specialists such as shamans often use magic. Evolutionary theories that seek to explain why laypersons find these specialists convincing focus on the origins of magical cognition and belief in the supernatural. In two studies, we reframe the problem by investigating relationships among ethnomedical specialists, who possess extensive theories of disease that can often appear “supernatural,” and religious healing specialists. In study 1, we coded and analyzed cross-cultural descriptions of ethnomedical specialists in 47 cultures, finding 24% were also religious (...) leaders and 74% used supernatural theories of disease. We identified correlates of the use of supernatural concepts among ethnomedical specialists; incentives and disincentives to patronize ethnomedical specialists; and distinct clusters of ethnomedical specialists that we label prestigious teachers, feared diviners, and efficacious healers. In study 2, we interviewed 84 Maasai pastoralists and their traditional religious and non-religious healing specialists. We found that laypersons relied on medicinal services based on combinations of efficacy, religious identity, and interpersonal trust. Further, laypersons and specialists largely used abstract concepts that were not conspicuously supernatural to describe how local medicines work. We conclude that religious healers in traditional societies often fulfill a practical and specialized service to local clients, and argue that supernatural theories of disease often reflect abstract cognition about rare phenomena whose causes are unobservable (e.g., infection, mental illness) instead of a separate “religious” style of thinking. (shrink)

Abstract The early Ru or ?Confucian? figure Xunzi (?Master Xun,? c. 310?c. 220 BCE) gives a sophisticated analysis of war, which he develops on the basis of a larger social and political vision that he works out in considerable detail. This larger vision of human society is thoroughly normative in the sense that Xunzi both argues for the value of his ideal conception of society, and relates these moral arguments for the Confucian Dao or Way to what I take to (...) be fairly hardheaded assessments of the dynamics of international relations in his late Warring States historical context. This combination of moral vision and political realism, combined with his advocacy of strong political authorities that nevertheless rule justly in service to the common good, makes his thought arguably more relevant to the contemporary world of contending nation-states, and a rising, undemocratic China, than any other pre-modern Confucian. Xunzi's own context, both intellectual and political/military, led him to argue about war in ways that look distinctive to contemporary Western ethicists ? and yet his preferred issues are revealing in themselves and are suggestive in relation to current debates in military ethics. In the first part of this paper I analyze Xunzi's argumentative strategy in debate about war, where he chooses to attack his adversaries on the question of how to cultivate true loyalty and obedience in subordinates. The second part briefly explores Xunzi's vision of the good society and how it fits into a multi-state world, which undergirds his critique of alternate discourses about war and government. The third examines the Xunzian vision of politics and war as a source for a contemporary Confucian theory of civilian-military relations. The fourth section explores some implications of a Xunzian account for international relations, through a brief comparison with the Kantian notion of ?perpetual peace? among liberal states, and whether such ?zones of peace? might be conceivable on Confucian grounds. The conclusion reflects on the ambiguous legacy of Xunzi's moralism in his analysis of war and statecraft, and the possible light this shines on contemporary Chinese political culture. (shrink)

Many cognitive and evolutionary theories of religion argue that supernatural explanations are byproducts of our cognitive adaptations. An influential argument states that our supernatural explanations result from a tendency to generate anthropomorphic explanations, and that this tendency is a byproduct of an error management strategy because agents tend to be associated with especially high fitness costs. We propose instead that anthropomorphic and other supernatural explanations result as features of a broader toolkit of well-designed cognitive adaptations, which are designed for explaining (...) the abstract and causal structure of complex, unobservable, and uncertain phenomena that have substantial impacts on fitness. Specifically, we argue that (1) mental representations about the abstract vs. the supernatural are largely overlapping, if not identical, and (2) when the data-generating processes for scarce and ambiguous observations are complex and opaque, a naive observer can improve a bias-variance trade-off by starting with a simple, underspecified explanation that Western observers readily interpret as “supernatural.” We then argue that (3) in many cases, knowledge specialists across cultures offer pragmatic services that involve apparently supernatural explanations, and their clients are frequently willing to pay them in a market for useful and effective services. We propose that at least some ethnographic descriptions of religion might actually reflect ordinary and adaptive responses to novel problems such as illnesses and natural disasters, where knowledge specialists possess and apply the best available explanations about phenomena that would otherwise be completely mysterious and unpredictable. (shrink)

When performing a skilled action—whether something impressive like a double somersault or something mundane like reaching for a glass of water—you exercise control over your bodily movements. Specifically, you guide their course. In what does that control consist? In this dissertation, I argue that it consists in attending to what you are doing. More specifically, in attending, agents harness their perceptual and perceptuomotor states directly and practically in service of their goals and, in doing so, settle the fine-grained manner (...) in which their bodies will move—details an intention alone leaves unsettled. This requires, among other things, that we reject views on which agents’ control is identical with their practical rationality. When all goes well, agents attentionally prioritize what is motivationally relevant to them to the exclusion of what would otherwise distract them from achieving their goals. However, sometimes agents attend distractedly—i.e., without prioritizing. As the aim of attention is to avoid distraction, this entails the possibility of defective attention. Defective attention, in turn, casts light on scenarios in which agents lose control over what they are doing, as when a skilled practitioner ‘chokes under pressure’. A complaint sometimes levelled against accounts, like mine, that claim to reduce agents’ control of their behaviour to that of causally efficacious mental states or events is that these accounts invariably deprive agents themselves of their rightful role in the generation of behaviour. This is the “Disappearing Agent Problem” for “reductive” or “event-causal” theories of action. I argue that, correctly understood, extant reductive theories do face a genuine Disappearing Agent Problem. However, it is a problem we solve by recognizing the role that conscious attention plays in making an action the agent’s own. Accordingly, I develop and defend an attentional account of action ownership. On this view, allocating conscious attention in service of your goals is sufficient for a kind of conscious perspective (“motivational perspective”), which, when active in controlling your behaviour, constitutes the behaviour as your own doing. As I explain, such perspective also contributes to explaining the subjective structure of your perceptual awareness of the world around you. (shrink)

Too often the study of philosophical texts is carried out in ways that do not pay significant attention to how the ideas contained within them are presented, articulated, and developed. This was not always the case. The contributors to this collected work consider Jewish philosophy in the medieval period, when new genres and forms of written expression were flourishing in the wake of renewed interest in ancient philosophy. Many medieval Jewish philosophers were highly accomplished poets, for example, and made conscious (...) efforts to write in a poetic style. This volume turns attention to the connections that medieval Jewish thinkers made between the literary, the exegetical, the philosophical, and the mystical to shed light on the creativity and diversity of medieval thought. As they broaden the scope of what counts as medieval Jewish philosophy, the essays collected here consider questions about how an argument is formed, how text is put into the service of philosophy, and the social and intellectual environment in which philosophical texts were produced. (shrink)

Modern epistemic questions have largely been focused around the individual and her ability to acquire knowledge autonomously. More recently epistemologists have begun to look more broadly in providing accounts of knowledge by considering its social context, where the individual depends on others for true beliefs. Hardwig explains the effect of this shift starkly, arguing that to reject epistemic dependency is to deny certain true beliefs widely held throughout society and, more specifically, it is to deny that science and scholarship can (...) provide true belief. Alternatively, Hardwig argues that beliefs could be granted to communities or groups but denied to individuals. This paper approaches these broad assertions using a group agency model from List and Pettit. Through a discussion of the ‘epistemic desideratum’ of group agents, I conclude that List and Pettit give us reason to accept some of Hardwig's concerns, but that attributing beliefs to groups does not require us to deny them to individuals, rather an individual can use a group agent as a source of epistemic dependence.Send article to KindleTo send this article to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle. Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service.GROUP AGENCY AND EPISTEMIC DEPENDENCYVolume 9, Issue 3Aaron DewittDOI: https://doi.org/10.1017/epi.2012.13Your Kindle email address Please provide your Kindle [email protected]@kindle.com Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Dropbox To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Dropbox. GROUP AGENCY AND EPISTEMIC DEPENDENCYVolume 9, Issue 3Aaron DewittDOI: https://doi.org/10.1017/epi.2012.13Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Google Drive To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Google Drive. GROUP AGENCY AND EPISTEMIC DEPENDENCYVolume 9, Issue 3Aaron DewittDOI: https://doi.org/10.1017/epi.2012.13Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Export citation Request permission. (shrink)

The left ventricular assist device was originally designed to be surgically implanted as a bridge to transplantation for patients with chronic end-stage heart failure. On the basis of the REMATCH trial, the US Food and Drug Administration and the US Centers for Medicare & Medicaid Services approved permanent implantation of the left ventricular assist device as a destination therapy in Medicare beneficiaries who are not candidates for heart transplantation. The use of the left ventricular assist device as a destination therapy (...) raises certain ethical challenges. Left ventricular assist devices can prolong the survival of average recipients compared with optimal medical management of chronic end-stage heart failure. However, the overall quality of life can be adversely affected in some recipients because of serious infections, neurologic complications, and device malfunction. Left ventricular assist devices alter end-of-life trajectories. The caregivers of recipients may experience significant burden (e.g., poor physical health, depression, anxiety, and posttraumatic stress disorder) from destination therapy with left ventricular assist devices. There are also social and financial ramifications for recipients and their families. We advocate early utilization of a palliative care approach and outline prerequisite conditions so that consenting for the use of a left ventricular assist device as a destination therapy is a well informed process. These conditions include: (1) direct participation of a multidisciplinary care team, including palliative care specialists, (2) a concise plan of care for anticipated device-related complications, (3) careful surveillance and counseling for caregiver burden, (4) advance-care planning for anticipated end-of-life trajectories and timing of device deactivation, and (5) a plan to address the long-term financial burden on patients, families, and caregivers. Short-term mechanical circulatory devices (e.g. percutaneous cardiopulmonary bypass, percutaneous ventricular assist devices, etc.) can be initiated in emergency situations as a bridge to permanent implantation of ventricular assist devices in chronic end-stage heart failure. In the absence of first-person (patient) consent, presumed consent or surrogate consent should be used cautiously for the initiation of short-term mechanical circulatory devices in emergency situations as a bridge to permanent implantation of left ventricular assist devices. Future clinical studies of destination therapy with left ventricular assist devices should include measures of recipients' quality of end-of-life care and caregivers' burden. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Apocalypse of Wisdom: Louis Bouyer's Theological Recovery of the Cosmos by Keith LemnaAaron WilliamsThe Apocalypse of Wisdom: Louis Bouyer's Theological Recovery of the Cosmos by Keith Lemna (Brooklyn, NY: Angelico, 2019), xxx + 488 pp.Keith Lemna has done the theological world a great service. In The Apocalypse of Wisdom: Louis Bouyer's Theological Recovery of the Cosmos, he offers the English-speaking world for the first time a (...) monograph on the thought of the Oratorian Louis Bouyer. Bouyer is undoubtedly one of the theological giants of the twentieth century. Born in Paris in 1913, he was ordained a Lutheran pastor in 1936. After only three years as a Lutheran clergyman, he was received into the Catholic Church at the Benedictine Abbey of Saint Wandrille. Then ordained as an Oratorian priest in 1944, he taught from 1946 to 1962 at the Institut Catholique de Paris and abroad for the three decades following.1 He is most well-known for his work on the liturgy both before and after the Second Vatican Council. With fifty books to his name, including a nine-part synthesis on Christian doctrine, the breadth of his theological vision and work is astounding. In France he is considered one of the four preeminent theologians of the post-World War II era, and his theological contemporaries in Europe, such as Hans Urs von Balthasar and Joseph Ratzinger / Benedict XVI, always held the Oratorian in high regard.2 Yet, in the English-speaking world, much of his work has gone without comment.3 Thankfully, into the void steps this excellent work by Lemna. [End Page 1353]Anyone familiar with the Bouyerian corpus knows the challenge of approaching it. With its vast array of subject matter, ranging from biblical to liturgical to historical to spiritual to speculative theology, one wonders whether there is any one thread woven throughout the varied strands, a single theme around which the whole sprawling corpus can be understood. In fact, there is, and Lemna has deftly identified it. For Bouyer, the fundamental question of theology is the world's relation to God.4 The structure of the first six books of his nine-part treatise on systematic theology attest to the priority of the question with the first three works addressing the question of the world, or the economy of creation and salvation, and the latter three works addressing the question of God, or theology properly speaking: the doctrine of the Trinitarian God. Interestingly, though Bouyer's work on theological cosmology, Cosmos, is the third book in the series, it was, in fact, the last of the six to be written. In this sense, as Lemna points out, "Cosmos is a capstone monograph... summarizing in important ways the decisive first six volumes" (xiv). Theological cosmology fully illuminates the God–world relation as Bouyer sees it, and since this relation sits at the heart of his thought, Cosmos is for Bouyer both his "most personal, as well as most speculative work" and indeed, "opens up the meaning of his other writings" beyond the dogmatic sphere (25). One could, then, scarcely choose a better entry point into the wide theological world of this "mind with a very special character," as Joseph Ratzinger saw him.5The Apocalypse of Wisdom is an expansive commentary on Bouyer's cosmology at the heart of which is a liturgical, even nuptial, vision of the whole of creation known and loved in the mind of God from all eternity, as the uncreated Wisdom of God. In creation God freely gives existence to the world ex nihilo, so that it might return to him in a liturgical song of praise and thanksgiving, as the Bride of his eternal Son, the eschatological and cosmic Church, created wisdom now made glorious and radiant through the indwelling of the Holy Spirit. As Lemna puts it, "Bouyer shows that cosmology should be a pursuit of wisdom, but that Wisdom is ultimately a gift revealed or uncovered by means of apokalypsis in the re-creative interventions of the divine Word and Holy Spirit in history" (xvii). The wisdom of man seeking a unified vision of the whole of reality [End... (shrink)

Financial crises are now commonplace in the global economy. It was not always so. For over two decades after World War II, under the Bretton Woods system of capital controls, financial crises were relatively rare.[1] Since the early 1970’s the number and frequency of financial crises (currency crises, banking crises, sovereign debt crises, or combinations thereof) increased dramatically, culminating in the enormously destructive global crisis of 2008-2009. (By one count, there were at least 124 banking crises between 1970 and 2008. (...) During the postwar decades before 1970 the number is: two.[2]) What explains the post-1970 rise? The date suggests a natural explanation: capital liberalization. With the early 1970’s breakdown of Bretton Woods, governments increasingly removed controls on private capital movements across their borders. As capital flows dramatically increased, economically integrated countries became markedly more susceptible to financial crises as compared to the postwar years of careful controls. While each crisis has its own varying local causes, and leaves plenty of blame to go around, the general tendency for crises to become more numerous and more frequent is substantially (even if not wholly) explained by a major trend in government policy: the choice of governments to remove capital controls has created a global economic environment in which financial crises readily break out. It is difficult to overstate the profoundly consequential nature of this choice. More than most any adverse economic event—and import surge, downturn in the business cycle, a commodity price spike—financial crises cause severe and potentially irreparable harm on a large and even global scale. Developing countries from Argentina to Mexico to Japan to Malaysia have become familiar with crisis-induced ravages of high unemployment, reduced tax revenue, exploding public debt, and cuts in social services. The losses often fall to very poor people, though they would be significant for most anyone.. (shrink)

Infrastructure comprises a combination of sociotechnical, political, and cultural arrangements that provide resources and services. The contributors to this volume show, in their respective fields, how infrastructures are both generative forces and the materialized products of quotidian practices that affect and guide people's lives. Organized via shared conceptual foci, this volume demonstrates infrastructuralist perspectives as an important transdisciplinary approach within the humanities.

The US government supports drug innovation. It is therefore crucial that it distinguish between high-value and low-value innovation in purchasing expensive prescription drugs and medical devices and ensure the continued discovery of transformative drugs and that patient and taxpayer funds are not wasted.

After nearly being killed off by CDs in the 1980s and 1990s, and despite the rise of streaming services like Spotify, vinyl records have had a major resurgence this century. Although nearly half of all records are purchased from online retailers and big-box stores, roughly half are bought at independent record shops, even though they are typically more expensive there. We believe one major reason for this is that record shops offer us aesthetic rewards that online retailers and megastores do (...) not. In this paper, we will examine the aesthetic value of record shops. Skeptics may think that their value owes largely to the music they sell, the nostalgia they can induce, or the social status they can confer. While we agree that these values play some role in explaining contemporary interest in record shops, we argue that they are valuable for a number of other distinctively aesthetic reasons. First, record shops function as aesthetic institutions that are objects of appreciation in their own right. Second, record shops afford worthwhile participatory experiences of an aesthetic nature. Finally, the experiences that one has at record shops may ultimately enhance one’s appreciation of the music one listens to at home. (shrink)

A number of recent writers have expressed scepticism about the viability of a specifically moral concept of obligation, and some of the considerations offered have been interesting and persuasive. This is a scepticism that has its roots in Nietzsche, even if he is mentioned only rather rarely in the debate. More proximately, the scepticism in question receives seminal expression in Elizabeth Anscombe's 1958 essay, ‘Modern Moral Philosophy’, a piece that is often paid lip-service to, but—like Nietzsche's work—has only rarely (...) been taken seriously by those wishing to defend the conception of obligation under attack. This is regrettable. Anscombe's essay is powerful and direct, and it makes a forthright case for the claim that, in the absence of a divine law conception of ethics, any specifically moral concept of obligation must be redundant, and that the best that can be hoped for in a secular age is some sort of neo-Aristotelianism. Anscombe is right about this, we think. And, among those who disagree, one of the very few to have taken her on at all explicitly is Christine Korsgaard, whose Kantianism of course commits her to the view that the concept of moral obligation is central, with or without God. Here, we try to show that Korsgaard loses the argument. (shrink)

We draw insights from Activity Theory within the field of human-computer interaction to quantitatively measure a mobile in-store experience (MIX), which includes the suite of shopping activities and retail services that a consumer can engage in when using their mobile device in brick-and-mortar stores. We developed and validated a nine-item, formative MIX index using survey data collected from fashion consumers in the United States (n= 1,267), United Kingdom (n= 370), Germany (n= 362), and France (n= 219). As survey measures of (...) consumer engagement in omnichannel retailing using a mobile device, the index items with stronger factor loadings described in-store shopping activities whereas those with weaker factor loadings described activities related to behavioral targeting and social networking. These results suggest that retailers should give consumers the autonomy to independently find, evaluate and purchase merchandise in brick-and-mortar stores, thereby enabling them to co-create personalized shopping experiences as active participants within an omnichannel retail servicescape. Our findings also suggest that retailers should provide consumers with more authentic ways to build community and brand affiliations than mobile marketing and social media promotions. In-store activities should not simply be a migration of pre-existing e-commerce capabilities onto mobile devices. An engaging mobile in-store experience should be an amalgam of physical and digital activities that produce a seamless shopping journey and leverage the unique properties of mobile devices – ultra-portability, location sensitivity, untetheredness, and personalization. Retail executives can use the validated MIX index to prepare strategic investments in mobile technology applications and capabilities for retail stores within their omnichannel operations. The nine-item MIX index is also well-suited for consumer surveys, which also makes it an attractive measure of consumer engagement in omnichannel retailing for future academic research. (shrink)

Certification marks are a type of trademark used to show that a product or service meets specific standards or qualities set by an independent organization (not by the manufacturer or seller). Certification marks could enhance the quality perception and oversight of generic drugs. Despite the FDA’s rigorous regulatory framework, skepticism about generic drug quality persists among patients and prescribers, partly due to the FDA’s limited ability to inspect manufacturing facilities. Independent certification marks — similar to USDA Organic or Energy (...) Star labels — could help communicate drug quality information more effectively to consumers, incentivize manufacturers to exceed baseline standards, and bolster trust in generics. Such a system could operate without legislative changes and offer a cost-effective supplement to existing FDA inspections, particularly given the challenges posed by an increasingly globalized drug supply chain and current FDA resource constraints. (shrink)

Psychedelic treatments, particularly 3,4-methylenedioxymethamphetamine (MDMA)-assisted and psilocybin-assisted therapies, have recently seen renewed interest in their clinical potential to treat various mental health conditions. Clinical trials for both MDMA-assisted and psilocybin-assisted therapies have shown to be highly efficacious for post-traumatic stress disorder and major depression. Recent research trials for psychedelic-assisted therapies (PAT) have demonstrated that although they are resource-intensive, their effects are rapid-acting, durable and cost-effective. These results have generated enthusiasm among researchers seeking to investigate psychedelic therapies in active-duty service (...) members of the US military, particularly those with treatment refractory mental health conditions. At the same time, psychedelics remain in early stages of clinical investigation, have not yet achieved regulatory approval for general clinical use and may confer unique psychological and neurobiological effects that could raise novel ethical considerations when treating active-duty service members. Should psychedelics achieve regulatory approval, military relevant considerations may include issues of access to these treatments, appropriate procedures for informed consent, confidentiality standards, and possible unanticipated mental health risks and other psychological sequelae. A service member’s deployability, as well as their ability to return to full military duty following PAT, may also be of unique concern. The authors argue that MDMA-assisted therapy currently represents a promising treatment that should be more rapidly investigated as a clinical therapy for service members while still taking a measured approach that accounts for the many military-specific uncertainties that remain. (shrink)

The US has found it hard to establish competition in the market for biologics, which are therapeutics derived from living cells. In the case of small-molecule drugs, the emergence of direct competition from generic drugs at the end of the exclusivity period has provided the impetus for price competition, leading to lower spending. In 2010, to spur competition in the biologics market, Congress created a simplified pathway for the US Food and Drug Administration (FDA) to approve comparable versions of biologic (...) drugs called biosimilars. Biosimilar competition in the US has nonetheless remained weaker than in European peer countries. For example, as of August 2020, there were 52 biosimilars available in Germany, and only 15 in the US.1 An important contributor to this “biosimilar gap” has been the fact that biosimilars to biologic blockbusters such as adalimumab (Humira) and etanercept (Enbrel) were only (or will only become) commercially available in the US several years after receiving FDA approval, while they were available in Europe years earlier.2 Through the end of 2021, it took biosimilars a median of 301 days between receiving FDA approval and becoming available for use.3 In one recent study, the median length of time between when a biologic drug was approved and when its first biosimilar was made available to US patients was 21.5 years.4 This paucity of competition has contributed to high US spending on biologics. According to the Department of Health and Human Services, in 2022 41% of US drug expenditures was spent on biologics, which represented 16% of US prescriptions.5. (shrink)

The “right to repair” movement highlights opportunities to reduce health care costs and promote public health resilience through increased competition in the way in which medical devices are serviced and updated over their lifespan. We review legislative and legal facets of third-party repair of medical devices, and conclude with specific recommendations to help this market function more efficiently to the benefit of patients and health care systems.

North America is in the grips of an epidemic of opioid-related poisonings. Overdose education and naloxone distribution programmes emerged as an option for structurally vulnerable populations who could not or would not access mainstream emergency medical services in the event of an overdose. These task shifting programmes utilize lay persons to deliver opioid resuscitation in the context of longstanding stigmatization and marginalization from mainstream healthcare services. OEND programmes exist at the intersection of harm reduction and emergency services. One goal of (...) OEND programmes is to help redress the health-related inequities common among people who use drugs, which include minimizing the gap between people who use drugs and the formal healthcare system. However, if this goal is not achieved these inequities may be entrenched. In this article, we consider the ethical promises and perils associated with OEND as task shifting. We argue that public health practitioners must consider the ethical aspects of task shifting programmes that may inadvertently harm already structurally vulnerable populations. We believe that even if OEND programmes reduce opioid-related deaths, we nevertheless question if, by virtue of its existence, OEND programmes might also unintentionally disenfranchise structurally vulnerable populations from comprehensive healthcare services, including mainstream emergency care. (shrink)

In this article we consider the material dimensions of schooling as constitutive of the possibilities inherent in “fixing” education. We begin by mapping out the problem of “fixing education,” pointing to the necrophilic tendencies of contemporary education—a desire to kill what otherwise might be life-giving. In this sense, to “fix” education is to make otherwise fluid processes-of-living static. We next point to the material realities of this move to fix. After establishing the material consequences of perpetually fixing schools, we provide (...) a brief overview of two critical perspectives that might be shown as attempts to “unfix” education: critical pedagogy and unschooling. Though both offer critiques of normative education, these approaches are also bound by their failure to fully engage with the material dimensions of schooling. As such, both critical pedagogy and unschooling inadvertently cut off key possibilities for human flourishing within educational environments. In their rush to “unfix”—to counter the necrophilic tendencies of contemporary education—these approaches exclude or otherwise foreclose upon resistive challenges to the normative order that extend from the margins. In response, we turn to the possibilities for unschooling within the materially public spaces of schools. These are the spaces where fixity fails—possibility extends from unschooling in schools, from unfixing the process of fixing education. We end by considering the possibilities inherent in Community Service Learning as a valuable means to engage in a radically public, and unfixed, educational system. (shrink)

Michael Fishbane is Nathan Cummings Distinguished Service Professor of Jewish Studies at the University of Chicago Divinity School. Trained in biblical studies, he also writes constructive hermeneutic theology.

This chapter examines modern Western objections to both authority and dependence, in both cases on the grounds that they threaten human autonomy, which implies that we should minimize both authority and dependence whenever possible. The chapter includes historical overviews of the modern Western “flight from authority” as well as the gradual fragmentation and transformation of notions of dependence on others. It examines Maine on status and contract, Berlin on liberty, and Mill and others on the dangers of paternalism. The chapter (...) analyzes the concepts of authority and autonomy through an engagement with Raz’s “service conception of authority,” arguing that early Confucians have a generally similar approach to the nature and value of authority, albeit with some important differences, which avoid some common objections to Raz’s views. The chapter closes with an overview of the rest of the book. (shrink)

In their discussion paper of November 2020, Cook et al present a draft protocol for navigating circumstances in which emergency services are overwhelmed. Their paper suggests that COVID-related triage decisions should be based on clinical assessment, patient and family consultation, and a range of ethical considerations. In this response, we note that the protocol exhibits an ambiguity that is likely to result in irresolvable dilemmas when put into practice. This ambiguity is exemplified in the paper’s prime ethical imperative (to ‘save (...) more lives and more years of life’), which takes the form of an undefined conjunction whose practical implications are left unspecified. We see this ambiguity in the prime imperative as one manifestation of a broader set of tensions in the protocol. We show that the discipline of human rights provides an essential supplement to the ethical framework on which Cook and colleagues rely, providing a framework for understanding and working through triage dilemmas involving age, discrimination and equality. (shrink)

In recent months, pharmaceutical manufacturers have brought legal challenges to a provision of the 2022 Inflation Reduction Act (IRA) empowering the federal government to negotiate the prices Medicare pays for certain prescription medications. One key argument made in these filings is that price negotiation is a “taking” of property and violates the Takings Clause of the US Constitution. Through original case law and health policy analysis, we show that government price negotiation and even price regulation of goods and services, including (...) patented goods, are constitutional under the Takings Clause. Finding that the IRA violates the Takings Clause would radically upend settled constitutional law and jeopardize the US’s most important state and federal health care programs. (shrink)

The transplant community has faced unprecedented challenges balancing risks of performing living donor transplants during the COVID-19 pandemic with harms of temporarily suspending these procedures. Decisions regarding postponement of living donation stem from its designation as an elective procedure, this despite that the Centers for Medicare and Medicaid Services categorise transplant procedures as tier 3b (high medical urgency—do not postpone). In times of severe resource constraints, health systems may be operating under crisis or contingency standards of care. In this manuscript, (...) the United Network for Organ Sharing Ethics Workgroup explores prioritisation of living donation where health systems operate under contingency standards of care and provide a framework with recommendations to the transplant community on how to approach living donation in these circumstances.To guide the transplant community in future decisions, this analysis suggests that: (1) living donor transplants represent an important option for individuals with end-stage liver and kidney disease and should not be suspended uniformly under contingency standards, (2) exposure risk to SARS-CoV-2 should be balanced with other risks, such as exposure risks at dialysis centres. Because many of these risks are not quantifiable, donors and recipients should be included in discussions on what constitutes acceptable risk, (3) transplant hospitals should strive to maintain a critical transplant workforce and avoid diverting expertise, which could negatively impact patient preparedness for transplant, (4) transplant hospitals should consider implementing protocols to ensure early detection of SARS-CoV-2 infections and discuss these measures with donors and recipients in a process of shared decision-making. (shrink)

Much popular discourse on automation is deterministic, engages at only a high level of abstraction, and assumes that technologies are neutral and autonomous rather than socially shaped. This popular discourse blames technology for worsening working conditions. A critique of this ‘automation discourse’ by Aaron Benanav maintains that low-paid work is growing not due to technology, but because of manufacturing overcapacity and underinvestment, which ruined capitalism’s growth engine. Similarly, Jason Smith argues that the growth of low-waged service work indicates (...) terminal stagnation. So called ‘smart machines’ have failed to deliver on their promised productivity gains. This article interrogates the foundations of these theses in Robert Brenner’s work. I argue that these approaches misdiagnose the problem, replacing technological determinism with economic determinism. Further, they misinterpret the recomposition of global capitalism and labour institutions while neglecting class struggle. I then question what the global rise of services, the institutional decoupling of productivity and wage gains, and AI-driven technologies mean for the present of work. Is global competition responsible for the stagnation of capitalist growth or something else? Are services inherently doomed to low wages? By addressing these questions through class antagonisms, this article offers an account of the present and future of work that is neither technologically nor economically determinist. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Religious Epistemology Through Schillebeeckx and Tibetan Buddhism by Jason VonWachenfeldtRobert MagliolaRELIGIOUS EPISTEMOLOGY THROUGH SCHILLEBEECKX AND TIBETAN BUDDHISM. By Jason VonWachenfeldt. T&T Clark: London, 2021. 240 pp.In his "Introduction," Jason VonWachenfeldt explains the "crisis of authority" experienced by many religious believers, and then commits his book (hereinafter RET) to a "dialogic negotiation" offering middle ways between religious tradition and postmodernity. The "dialogic negotiation" is between the brilliant but controversial (...) Catholic theologian, Edward Schillebeeckx (1914–2009), and the brilliant but controversial Tibetan monk (then ex-monk), Gendun Chopel (1903–1951). They both deconstruct the epistemologies of their respective traditions, but insist on the orthodoxy of their "middle ways."VonWachenfeldt opts for Aaron Stalnaker's methodology of "bridge concepts" (topics enabling interfaith comparison) and the comparison of two "historically situated" individuals (13). He names "religious epistemology" as RET's "bridge-concept," and to further facilitate comparison, three epistemological "categories" are posited: "perspectivalism, hermeneutics, and apophaticism" (64). Schillebeeckx's "phenomenological Thomism" constitutes his perspectivalist first phase, and holds that revelation includes both a "concrete-existential" and non-conceptual "implicit intuition" of the divine reality (32). There is an antinomy between the individual's act of abstraction and the "implicit intuition" of the "reality of God in Godself" (33).Chopel's negative way is more extreme. Chopel is a Madhyamakin but rejects Prāsaṅgika-Madhyamaka's version which affirms the "conventional validity" of the mundane. For Chopel, all formations lack even conventional validity but "common [End Page 404] beings" falsely affirm them (35). The few "noble ones" (the enlightened) are those aware of pure emptiness (understood as "absence," not "openness"). Schillebeeckx's second phase affirms that one is embedded in ongoing history and cannot escape mundane finitude. God must be seen as "mystery" active within it (45). Chopel's second phase extends the notion that an unbridgeable chasm exists between the conventional and the ultimate but that the Buddha can manipulate the mundane so the leap to enlightenment can occur (49). Schillebeeckx's third phase practices a "negative realist metaphysic": The individual encounters the "really real" external to oneself only by way of "glimpses negative in nature" (58). Chopel's apophaticism describes ultimate reality in terms of a "nonaffirming negative" (63).Next, RET treats the role of religious community in knowledge formation (67). For Schillebeeckx, our "non-divine finitude is precisely the place where the infinite and the finite come most closely into contact" (90). The later Schillebeeckx retains loyalty to the institutional Church but because of the finitude of language and human nature he deems it necessarily subject to critique (92). Chopel practices a "pious skepticism" (97), and increasingly satirizes institutional monasticism (circa 1934, he disrobes). Addressing the role of historical founders of religions, Schillebeeckx maintains that theology should shift from an unsalvageable truth lost in the past to the more eschatological language of "the [always] Coming One" (123). Jesus's epistemological authority does not reside in his ability "to supply answers" as much as it is to open up individuals to "a future reality in the making" (148). Honorific titles such as "Savior" or "Christ" as such are not serviceable. Jesus's story is an exemplar of how to construct meaning in our lives by the "praxis" of helping the suffering. Chopel likewise demythologizes Sakyamuni Buddha (151), but—unlike Schillebeeckx—insists he does so endogenously. For example, he enters the definitive/provisional (nītārtha/neyārtha) debate, but argues that all the teachings of Śākyamuni are both—they are definitive for those whom they help toward emptiness and merely provisional for all others (157, 158).RET's chapter 5 addresses the authority of personal experience in the apophatic knowledge of ultimate reality. How is it possible for "true knowledge" to be "primarily experiential in nature as distinct from being conceptually or linguistically based?" (163). Schillebeeckx holds that our very experience of human finitude brings us negatively in contact with the "unknown ultimate reality itself" (169). He maintains that the apparent lack of ontological contact between beings and ultimate reality (God) is "one-sided," persisting only from the side of our finitude and not from the side of ultimate reality: Though humans can never directly... (shrink)

Melchizedek’s meeting with Abraham in the King’s Valley would mark the history of the chosen people. As king of Salem and priest of the Almighty God, Melchizedek meets the patriarch with bread and wine and then blesses him in the name of the God they both served. Assuming this liturgical ritual Abraham offers Melchizedek a tenth of everything, by this acknowledging and accepting his sacerdotal service. Even though at a first sight their gestures are somewhat natural, we will understand (...) going through our study that the attitude of each character implies a deeper significance. This is emphasized firstly in psalms, in the context of several Messianic sentences, which refer to an eternal priesthood that finds its origins not in the service of Aaron, but in that of Melchizedek. This text would generate and fundament later the Pauline discourse on the priesthood of Jesus Christ and implicitly of the Christians. The resemblance of Melchizedek with Jesus Christ is maximized by Saint Apostle Paul who states that the king of Salem was “without father or mother, without genealogy, without beginning of days or end of life”. Who is, in fact, this mysterious character? Why did the Hebrew want to identify him with a known biblical character? What are the reasons that determined the Christian authors to recompose the history of this character? These are just a few of the questions we intend to answer through the research that we are about to present. (shrink)

This case recounts the founding of HealthSouth Rehabilitation, its rapid growth, financial mishandlings and the struggle former CFO Aaron Beam had in dealing with a conscience that kept him awake at night. Beam had met HealthSouth founder Richard Scrushy when applying for a job with Lifemark Hospital Corporation in Texas in 1980. After Lifemark was bought by AMI in 1983, Scrushy invited Beam to join him in the launching of his new company in Birmingham, Alabama. The uniqueness of the (...) hospital was that it would provide inpatient surgery for those who had suffered an injury, but it would also provide outpatient services such as rehabilitation, nutrition guidance and psychological counseling. This type of structure was appealing to insurance companies because it would move the patient out of the hospital much quicker and save the cost of extended hospitalization. The company experienced rapid growth and went public within three years of launch. By 1996, the top executives of the company realized that they would not be able to meet Wall Street analysts’ forecasts which would affect the price of their stock and reduce their holdings. They decided to “cook the books” temporarily to meet quarterly expectations. However, once the financial mishandling had begun, the executives found it difficult to reverse their actions and report accurate numbers to the public. Beam decided to retire from the company in 1996; and after this action, he continued to find it difficult to sleep at night because of his involvement in the fraud. The issue in the case is whether Beam should consider coming forward and revealing to the Securities and Exchange Commission how the books had been doctored so that he could salvage his damaged conscience. (shrink)

This essay explores the interrelation of skills and virtues. I first trace one line of analysis from Aristotle to Alasdair MacIntyre, which argues that there is a categorical difference between skills and virtues, in their ends and intrinsic character. This familiar distinction is fine in certain respects but still importantly misleading. Virtue in general, and also some particular virtues such as ritual propriety and practical wisdom, are not just exercised in practical contexts, but are in fact partially constituted by the (...) mastery of certain skills. This has implications for moral psychology, specifically how we might understand the acquisition of virtue, as well as its very nature. To try to make this claim plausible I analyze two case studies from early Confucianism: treatment of ritual propriety as a cardinal virtue, and Mencius's less carefully integrated treatment of excellence at moral discernment. I conclude by revisiting the question of the relations between skill and virtue, and exploring a few of the difficulties implied by my account of early Confucian ethics. (shrink)

Research on brain or cognitive/affective processes, culture, social interaction, and structural analysis are overlapping but often independent ways humans have attempted to understand the origins of their evolution, historical, and contemporary development. Each level seeks to employ its own theoretical concepts and methods for depicting human nature and categorizing objects and events in the world, and often relies on different sources of evidence to support theoretical claims. Each level makes reference to different temporal bandwidths (milliseconds, seconds, minutes, hours, days, months, (...) years, decades, and centuries) and focuses on different spatio-temporal activities and controlled and non-controlled stimulus conditions. Biological mechanisms and environmental pressures for survival simultaneously created a gradual intersection and enhancement of cognitive/affective skills, cultural practices, and changes in collaborative social interaction and communicative skills. The evolution of a given level of analysis is assumed to have been incremental and overlapping. These innovative and independent ways humans have learned to characterize their brain or cognitive/affective and social/economic/political life often depend on unexamined, representational re-descriptions or cognitive/affective and socio-cultural devices and forms of communication that facilitate the depiction of practices and beliefs we attribute to respondents or subjects and research colleagues. (shrink)

Spurred by a severe shortage of cadaveric organs, there has been a marked growth in living organ donation over the past several years. This has stimulated renewed interest in the ethics of this practice. The major concern has always been the possibility that a physician may seriously harm one person while trying to improve the well-being of another. As Carl Elliott points out, this puts the donor's physician in a difficult predicament: when evaluating a person who volunteers to donate an (...) organ, “a doctor is in the position of deciding not simply whether a subject's choice is reasonable … but whether he [the doctor] is morally justified in helping the subject accomplish it.”1 This question has become even more difficult since the introduction of living donor operations that are more risky than living kidney donation and the suggestion that volunteers at added risk may sometimes be acceptable.2 So, how can we decide when the risk is too much? (shrink)

Transplantation is now the best therapy for eligible patients with end-stage organ disease. For patients with failed kidneys, successful renal transplantation improves the quality and increases the quantity of their lives. For people with other types of organ failure, transplantation offers the only hope for long-term survival. a.

Like Kant's Critique of Pure Reason, we now have both an A- and a substantially revised B-edition of Henry Allison's commentary to and defence of that work: Kant's Transcendental Idealism: An Interpretation and Defense. Unlike Kant's Critique, however, Allison's first edition is unlikely to persist as an occasional rival to the second, since reviewers rightly consider the second to have superseded the landmark scholarship of the first. Nevertheless, before Allison's first edition is entirely supplanted, I would like to save a (...) neglected insight from its treatment of the B-deduction that is not retained in the second edition. (shrink)

This paper examines Hermann Cohen's idiosyncratic construction of a medieval Jewish philosophical tradition, focusing primarily, though not exclusively, on his Charakteristik der Ethik Maimunis . This construction, not unlike modern accounts, is filtered through the central place of Maimonides. For Cohen, however, Maimonides' centrality is defined not by his systematization of Aristotelianism, but by his elevation of ethics over metaphysics. The ethical and pantheistic concerns of Maimonides' precursors, according to this reading, anticipate his uniqueness. Whereas Shlomo ibn Gabirol's pantheistic doctrine (...) of emanation, for example, assigned little weight to ethics, Abraham ibn Daud rebelled against such a doctrine. Ibn Daud—much like Bahya ibn Paquda and Abraham ibn Ezra—becomes part of a Jewish philosophical tradition that culminates in Maimonides' rejection of Aristotelian metaphysics. In particular, this paper examines the way in which Cohen envisaged the pre-Maimonidean philosophical tradition, putting his highly critical reading of Shlomo ibn Gabirol and his pantheistic obsession with prime matter in counterpoint with his more favorable readings of Abraham ibn Daud and Bahya ibn Paquda. (shrink)

Confidential sourcing has proven to be an effective tool for investigative journalism, particularly when highly secretive or high public-impact information is at stake and there are too few transparent sources to adequately inform a news story. Nonetheless, many journalists choose to use confidential sources sparingly or not at all because the potential harms in using confidential sources outweigh, in their view, their potential benefits. This chapter explores three key facets of confidential sourcing in an effort to provide a practical model (...) of ethical deliberation for the use of confidential sources. First, it argues that there are justifications for the use of confidential sources in journalism. Second, it discusses what conditions are necessary for the use of confidential sources, what procedures should be in place to use them best, and why, in these cases, confidential sourcing is at least morally permissible, if not morally obligatory. Finally, contrary to the journalistic convention that once a confidential agreement is made, it cannot be broken, the chapter argues for why journalists are at least permitted — even, at times, obligated — to break confidential agreements. (shrink)

"This book is a practical business guide for managers and executives covering bribery and FCPA compliance issues that they need to understand to ensure they are ...

The careful historical and metaphilosophical attention recently bestowed upon analytic philosophy has revealed that traditional ways of defining it are inadequate. In the face of this inadequacy, contemporary authors have proposed new definitions that detach analytic philosophy from its turn of the twentieth century origins. I argue that this contemporary trend in defining analytic philosophy is misguided, and that it diminishes the likelihood of our coming to an accurate historical and metaphilosophical understanding of it. This is especially unsatisfactory since such (...) understanding is essential to finding an adequate remedy for the widely perceived ills of contemporary analytic philosophy. I suggest that a more fruitful approach to developing such understanding might begin with treating the unity of analytic philosophy as illusory. (shrink)

The Purpose of this paper is to ask how far Locke can be said to have anticipated modern theories of number, particularly the intuitionist theory of Brouwer and Heyting. It has in mind Mr Edward E. Dawson's statement that Locke's account of number was not merely ‘a good effort in his own day’ but that ‘what Locke had to say really was quite fundamental, and a good deal of modern mathematics assumes his position, either explicitly or implicitly’. Mr Dawson thinks (...) that some of the central notions of the intuitionist theory are already present in the Essay Concerning Human Understanding , II, xvi, ‘Of Number’. We should like to examine the view. (shrink)

I am an historian in a country in which it is not only impossible to say what the future will be, but in which the past itself—as someone put it—is susceptible to change. This country is currently going through an unprecedented crisis that has turned both its material and political as well as spiritual life upside-down. The crisis, the roots of which stretch back over decades, has made life virtually unbearable for many of its citizens. Yet for the historian, and (...) for the philosopher and sociologist, this crisis affords an unusual opportunity. As a result of the earthquakes that have shaken the former Soviet Union, formerly hidden layers of history—and the forces that underpin them—have been revealed. Such cases do not often arise. To a scholar endeavoring to discover the secret springs of unfolding events, Russia represents a gigantic and unique “laboratory.” Although it is easier to judge the extent of a cataclysm, to comprehend its deeper import, after the event, this does not relieve the contemporary—who participates in historical events—of the duty of trying to understand, to the extent possible, the nature of the changes taking place. (shrink)

The novelties of the contemporary international order require a rethinking of the normative foundations of criminal justice. Although one can understand the relevance of basic principles such as th...

A.1. Some philosophers, including Tarski and Russell, have concluded from a study of various versions of the Liar Paradox ‘that there must be a hierarchy of languages, and that the words “true” and “false”, as applied to statements in any given language, are themselves words belonging to a language of higher order’. In his famous essay on truth Tarski claimed that ‘colloquial’ language is inconsistent as a result of its property of ‘universality’: that is, whatever can be said at all (...) can in principle be said in it, with an extended vocabularly if necessary. Thus, in English we can talk about English expressions, what they denote, what they say, whether what they say is true or false, and so on: English contains its own metalanguage. This universality enables us to construct sentences which say of themselves that they are false, and by applying the law of excluded middle to them we easily derive a contradiction. Tarski concludes that ‘these antinomies seem to provide a proof that every language which is universal in the above sense, and for which the normal laws of logic hold, must be inconsistent’ . He then proposes to avoid such contradictions by the use of a hierarchy of languages such that statements about any one language can be made only in a different language at a higher level. (shrink)