How Doctors Think defines the nature and importance of clinical judgment. Although physicians make use of science, this book argues that medicine is not itself a science but rather an interpretive practice that relies on clinical reasoning. A physician looks at the patient's history along with the presenting physical signs and symptoms and juxtaposes these with clinical experience and empirical studies to construct a tentative account of the illness. How Doctors Think is divided into four parts. Part one introduces the (...) concept of medicine as a practice rather than a science; part two discusses the idea of causation; part three delves into the process of forming clinical judgment; and part four considers clinical judgment within the uncertain nature of medicine itself. In How Doctors Think, Montgomery contends that assuming medicine is strictly a science can have adverse side effects, and suggests reducing these by recognizing the vital role of clinical judgment. (shrink)

Narrative analysis is well established as a means of examining the subjective experience of those who suffer chronic illness and cancer. In a study of perceptions of the outcomes of treatment of cancer of the colon, we have been struck by the consistency with which patients record three particular observations of their subjective experience: the immediate impact of the cancer diagnosis and a persisting identification as a cancer patient, regardless of the time since treatment and of the presence or absence (...) of persistent or recurrent disease; a state of variable alienation from social familiars, expressed as an inability to communicate the nature of the experience of the illness, its diagnosis and treatment; and a persistent sense of boundedness, an awareness of limits to space, empowerment and available time. These subjectivities were experienced in varying degree by all patients in our study. Individual responses to these experiences were complex and variable. The experiences are best understood under the rubric of a category we call “liminality”. We believe that all cancer patients enter and experience liminality as a process which begins with the first manifestations of their malignancy. An initial acute phase of liminality is marked by disorientation, a sense of loss and of loss of control, and a sense of uncertainty. An adaptive, enduring phase of suspended liminality supervenes, in which each patient constructs and reconstructs meaning for their experience by means of narrative. This phase persists, probably for the rest of the cancer patient’s life. The experience of liminality is firmly grounded in the changing and experiencing body that houses both the disease and the self. Insights into the nature of the experience can be gained from the Existentialist philosophers and from the history of attitudes to death. Understanding liminality helps us to understand what it is that patients with cancer seek from the system to which they turn for help. Its explication should therefore be important for those who provide health care, those who educate health care workers and those concerned to study and use outcomes as administrative and policy making instruments. (shrink)

We theorize that social media will reduce the incidence of corporate greenwash. Drawing on the management literature on decoupling and the economic literature on information disclosure, we characterize specifically where this effect is likely to be most pronounced. We identify important differences between social media and traditional media, and present a theoretical framework for understanding greenwash in which corporate environmental communications may backfire if citizens and activists feel a company is engaging in excessive self-promotion. The framework allows us to draw (...) out a series of propositions regarding the impact of social media on corporate decisions whether to greenwash, and what channels to use for environmental communication. We conclude with a number of suggestions for future research. (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain (...) in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

High-dose chemotherapy and autologous stem cell transplantation is used to treat some advanced malignancies. It is a traumatic procedure, with a high complication rate and significant mortality. ASCT patients and their carers draw on many sources of information as they seek to understand the procedure and its consequences. Some seek information from beyond orthodox medicine. Alternative beliefs and practices may conflict with conventional understanding of the theory and practice of ASCT, and ‘contested understandings’ might interfere with patient adherence to the (...) strict and demanding protocols required for successful ASCT.The present study, conducted in Sydney, Australia, examines narrative-style interviews with 10 sequentially recruited ASCT patients and nine of their carers conducted at the time of transplant and three months later. Transcripts were read for instances of mention of alternative advice, and for instances of contested understanding of information relevant to the transplant.Patients and carer pairs expressed closely concordant views about alternative advice. Five pairs were consulting alternative practitioners. Contested understanding was expressed in four domains—understandings of the transplant itself and its underlying theory, of the relationship between the components of the ‘transplant’, of the nature and role of stem cells, and of beliefs about bodily function and life-style. Contested understandings of the transplant treatment were expressed as predominantly personal interpretations of orthodox informationPatients and carers seemed to recognise that alternative and conventional systems were discordant, yet they were able to separate the two, and adhere to each practice without prejudicing their medical treatment. A single case of late, post-transplant repudiation of Western medicine is discussed to emphasise some of the possible determinants of dissonance when it does occur. (shrink)

In the last decade, the organization of pharmaceutical research on neglected tropical diseases has undergone transformative change. In a context of perceived “market failure,” the development of new medicines is increasingly handled by public-private partnerships. This shift toward hybrid organizational models depends on a particular form of exchange: the sharing of proprietary assets in general and of intellectual property rights in particular. This article explores the paradoxical role of private property in this new configuration of global health research and development. (...) Rather than a tool to block potential competitors, proprietary assets function as a lever to attract others into risky collaborative ventures; instead of demarcating public and private domains, the sharing of property rights is used to increase the porosity of that boundary. This reimagination of the value of property is connected to the peculiar timescape of global health drug development, a promissory orientation to the future that takes its clearest form in the centrality of “virtual” business models and the proliferation of strategies of deferral. Drawing on the anthropological literature on inalienable possessions, we reconsider property’s traditional exclusionary role and discuss the possibility that the new pharmaceutical “commons” proclaimed by contemporary global health partnerships might be the precursor of future enclosures. (shrink)

This discussion paper considers how seldom recognised theories influence clinical ethics committees. A companion paper examined four major theories in social science: positivism, interpretivism, critical theory and functionalism, which can encourage legalistic ethics theories or practical living bioethics, which aims for theory–practice congruence. This paper develops the legalistic or living bioethics themes by relating the four theories to clinical ethics committee members’ reported aims and practices and approaches towards efficiency, power, intimidation, justice, equality and children’s interests and rights. Different approaches (...) to framing ethical questions are also considered. Being aware of the four theories’ influence can help when seeking to understand and possibly change clinical ethics committee routines. The paper is not a research report but is informed by a recent study in two London paediatric cardiac units. Forty-five practitioners and related experts were interviewed, including eight members of ethics committees, about the work of informing, preparing and supporting families during the extended process of consent to children’s elective heart surgery. The mosaic of multidisciplinary teamwork is reported in a series of papers about each profession, including this one on bioethics and law and clinical ethics committees’ influence on clinical practice. The qualitative social research was funded by the British Heart Foundation, in order that more may be known about the perioperative views and needs of all concerned. Questions included how disputes can be avoided, how high ethical standards and respectful cooperation between staff and families can be encouraged, and how minors’ consent or refusal may be respected, with the support of clinical ethics committees. (shrink)

In The legal determinants of health: Harnessing the power of law for global health and sustainable development, Gostin et al. provide a sustained account of how law can and should be used as an instrument of health promotion. We pick up on the themes of this report with a specific focus of the importance of abortion for women’s sexual and reproductive health and the impact that particular ways of framing abortion in law can have on the lives of women and (...) girls. In this short comment, we wish to emphasize that abortion regulations need to move beyond frameworks based on narrow understandings of harm towards more progressive agendas that take into account the social determinants of health in order to reduce barriers to care. This contribution is particularly relevant to the Commission’s criticism that those ‘[l]aws that stigmatise or discriminate against marginalized populations are especially harmful and exacerbate health disparities’. (shrink)

The study examines the relative merits of a noncompatibility and a restructuring explanation of the recurrent empirical finding that a prominent attribute looms larger in choices than in judgments. Pairs of equally attractive options were presented to 72 undergraduates who were assigned to six conditions in which they performed (1) only preference judgments or choices, (2) preference judgments or choices preceded by judgments of attractiveness of attribute levels, or (3) preference judgments or choices accompanied by think-aloud reports. The results replicated (...) the prominence efTect for choices, but a prominence effect was also found for preference judgments. In accordance with the restructuring explanation, the think-aloud protocols indicated that options were more often restructured in choices than in preference judgments. However, restructuring could not explain the prominence effect observed for preference judgments. A modified compatibility hypothesis is offered as an alternative explanation. (shrink)

A violation of procedure invariance in preference measurement is that the predominant or prominent attribute looms larger in choice than in a matching task. In Experiment 1, this so-called prominence effect was demonstrated for choices between pairs of options, choices to accept single options, and preference ratings of single options. That is, in all these response modes the prominent attribute loomed larger than in matching. The results were replicated in Experiment 2, in which subjects chose between or rated their preference (...) for pairs of options which were matched to be equally attractive either in the same session or 1 week earlier. On the basis of these and previous results, it is argued that the prominence effect is a reliable phenomenon. However, none of several cognitive explanations which have been offered appears to be completely viable. (shrink)

Place, practice and status have played significant and interacting roles in the complex history of primatology during the early to mid-twentieth century. This paper demonstrates that, within the emerging discipline of primatology, the field was understood as an essential supplement to laboratory work. Founders argued that only in the field could primates be studied in interaction with their natural social group and environment. Such field studies of primate behavior required the development of existing and new field techniques. The practices and (...) sites developed by American primatologist Clarence Ray Carpenter were used to demonstrate that scientific standards could be successfully applied to the study of primates in the field. In an environment in which many field biologists fought for higher scientific status, Carpenter gradually adopted increasingly interventionist techniques. These techniques raised epistemological problems for studies whose value rested on the naturalness of the behaviors observed. Thus, issues of status shaped field practices and subsequently altered Carpenter's criteria for what constituted natural primate behavior. (shrink)

When a prominent attribute looms larger in one response procedure than in another, a violation of procedure invariance occurs. A hypothesis based on compatibility between the structure of the input information and the required output was tested as an explanation of this phenomenon. It was also compared with other existing hypotheses in the field. The study had two aims: (1) to illustrate the prominence effect in a selection of preference tasks (choice, acceptance decisions, and preference ratings); (2) to demonstrate the (...) processing differences in a matching procedure versus the selected preference tasks. Hence, verbal protocols were collected in both a matching task and in subsequent preference tasks. Silent control conditions were also employed. The structure compatibility hypothesis was confirmed in that a prominence effect obtained in the preference tasks was accompanied by a lower degree of attention to the attribute levels in these tasks. Furthermore, as predicted from the structure compatibility hypothesis, it was found that fewer comparisons between attribute levels were performed in the preference tasks than in the matching task. It was therefore concluded that both these processing differences may explain the occurrence of the prominence effects. (shrink)

Several studies have shown that preference is not necessarily synonymous with choice. In particular, the most preferred object from a set of objects presented in a non—choice context is not necessarily chosen when the same objects are options in a choice situation (Lichtenstein & Slovic, 1971, 1973; Tversky, Sattah, & Slovic, 1988) . Our research on the choice—preference discrepancy replicates these findings and thus bears some resemblance to the study by Tversky, Sattah, and Slovic (1988). Two competing explanations are tested.

Bioethics can be considered as a topic, an academic discipline, a field of study, an enterprise in persuasion. The historical specificity of the forms bioethics takes is significant, and raises questions about some of these approaches. Bioethics can also be considered as a governance practice, with distinctive institutions and structures. The forms this practice takes are also to a degree country specific, as the paper illustrates by drawing on the author’s UK experience. However, the UNESCO Universal Declaration on Bioethics can (...) provide a starting point for comparisons provided that this does not exclude sensitivity to the socio-political context. Bioethics governance practices are explained by various legitimating narratives. These include response to scandal, the need to restrain irresponsible science, the accommodation of pluralist views, and the resistance to the relativist idea that all opinions count equally in bioethics. Each approach raises interesting questions and shows that bioethics should be studied as a governance practice as a complement to other approaches. (shrink)

This paper addresses the growing problem of retractions in the scientific literature of publications that contain bad data, also called “false science.” While the problem is particularly acute in the biomedical literature because of the life-threatening implications when treatment recommendations and decisions are based on false science, it is relevant for any knowledge domain, including the social sciences, law, and education. Yet current practices for handling retractions are seen as inadequate. We use the metaphor of a virus to illustrate how (...) such studies can spread and contaminate the knowledge system, when they continue to be treated as valid. We suggest drawing from public health models designed to prevent the spread of biological viruses and compare the strengths and weaknesses of the current governance model of professional self-regulation with a proposed public health governance model. The paper concludes by considering the value of adding a triple-helix model that brings industry into the university-state governance mechanisms and incorporates bibliometric capabilities needed for a holistic treatment of the retraction process. (shrink)

In their 2018 article in the Cambridge Quarterly of Healthcare Ethics, Little, Lipworth, and Kerridge unpack the concept of corruption and clarify the mechanisms that foster corruption and allow it to persist, noting that organizations are “corruptogenic.” To address the “so-what” question, I draw on research about trust and trustworthiness, emphasizing that a person’s well-being and sense of security require trust to be present at both the individual and organizational levels—which is not possible in an environment where corruption and misconduct (...) prevail. I highlight similarities in Little et al.’s framing of corruption to the persistent problem of scientific misconduct in research and publishing. I acknowledge the challenges in stemming corruption in science and medicine and conclude with a discussion about the need to reinvigorate a web of stakeholders to actively engage in professional regulation. (shrink)

The United Kingdom has many bodies that play their part in carrying out the work of national ethics committees, but its nearest equivalent of a U.S. presidential bioethics commission is the Nuffield Council on Bioethics, established in 1991. The Council is charged with examining ethical questions raised by developments in biological and medical research, publishing reports, and making representations to appropriate bodies in order to respond to or anticipate public concern. It is a nongovernment organization with no defined or guaranteed (...) channels of influence. It has no authority merely by virtue of the position it holds. Rather, it has established relational authority based on its reputation. Unlike the U.S. bioethics commission, it is not part of executive government, nor is it constituted to contribute to the legislative branch, as does the French Comité Consultatif National d'Ethique. Its nongovernmental status notwithstanding, the Nuffield Council's work affects the U.K. government and the British public, and the Council has achieved international recognition for its reports. I was the chairperson from 2012 to 2017 and draw on my experience in this piece to consider three key audiences: governments, publics, and the international community. (shrink)

Herman Cappelen has recently argued in favor of what he calls “the no assertion view”, where the putative speech act is replaced with Paul Grice’s category of ‘sayings’. To make his case, Cappelen produces four arguments against Timothy Williamson’s normative view of assertion, holding that the same arguments can be used mutatis mutandis against other non-normative views of assertion. In this paper I examine all four of Cappelen’s arguments against normative theories of assertion, and conclude that they fail.

Lists of species underpin many fields of human endeavour, but there are currently no universally accepted principles for deciding which biological species should be accepted when there are alternative taxonomic treatments (and, by extension, which scientific names should be applied to those species). As improvements in information technology make it easier to communicate, access, and aggregate biodiversity information, there is a need for a framework that helps taxonomists and the users of taxonomy decide which taxa and names should be used (...) by society whilst continuing to encourage taxonomic research that leads to new species discoveries, new knowledge of species relationships, and the refinement of existing species concepts. Here, we present 10 principles that can underpin such a governance framework, namely (i) the species list must be based on science and free from nontaxonomic considerations and interference, (ii) governance of the species list must aim for community support and use, (iii) all decisions about list composition must be transparent, (iv) the governance of validated lists of species is separate from the governance of the names of taxa, (v) governance of lists of accepted species must not constrain academic freedom, (vi) the set of criteria considered sufficient to recognise species boundaries may appropriately vary between different taxonomic groups but should be consistent when possible, (vii) a global list must balance conflicting needs for currency and stability by having archived versions, (viii) contributors need appropriate recognition, (ix) list content should be traceable, and (x) a global listing process needs both to encompass global diversity and to accommodate local knowledge of that diversity. We conclude by outlining issues that must be resolved if such a system of taxonomic list governance and a unified list of accepted scientific names generated are to be universally adopted. (shrink)

Interviewing as part of broadcast news includes a wide range of practices that go beyond calling public figures to account in ways that have received so much attention and analysis in the research literature. This article examines a major strand of news interviewing which it identifies as ‘experiential’ and argues, on the basis of close discourse analysis of interviews drawn from coverage of the 2008 Beijing Olympics and the 2005 London bombings, that the focus on personal experience and emotion in (...) them is managed in ways quite distinct from accountability interviewing. Indeed, the apparently formulaic quality of the verbal performance in these interviews gives shape to experience in a fashion close to ritual but demands a quite different kind of alignment from the audience than that implicated by accountability interviewing. (shrink)

We examine the link between the growing emphasis on corporate social responsibility at the organizational level and beliefs about social responsibility at work (SRW) expressed by individuals. Drawing from theories of professionalism and diffusion of innovations (including practices and beliefs), we advance hypotheses about beliefs of managers and non-managers in 11 countries at two time periods, and use a unique international data set to test our hypotheses. Our general prediction that managers would score higher than non-managers on a measure of (...) SRW was not supported. However, further analysis revealed a more complex relationship moderated by the contextual factors of time frame and country inequality level. We discuss implications and extensions for future research. (shrink)

In this volume, fourteen scholars, many of them contemporaries of Professor Frank, engage with his legacy with important and seminal works which take some of ...

Non-recent (historic) childhood sexual abuse is an important issue to research, though often regarded as taboo and frequently met with caution, avoidance or even opposition from research ethics committees. Sensitive research, such as that which asks victim-survivors to recount experiences of abuse or harm, has the propensity to be emotionally challenging for both the participant and the researcher. However, most research suggests that any distress experienced is usually momentary and not of any clinical significance. Moreover, this type of research offers (...) a platform for voices which have often been silenced, and many participants report the cathartic effect of recounting their experiences in a safe, non-judgemental space. With regard to the course of such research, lines of inquiry which ask adult participants to discuss their experiences of childhood sexual abuse may result in a first-time disclosure of that abuse by the victim-survivor to the researcher. Guidance about how researchers should respond to first-time disclosure is lacking. In this article, we discuss our response to one research ethics committee which had suggested that for a qualitative study for which we were seeking ethical approval (investigating experiences of pregnancy and childbirth having previously survived childhood sexual abuse), any disclosure of non-recent (historic) childhood sexual abuse which had not been previously reported would result in the researcher being obliged to report it to relevant authorities. We assess this to be inconsistent with both law and professional guidance in the United Kingdom; and provide information and recommendations for researchers and research ethics committees to consider. (shrink)

The authors explore the changing dynamics of gendered familial caregiving in urban China within the context of economic reforms and the continued cultural influence of xiao. Data collected in China through interviews with 110 familial caregivers were used to examine cultural and structural influences on the caregiving behavior of adult children. Results from multiple regression analyses provide evidence of a gendered division of parental care tasks, a decline in the patrilocal tradition of caregiving, and a strong social pressure that influences (...) caregiving behavior. Structural factors linked to caregiving performance included family size, lack of pensions for elders, and caregivers’ employment status and income. Findings portend deleterious effects for the women who are now caregivers as they are likely to live longer but be more financially dependent and have fewer children available to help them. (shrink)

Each of the five volumes in the Stone Art Theory Institutes series—and the seminars on which they are based—brings together a range of scholars who are not always directly familiar with one another’s work. The outcome of each of these convergences is an extensive and “unpredictable conversation” on knotty and provocative issues about art. This fourth volume in the series, _Beyond the Aesthetic and the Anti-Aesthetic_, focuses on questions revolving around the concepts of the aesthetic, the anti-aesthetic, and the political. (...) The book is about the fact that now, almost thirty years after Hal Foster defined the anti-aesthetic, there is still no viable alternative to the dichotomy between aesthetics and anti- or non-aesthetic art. The impasse is made more difficult by the proliferation of identity politics, and it is made less negotiable by the hegemony of anti-aesthetics in academic discourse on art. The central question of this book is whether artists and academicians are free of this choice in practice, in pedagogy, and in theory. The contributors are Stéphanie Benzaquen, J. M. Bern­stein, Karen Busk-Jepsen, Luis Camnitzer, Diarmuid Costello, Joana Cunha Leal, Angela Dimitrakaki, Alexander Dumbadze, T. Brandon Evans, Geng Youzhuang, Boris Groys, Beáta Hock, Gordon Hughes, Michael Kelly, Grant Kester, Meredith Kooi, Cary Levine, Sunil Manghani, William Mazzarella, Justin McKeown, Andrew McNamara, Eve Meltzer, Nadja Millner-Larsen, Maria Filomena Molder, Carrie Noland, Gary Peters, Aaron Richmond, Lauren Ross, Toni Ross, Eva Schürmann, Gregory Sholette, Noah Simblist, Jon Simons, Robert Storr, Martin Sundberg, Timotheus Vermeulen, and Rebecca Zorach. (shrink)

Building on the long-standing tradition of challenging oppression and questioning whose interests are being served in the field of language education, we report on a study that involved a group of U.S.-based graduate students who collaborated with a ninth-grade English teacher in Nepal. The study comes out of a larger project that sought to internationalize the curriculum of a graduate educational linguistics course at a U.S. university. At the heart of this internationalizing curriculum endeavour was a commitment to expose graduate (...) students in the U.S. to the issues of language teaching outside of the U.S. This was done through co-designing of a unit of lessons, with six graduate students meeting virtually with their teacher partner, Ditya, in Nepal over the course of a semester. The graduate students and Ditya constitute our research participants. The graduate student participants learned about the need to develop pedagogical materials that were relevant to the local context in Nepali classroom, and not attempt to transplant a Western-centric curriculum onto the Nepali classroom. In keeping with recent calls to decolonize higher education, we illustrate how critical theory in general and decolonizing pedagogy in particular can be infused into a U.S. graduate curriculum by drawing on the rich, indigenous knowledge and resources of a teacher collaborator from the Global South. We do this by reporting how this critical, decolonizing goal was realized through collaborative professionalism, which is characterized by the sharing of knowledge, skills, and experience to improve student achievement, reflection, dialogue and collective responsibility. (shrink)

I sketch an explanatory framework that fits a variety of contemporary research programs in cognitive science. I then investigate the scope and the implications of this framework. The framework emphasizes (a) the explanatory role played by the semantic content of cognitive representations, and (b) the important mechanistic, non-intentional dimension of cognitive explanations. I show how both of these features are present simultaneously in certain varieties of cognitive explanation. I also consider the explanatory role played by grounded representational content, that is, (...) content evaluated by appeal to its truth, falsity, accuracy, inaccuracy and other relational properties. (shrink)

This essay attempts to rethink what is here called “the Socratic Moment” in Western philosophy, that is, the unique turn that philosophy takes in the early Socratic dialogues of Plato. The essay begins by contesting the traditional view that the goal of Socratic inquiry is to gain irrefutable knowledge of ethical concepts such as courage, justice, friendship, and the holy for the purposes of future action. It argues instead, through a close reading of key passages from Plato’s Apology and Euthyphro, (...) that Socratic inquiry actually begins with the concept under consideration in order to put the interlocutor themself—their beliefs and their actions—into question. (shrink)

Why does sub-Saharan Africa exhibit the highest rates of gender inequality in the world? This article evaluates the contributions of Christian missionary societies in German East Africa to current socioeconomic gender inequalities in Tanzania. Previous studies ascribe a comparatively benign long-term effect of missionary societies, in particular of the Protestant denomination, on economic, developmental, and political outcomes. This article contrasts that perception by focusing on the wider cultural impact of the civilizing mission in colonial Africa. The analysis rests on a (...) novel georeferenced dataset on German East Africa—based on digitized colonial maps and extensive historical records available in the German colonial archives—and the most recently available DHS-surveys. The results highlight the formative role of Catholic missionary societies in German East Africa in shaping gender inequalities currently witnessed in Tanzania. (shrink)