The recent review by Monrad1 presents several issues about secondary vaccine trials. It lays out the case in which a vaccine has been tested through phases I–III and is being deployed. Subsequently, consideration is being given to conducting ‘trials for another vaccine for the pathogen’. Monrad states: ‘In summary, we may say that researchers have strong prima facie reasons not to conduct a secondary vaccine trial.’ Monrad discusses several factors meriting careful consideration about the need for developing and testing more (...) than one vaccine: relative efficacy, length of immunity, adverse reactions, ease of storage and administration, economic and logistical factors. What is not addressed are the ethical duties that exist when there are competing phase III vaccine candidates for COVID-19. We have serious concerns about potential ethical inadequacies about these ongoing trials and …. (shrink)

There has been a great deal of discussion, in this journal and others, about obstacles hindering the evolution of the philosophy of medicine. Such discussions presuppose that there is widespread agreement about what it is that constitutes the philosophy of medicine.Despite the fact that there is, and has been for decades, a great deal of literature, teaching and professional activity carried out explicitly in the name of the philosophy of medicine, this is not enough to establish that consensus exists as (...) to the definition of the field. And even if consensus can be obtained as to what constitutes the philosophy of medicine, this does not mean that it exists as a field. (shrink)

The field of medical rehabilitation is relatively new.... Until recently, the ethical problems of this new field were neglected. There seemed to be more pressing concerns as rehabilitation medicine struggled to establish itself, sometimes in the face of considerable skepticism or hostility. There also seemed no pressing moral questions of the kind and intensity to be encountered, say, in high-technology acute care medicine or genetic engineering.... Those in biomedical ethics could and did easily overlook the quiet, less obtrusive issues of (...) rehabilitation.... The Hastings Center set out in 1985 to rectify that situation.... To explore the issues, the Center assembled a group of practitioners in the field, Hastings Center staff members, and individuals experienced in other areas of medical ethics.... The report that follows was written by Arthur Caplan and Daniel Callahan, assisted by Dr. Janet Haas of the Moss Rehabilitation Hospital in Philadelphia... (shrink)

Patients have received experimental pharmaceuticals outside of clinical trials for decades. There are no industry-wide best practices, and many companies that have granted compassionate use, or ‘preapproval’, access to their investigational products have done so without fanfare and without divulging the process or grounds on which decisions were made. The number of compassionate use requests has increased over time. Driving the demand are new treatments for serious unmet medical needs; patient advocacy groups pressing for access to emerging treatments; internet platforms (...) enabling broad awareness of compelling cases or novel drugs and a lack of trust among some that the pharmaceutical industry and/or the FDA have patients’ best interests in mind. High-profile cases in the media have highlighted the gap between patient expectations for compassionate use and company utilisation of fair processes to adjudicate requests. With many pharmaceutical manufacturers, patient groups, healthcare providers and policy analysts unhappy with the inequities of the status quo, fairer and more ethical management of compassionate use requests was needed. This paper reports on a novel collaboration between a pharmaceutical company and an academic medical ethics department that led to the formation of the Compassionate Use Advisory Committee. Comprising medical experts, bioethicists and patient representatives, CompAC established an ethical framework for the allocation of a scarce investigational oncology agent to single patients requesting non-trial access. This is the first account of how the committee was formed and how it built an ethical framework and put it into practice. (shrink)

If scientists can successfully clone sheep, will humans be next? Today's headlines read like a science fiction novel! Due Consideration takes a poignant look at the rapidly changing field of biomedicine and the consequences it will have on our lives. Arthur Caplan, one of this nation's leading bioethicists, explores these issues and analyzes moral questions including: * Will we retain our essential humanity if we modify our biological blueprint? * Would it be irresponsible to procreate without a thorough genetic (...) examination? * Who will decide if physical traits like short stature and baldness are considered diseases? * Can biomedicine make our lives better? You'll also learn about the most current and controversial topics such as: * Cloning, abortion and assisted suicide. * Genetically engineering a human to be immune from infectious diseases. * The ability to "design" our children from head to toe. * Diagnosing and treating illnesses during fetal development. * Programs to prevent the transmission of HIV. No other book on the market today combines this analytic clarity with the latest from medical journals and media headlines. Now, you can decide for yourself what the future ought to hold in store. (shrink)

Alan H, Goldman, The Moral Foundations of Professional Ethics Totowa, N.J.: Rowman and Littlefield, 1980, Pp. ix + 305.

The world today is facing unprecedented challenges of governance far beyond what the United Nations, established more than 70 years ago, was designed to face. The grave effects of global climate change are already manifesting themselves, requiring rapid, far-reaching and unprecedented changes in all aspects of society if we are to arrest catastrophic and probably irreversible consequences. Science has uncovered the frightening and rapid collapse in global biodiversity, threatening ecosystems across the planet that maintain the correct functioning of the biosphere, (...) upon which we rely for survival. But there is more; there are other global catastrophic risks. We live in a world in which a diminished faith in our political leaders and governmental structures, public disillusionment with partisan politics and a willingness to believe populist promises, disturbing trends in income inequality, human rights violations and the spread of corruption have coincided with the rise of autocratic leaders, often intent on awakening the voices of nationalisms which have been so destructive during the 20th century. The rejection by some nations of the benefits of multilaterism and international cooperation, which have been at the center of the postwar global order, has heightened the risks of fundamental instabilities that could precipitate a range of major crises, disregarding the lessons of the past. (shrink)

If social relations often require the choice of a cooperative solution to a prisoners' dilemma, we must ask how people generally solve the games. Three possible devices are that those who choose non-cooperative strategies get a bad reputation and so learn to be cooperative, that people are taught by parents that non-cooperators have unhappy lives, or that an official can be paid a salary to make the cooperative choice. By analyzing erotic love and marriage, and why people try to do (...) their jobs, it is suggested that these devices result in people often solving prisoners' dilemma games without being conscious of them. How then do these structures that 'have the function' of solving prisoners' dilemmas get created and maintain themselves? It is suggested that Deweyan consciousness, existing only when structural strains or unsolved games create personal problems, is adequate to explain many such functional structures. (shrink)

Health, Disease, and Illness brings together a sterling list of classic and contemporary thinkers to examine the history, state, and future of ever-changing "concepts" in medicine.

In the space at my disposal I cannot attempt to deal with all the points which arise in the Second Part of the dialogue, and I therefore confine myself to a few which seem to be of special interest and importance. I hope it may be possible to deal more exhaustively with the dialogue in a fuller commentary. As in the previous part of the article, I have assumed the results of my study of the Sophist already referred to.

Bacteria can grow rapidly, yet there are some that grow slowly under apparent optimal conditions. These organisms are usually present in environments with low levels of nutrients, and are not found in conditions of more plentiful nutrients. They are known as “oligotrophs”in contrast to “copiotrophs”, which are common in environments with greater nutritional opportunities. This essay asks why do the oligotrophs not occupy richer environments, and why are copiotrophs not more prevalent in chronic starvation environments? BioEssays 23:657–661, 2001. © 2001 (...) John Wiley & Sons, Inc. (shrink)

Traditionally, species have been treated as classes or kinds in philosophical discussions of systematics and evolutionary biology. Recently a number of biologists and philosophers have proposed a drastic revision of this traditional ontological categorization. They have argued that species ought be viewed as individuals rather than as classes or natural kinds. In this paper an attempt is made to show that (a) the reasons advanced in support of this new view of species are not persuasive, (b) a reasonable explication can (...) be given of the treatment of species as classes that is consistent with current theory and practice in evolutionary biology and systematics, and (c) that once certain confusions concerning the species concept have been clarified, there are good theoretical grounds for maintaining that species are best viewed as classes or kinds. (shrink)

Some argue that to be effective in healthcare settings autonomy needs to be strengthened. The author thinks autonomy is fundamentally inadequate in healthcare settings and requires supplementation by experience-based paternalism on the part of doctors and healthcare providers.

Fibroblast growth factors (FGFs) comprise a large family of developmental and physiological signaling molecules. All FGFs have a high affinity for the glycosaminoglycan heparin and for cell surface heparan sulfate proteoglycans. A large body of biochemical and cellular evidence points to a direct role for heparin/heparan sulfate in the formation of an active FGF/FGF receptor signaling complex. However, until recently there has been no direct demonstration that heparan is required for the biological activity of FGF in a developmental system in (...) vivo. A recent paper by Lin et al.(1) has broken through this barrier to demonstrate that heparan sulfate is essential for FGF function during Drosophila development. The establishment of a role for heparan sulfate in FGFR activation in vivo suggests that tissue-specific differences in the structure of heparan may modulate the activity of FGF. BioEssays 22:108–112, 2000. ©2000 John Wiley & Sons, Inc. (shrink)

Biomedical science suffered a loss of trust during the Covid‐19 pandemic. Why? One reason is a crisis fueled by confusion over the epistemology of science. Attacks on biomedical expertise rest on a mistaken view of what the justification is for crediting scientific information. The ideas that science is characterized by universal agreement and that any evolution or change of beliefs about facts and theories undermines trustworthiness in science are simply false. Biomedical science is trustworthy precisely because it is fallible, admits (...) error, adjusts to new information, and, most importantly, is practical. Successful diagnosis and cure demarcate the boundaries of warranted knowledge. The other reason is sociological. As the pandemic made all too clear, the loss of faith in scientific experts was due to the failure of most of them to engage in regular public dialogue, reflecting a failure to recognize the obligation that science has to bolster trust in its work and findings by concerted public engagement. (shrink)

There are competing ethical concerns when it comes to designing any clinical research study. Clinical trials of possible treatments for Ebola virus are no exception. If anything, the competing ethical concerns are exacerbated in trying to find answers to a deadly, rapidly spreading, infectious disease. The primary goal of current research is to identify experimental therapies that can cure Ebola or cure it with reasonable probability in infected individuals. Pursuit of that goal must be methodologically sound, practical and consistent with (...) prevailing norms governing human subjects research. Some maintain that only randomized controlled trials with a placebo or standard-of-care arm can meet these conditions. We maintain that there are alternative trial designs that can do so as well and that sometimes these are preferable to RCTs. (shrink)

This collection of essays emphasizes society s increasingly responsible engagement with ethical challenges in emerging medical technology. Expansion of technological capacity and attention to patient safety have long been integral to improving healthcare delivery but only relatively recently have concepts like respect, distributive justice, privacy, and autonomy gained some power to shape the development, use, and refinement of medical tools and techniques. Medical ethics goes beyond making better medicine to thinking about how to make the field of medicine better. These (...) essays showcase several ways in which modern ethical thinking is improving safety, efficacy and efficiency of medical technology, increasing access to medical care, and empowering patients to choose care that comports with their desires and beliefs. Included are complimentary ethical approaches as well as compelling counter-arguments. Together, the articles demonstrate how improving the quality of medical technology relies on every stakeholder -- not just medical researchers and scientists -- to assess each given technology s strengths and pitfalls. This collection also portends one of the next major issues in the ethics of medical technology: developing the requisite moral framework to accompany shifts toward patient-centred personalized healthcare.". (shrink)

Myxobacteria are social organisms that usually remain together even though they are not chemically attached to each other. They cooperatively feed and form aggregates and fruiting bodies. Their mode of movement, the forces and mechanisms that allow movement, the factors that keep them together, and the processes leading to the structures composed of many cells are only now beginning to be understood. Possibilities that may be key to their abilities are three models proposed elsewhere for different aspects of their biology. (...) One hypothesis attempts to explain mound and fruiting body formation by assuming that the cells move in circular patterns around the major cell mass. The second explains gliding motility on the existence of shunts that periodically short out the proton gradient across the cell membrane, causing expansion and contraction of portions of the cell. The third model proposes that occasionally cells arise that move unidirectional instead of back and forth. These few cells may lead the majority of cells in new directions. BioEssays 20:1030–1038, 1998. © 1998 John Wiley & Sons, Inc. (shrink)

A great deal has been written during the past decade about the subject of sociobiology. The appearance of E. O. Wilson’s massive text, Sociobiology: The New Synthesis, set off interdisciplinary tremors whose vibrations are still being felt in such exotic parts of the academic world as philosophy. Yet despite all the attention directed toward sociobiology within and beyond the university by both its admirers and detractors, some very basic issues pertaining to the subject remain notably obscure.