Most new drugs are protected by pharmaceutical patents, which give the patent holder exclusive control over that drug’s supply for 20 years. When the patent term expires, the drug becomes available for generic production by any company. The resulting competition typically leads to dramatic reductions in price. In Brazil, generic drugs are on average 40% cheaper than reference or brand-name drugs. In the United States, the Federal Drug Administration reports up to 85% price differences. Consumers in India have witnessed more (...) than 100-fold price reduction for antiretroviral drugs due to generic production. Generics thus play a key role in broadening access to health care, mostly by driving costs down, both in the developing and developed world. (shrink)

This chapter compares the institutional setting and integrations processes in Switzerland and the EU. The major findings are that EU integration is trying to achieve more political integration and accommodation of a much higher degree of diversity in much less time than has ever been the case in Switzerland. Integration and expansion processes that were slower and non-linear in Switzerland and that happened in separate phases (e.g. religious diversification, linguistic diversification, territorial expansion, etc.) are all going on at the same (...) time in the EU. Especially integration and accession with enormous shocks of diversification are engineered at the same time in the EU. From this point of view, the EU has already tried to go beyond many stages that took centuries to be completed in Switzerland. The institutional design of the European Union seems to echo quite well the federal state formation process in Switzerland. The following precisions are however necessary in the comparative perspective. First, the momentary stage of European Integration, characterized by intergovernmental crisis management, resembles the (dysfunctional) intergovernmental centralism of the Swiss cantons during the decades before the formation of the federal-state in 1848. Second, due to the greater diversity of the European Union, this quasi-federal system has derived in extreme asymmetries between the member states. Since EU identity is not well entrenched among European citizens (and politicians), it has been hard to design institutions and policies of common territorial protection and redistribution and there is mistrust towards centralistic EU institutions (specially in the countries more affected by the economic crisis). Most European citizens do not feel that their interests are taken into account by the European Union. Third, it is important to note that in Swiss federalism the municipalities play an important role, they are much more than just administrative districts. This city-centred and bottom up construct of citizenship is guaranteed by the Swiss federal constitution. Citizens feel that their most immediate and local identity is not jeopardized but rooted in and guaranteed by the Swiss federal constitution. Compared to sub-national Swiss federalism, EU federalism is entirely focused on the nation-state and the EU institutions. Serious consideration ought to be given to the idea that European citizenship is not only about bringing citizenship to a higher European level but also about bringing it more to the root-level of citizenship: the city. Direct democracy has acted as a federator in the Swiss context. Switzerland made direct democracy and direct democracy made Switzerland. There has been a slow and iterative process of adaptation of structurally similar institutions of direct democracy at all levels (communal, cantonal, federal) of all units (all communes, all cantons, confederation roughly between 1830-1891. To the contrary, the EU is only incipiently in a process of introducing direct democracy (in some member-states and ECI), and so far direct democracy is mainly practiced as national plebiscitary democracy. Under this guise it is seen as a threat to EU integration and probably not without good reason. While in Switzerland the coherent introduction of direct democracy at all levels of the polity in the long run served as an important unifier, direct democracy has even not been considered as integrative part of all levels of political integration in the EU. It is of great interest that the one element in which the European Union has based the construction of EU citizenship and identity – mobility of residence – has been implicitly discouraged in Switzerland. The institutional design as incorporated in Swiss multicultural identity (which aims fundamentally at the protection of cantonal autonomy, culture and language) has facilitated that Switzerland is called today a successful multicultural society. Most citizens identify with Switzerland as a country and they like it as it is, but they do not want to take advantage of their formal right to move to other parts of the country, especially not across language borders. The same institutional design that has made of Switzerland a successful case of multiculturalism and democracy poses important barriers that make it difficult for the Swiss to move their residence across their country. Considering that one of the main features of European citizenship is the freedom of movement and residence, this poses a main concern. The Swiss compromise between the formal right and economic necessity of mobility on the one hand and the protection of political and cultural sub-identities on the other hand, is commuting. Due to the vast size, this is of limited applicability in the EU. However, in a Europe of cities and trans-border regions, commuting is an important option provided that every European citizen lives reasonably close to an important economic centre. In short, the Europe of commuters deserves attention in the context of EU citizenship. (shrink)

ObjectivesTo describe reporting of informed consent in pragmatic trials, justifications for waivers of consent and reporting of alternative approaches to standard written consent. To identify factors associated with (1) not reporting and (2) not obtaining consent.MethodsSurvey of primary trial reports, published 2014–2019, identified using an electronic search filter for pragmatic trials implemented in MEDLINE, and registered in ClinicalTrials.gov.ResultsAmong 1988 trials, 132 (6.6%) did not include a statement about participant consent, 1691 (85.0%) reported consent had been obtained, 139 (7.0%) reported a (...) waiver and 26 (1.3%) reported consent for one aspect (eg, data collection) but a waiver for another (eg, intervention). Of the 165 trials reporting a waiver, 76 (46.1%) provided a justification. Few (53, 2.9%) explicitly reported use of alternative approaches to consent. In multivariable logistic regression analyses, lower journal impact factor (p=0.001) and cluster randomisation (p<0.0001) were significantly associated with not reporting on consent, while trial recency, cluster randomisation, higher-income country settings, health services research and explicit labelling as pragmatic were significantly associated with not obtaining consent (all p<0.0001).DiscussionNot obtaining consent seems to be increasing and is associated with the use of cluster randomisation and pragmatic aims, but neither cluster randomisation nor pragmatism are currently accepted justifications for waivers of consent. Rather than considering either standard written informed consent or waivers of consent, researchers and research ethics committees could consider alternative consent approaches that may facilitate the conduct of pragmatic trials while preserving patient autonomy and the public’s trust in research. (shrink)

The DAPRECO knowledge base is the main outcome of the interdisciplinary project bearing the same name. It is a repository of rules written in LegalRuleML, an XML formalism designed to be a standard for representing the semantic and logical content of legal documents. The rules represent the provisions of the General Data Protection Regulation, the new Regulation that is significantly affecting the digital market in the European Union and beyond. The DAPRECO knowledge base builds upon the Privacy Ontology, which provides (...) a model for the legal concepts involved in the GDPR, by adding a further layer of constraints in the form of if-then rules, referring either to standard first order logic implications or to deontic statements. If-then rules are formalized in reified Input/Output logic and then codified in LegalRuleML. Reified Input/Output logic is an application of standard Input/Output logic for legal reasoning, in which Input/Output logic is combined with the reification-based approach in Hobbs and Gordon. The DAPRECO knowledge base is then a case study for reified Input/Output logic, and it shows that the formalism indeed appears to be a good candidate to effectively formalize, via uniform and simple representations, complex linguistic/deontic phenomena that may be found in legal texts. To date, the DAPRECO knowledge base is the biggest knowledge base in LegalRuleML and Input/Output logic freely available online. (shrink)

Motivated by the call for more research on students’ perceptions of their ethical development in business education programs, this study examines students’ reflections on how their understanding of ethics was challenged and/or changed, and what facilitated the development of ethical decision-making approaches in a first-year accounting course. The results indicate that students developed more sophisticated and contextualised views of ethical issues in business, government and social contexts including the need to consider their impact on various stakeholders. Students attributed this development (...) to the various elements in the integrated course design including the real cases sourced in current newspaper articles, an ethical decision-making framework with various ethical perspectives, the reflective journal component and the ability to work in groups. These findings have implications for the design of effective ethics education programs in business. (shrink)

The Human Agenda is the first Special Edition of The Cambridge Journal of Law, Politics, and Art (CJLPA), an interdisciplinary journal founded at the University of Cambridge. Focused on the unique intersections of law, politics and art in the context of human rights, contributors to the Special Edition include David Baragwanath, Luis Moreno Ocampo, Nadia Murad, Nancy Hollander, Andrew Clapham, Vladimir Osechkin, Mansour al-Omari, and many others. A full table of contents is available through the publication's own page.

This study explored perceived benefits and risks of participation in HIV research among 33 female sex workers in Tecún Umán, Guatemala. Stigma associated with sex work and HIV was a critical barrier to research participation. Key benefits of participation included access to HIV/sti prevention and testing, as well as positive and trusting relationships between sex workers and research teams. Control exerted by managers had mixed influences on perceived research risks and benefits. Results underscore the critical need for HIV investigators to (...) develop population-tailored procedures to reduce stigma; engage managers; and reinforce trusting, reciprocal relationships between sex work communities and researchers. (shrink)

In 1976 an interdisciplinary study on risks and risk evaluations was inaugurated in Sweden and was sponsored by the Committee for Future-oriented Research. One of the basic assumptions of the Swedish risk project was that modern society has created “new, increasingly complicated and large-scale technical systems.” It also assumed that “large systems are economically efficient, but vulnerable and therefore create risks.” A third assumption was that “the ever rising standard of living is purchased at the cost of certain additional risks.” (...) The perspective of the project was thus markedly historically oriented. (shrink)

Quality and service improvement (QSI) research employs a broad range of methods to enhance the efficiency of healthcare delivery. QSI research differs from traditional healthcare research and poses unique ethical questions. Since QSI research aims to generate knowledge to enhance quality improvement efforts, should it be considered research for regulatory purposes? Is review by a research ethics committee required? Should healthcare providers be considered research participants? If participation in QSI research entails no more than minimal risk, is consent required? The (...) lack of consensus on answers to these questions highlights the need for ethical guidance. Three distinct approaches to classifying QSI research in accordance with existing ethical principles and regulations can be found in the literature. In the first approach, QSI research is viewed as distinct from other types of healthcare research and does not require regulation. In the second approach, QSI research falls within regulatory guidelines but is exempt from research ethics committee review. In the third approach, QSI research is deemed to be part of the learning healthcare system and, as such, is subject to a different set of ethical principles entirely. In this paper, we critically assess each of these views. While none of these approaches is entirely satisfactory, we argue that use of the ethical principles governing research provides the best means of addressing the numerous questions posed by QSI research. (shrink)

Proximity and interpersonal contact are prominent components of social connection. Giving affective touch to others is fundamental for human bonding. This brief report presents preliminary results from a pilot study. It explores if exposure to bonding scenes impacts the activity of specific muscles related to physical interaction. Fingers flexion is a very important component when performing most actions of affectionate contact. We explored the visuo-motor affective interplay by priming participants with bonding scenes and assessing the electromyographic activity of the fingers (...) flexor muscle, in the absence of any overt movements. Photographs of dyads in social interaction and of the same dyads not interacting were employed. We examined the effects upon the electromyographical activity: during the passive exposure to pictures, and during picture offset and when expecting the signal to perform a fingers flexion task. Interacting dyads compared to matched non-interacting dyads increased electromyographic activity of the fingers flexor muscle in both contexts. Specific capture of visual bonding cues at the level of visual cortex had been described in the literature. Here we showed that the neural processing of visual bonding cues reaches the fingers flexor muscle. Besides, previous visualization of bonding cues enhanced background electromyographic activity during motor preparation to perform the fingers flexion task, which might reflect a sustained leakage of central motor activity downstream leading to increase in firing of the respective motor neurons. These data suggest, at the effector level, an implicit visuo-motor connection in which social interaction cues evoke intrinsic dispositions toward affectionate social behavior. (shrink)

Through cultural transmission, repeated learning by new individuals transforms cultural information, which tends to become increasingly compressible . Existing diffusion chain studies include in their design two processes that could be responsible for this tendency: learning and reproducing . This paper manipulates the presence of learning in a simple iterated drawing design experiment. We find that learning seems to be the causal factor behind the increase in compressibility observed in the transmitted information, while reproducing is a source of random heritable (...) innovations. Only a theory invoking these two aspects of cultural learning will be able to explain human culture's fundamental balance between stability and innovation. (shrink)

This paper highlights alternative responsible business models with an outspoken and profound dedication to contribute to a sustainable development. Themarket of alternatives and their networking activities to make the alternative market grow will be discussed in terms of programs and anti-programs. Another issue brought up is their ability to stick to the responsible knitting, as they grow and develops in a capitalistic market surrounding.

As a neonatal neurologist, I serve families facing tragic decisions in which they must balance trade-offs between death and life with profound disability. I often find myself in complex discussions about future outcome, in which families sort through in real-time what information they value most in making such a choice. Will he laugh? Will he be in pain? Will he know how much he’s loved? In this month’s feature article, Brick et al share the results of an online survey aimed (...) at assessing public views on when a life is not worth living, in an effort to inform ongoing legal and clinical debates about withdrawal of life-sustaining treatment for children. These findings raise important questions about how we define and measure outcomes that matter to parents as they make these tragic decisions. It is challenging to interpret these findings in the absence of context of how decision-making for infants occurs in real-time. The nature of this study and its objective required that cases be substantially simplified. As the authors acknowledge, the prognoses and function of the children involved in these cases were often deeply contested. Prognostic uncertainty is common for children with significant …. (shrink)

Representation is integral to the functioning and legitimacy of modern government. Yet political theorists have often been reluctant to engage directly with questions of representation, and empirical political scientists have closed down such questions by making representation synonymous with congruence. Conceptually unproblematic and normatively inert for some, representation has been deemed impossible to pin down analytically and to defend normatively by others. But this is changing. Political theorists are now turning to political representation as a subject worthy of theoretical investigation (...) in its own right. In their effort to rework the theory of political representation, they are also hoping to impact how representation is assessed and studied empirically. This volume gathers together chapters by key contributors to what amounts to a "representative turn" in political theory. Their approaches and emphases are diverse, but taken together they represent a compelling and original attempt at re-conceptualizing political representation and critically assessing the main theoretical and political implications following from this, namely for how we conceive and assess representative democracy. Each contributor is invited to look back and ahead on the transformations to democratic self-government introduced by the theory and practice of political representation. Representation and democracy: outright conflict, uneasy cohabitation, or reciprocal constitutiveness? For those who think democracy would be better without representation, this volume is a must-read: it will question their assumptions, while also exploring some of the reasons for their discomfort. Reclaiming Representation is essential reading for scholars and graduate researchers committed to staying on top of new developments in the field. (shrink)

The aim of this paper is to enhance doctors’ awareness of implicit understandings between doctors and patients in the context of pre-operative communication of risks. This paper draws on insights from the philosophy of language – in particular pragmatic analysis tools – that make explicit the implicit understandings of the interaction. Mastering not only _what is said_ but also _what is unsaid_ allows doctors to improve their communication with their patients. I suggest that being aware of the implications of the (...) interactions is useful for improving both the doctor’s and the patient’s experience, further strengthening the therapeutic alliance. In this article I analyze actual cases involving pre-operative evaluation before cardiac surgery from a philosophy of language perspective. The paper is structured as follows: a description of the relevant philosophy of language tools that I will apply; an overview of the risk-communication context; an explanation of the link between “the implicit dimension” and trust, addressing whether the doctor needs to convey the whole truth; and the analysis of real cases. In conclusion, I re-emphasize the importance of implicit meanings during risk communication. (shrink)

Para conocer las buenas prácticas éticas, se realizó un estudio exploratorio-descriptivo, basado en una metodología de enfoque mixto, divida en dos etapas. En la primera de carácter cualitativo se aplicó una entrevista a profundidad, y en la segunda se planteó el instrumento de recolección de datos: la encuesta. Se definió la población objeto de estudio, de acuerdo con el ranking Merco (Monitor Empresarial de Reputación Corporativa), considerando una muestra intencional de 20 empresas de Ecuador. Las conclusiones corroboraron que los valores (...) en el contexto de la organización son la base de la cultura organizacional, que guían su actuar. (shrink)

Understanding what it means toconsent is of considerable importance sincesignificant moral issues depend on how this actis defined. For instance, determining whetherconsent has occurred is the deciding factor insexual assault cases; its proper occurrence isa necessary condition for federally fundedhuman subject research. Even though mosttheorists recognize the legal and moralimportance of consent, there is still littleagreement concerning how consent should bedefined, or whether different domains involvingconsent demand context-specific definitions.Understanding what it means to consent isfurther complicated by the fact that currentlegal (...) conceptions are not necessarily groundedin argument; they typically depend on appealsto authority and precedent. The purpose ofthis paper is to use speech act theory toprovide a theoretically grounded conception ofconsent; such a conception can aid in the justresolution of legal and moral disputes thathinge on whether an act of consent occurred. (shrink)

To date, COVID-19 has spread across the world, changing our way of life and forcing us to wear face masks. This report demonstrates that face masks influence the human ability to infer emotions by observing facial configurations. Specifically, a mask obstructing a face limits the ability of people of all ages to infer emotions expressed by facial features, but the difficulties associated with the mask’s use are significantly pronounced in children aged between 3 and 5 years old. These findings are (...) of essential importance, as they suggest that we live in a time that may potentially affect the development of social and emotion reasoning, and young children’s future social abilities should be monitored to assess the true impact of the use of masks. (shrink)

This research is motivated by the criticism levelled at the academic community for its failure to incorporate sufficient ethics education into the accounting curriculum :53–71, 2004; Madison and Schmidt 2006). The inclusion of ethics decision-making frameworks by professional bodies in their codes of conduct or as a standalone tool and the encouragement of their use as a part of ethics education to help students to identify and think through ethical issues in a business context has been subject to very limited (...) research to date. The aim of this study is to provide evidence of the impact of providing a framework on its own and providing a framework as part of a comprehensive integrated ethics education component of a first-year unit of study, on accounting students’ ethical sensitivity and judgment. Results indicate that providing students with a framework only does not increase students’ ethical sensitivity but does support their ethical judgment. In contrast, the integrated ethics component does increase student’s ethical sensitivity, however, an unexpected finding of this study is that increases in students’ ethical judgement are greater if they have not been previously exposed to the framework. Taken together, our findings suggest that it is the framework that has a significant impact on students’ ethical judgment, while an integrated ethics education can expose students to a range of ethical issues and thereby improve their ethical sensitivity, a critical component which initiates the ethical decision-making process. (shrink)

The results in this paper are in a context of abstract elementary classes identified by Shelah and Villaveces in which the amalgamation property is not assumed. The long-term goal is to solve Shelah’s Categoricity Conjecture in this context. Here we tackle a problem of Shelah and Villaveces by proving that in their context, the uniqueness of limit models follows from categoricity under the assumption that the subclass of amalgamation bases is closed under unions of bounded, -increasing chains.

Historians have recently paid increasing attention to the role of the disputation in Italian universities and humanist circles. By contrast, the role of disputations as forms of entertainment at fifteenth-century Italian courts has been somewhat overlooked. In this article, the Milanese "scientific duel" described in Luca Pacioli's De divina proportione is taken as a vantage point for the study of the dynamics of scientific patronage and social advancement as reflected in Renaissance courtly disputes. Pacioli names Leonardo da Vinci as one (...) of the participants in the Milanese dispute. In this paper I argue that Leonardo's Paragone and Pacioli's De divina proportione are likewise the outcome of the Milanese "scientific duel." By challenging the traditional hierarchy of the arts, they both exemplify the dynamics of social and intellectual promotion of mathematicians and artists in the privileged setting of Renaissance courts, where courtly patronage could subvert the traditional disciplinary rankings. (shrink)

James Tully's account of a ?post?imperial constitutionalism?, in his book Strange Multiplicity, wrongly rejects the ideal of impartiality in modern political theory. Pace Tully, this paper argues for a conception of impartiality called ?justice as provisionality?. This is demonstrated by explaining the concept of a ?contrastive hard case?. These cases, exemplified both by indigenous peoples? struggles for recognition and ?traditional? justifications for violence against women, centrally involve conflicts over the cultural interpretation of value. The paper argues that the just adjudication (...) of these cases depends on understanding two different senses of the term ?provisionality?. These demonstrate that the post?imperial state can give impartial reasons for the rights of parties to ?contrastive? claims in a way that integrates the concerns of both feminists and cultural pluralists. The two senses of provisionality are: first, that consequent upon historical injustice, the post?imperial state should recognize the legitimacy of citizens? partial reasons for their actions and practices; and hence, should recognise that the domain of public, impartial reason is always provisional and incomplete. Second, our capacities for reason are dependent on public and nonpublic provision, protection and care. This is because diverse inequalities and injustices could prevent vulnerable people, in some cases women, from acting according to reasons at all. (shrink)

This article offers a comparative analysis of experimental fetal surgery and fetal tissue research. The author argues that fetuses are positioned differently across each set of practices, with significant implications for actors in these domains. By empirically charting the ways in which humanity is or is not attributed to fetal work objects, the author's argument challenges contemporary debates in science studies that tend to conceptualize human and nonhuman in dualistic terms. This analysis instead shows the heterogeneous attribution of these categories, (...) as well as the spaces, margins, and positions, which constitute them as distinct. (shrink)

Discussions of the framework and terminology associated with the right to health tend to treat the indeterminacy of ‘health’ as conceptual noise that the construction of effective policy must not focus on, but find ways of bracketing out. On this basis, the right to health is broadly regarded as a social and economic, rather than a civil and political right. This article draws critically on literature about the implications of developments in medical biotechnologies, to argue that a positive acknowledgement of (...) the indeterminate character of health should transform, rather than simply hinder, the quality of debate over what is to be understood and expected in connection with a right to health. A focus on indeterminacy allows for the perception and the formulation of health-related demands that may not stem from the scarcity of material resources or technical means, but from the misplaced authority of particular voices in defining what possibilities are to be seriously envisaged. This proposition only becomes politically effective, it is argued, when ‘indeterminacy’ (and the capacity for normativity) is referred to life itself and not merely to social and moral judgements about life. Although more immediately pertinent to the concerns of relatively privileged populations, the focus on indeterminacy provides a key to generating a certain symmetry and complementarity of interest, across the privileged/underprivileged divide, in promoting health as a (human) right. (shrink)

Amid now extensive debates about cosmopolitanism in political theory, this article explores the implications of Axel Honneth’s recognition theory for issues in international justice, not least the dire situation of poverty in the world. In contrast with a purely resource-distributive approach, the essay turns particularly to Honneth’s recent revival of the Lukácsian concept of reification as a process of self-distancing from the elementary humanity of others. Specifically, Honneth re-formulates reification as a failure of an elementary or ‘antecedent’ form of recognition. (...) From the perspective of his theory, reification connotes the forgetfulness of others’ fundamental humanity. While Honneth takes such forgetfulness to become most readily apparent in dramatic violations such as the Holocaust, the article interprets his theory to explain, and eventually to challenge, the passive acceptance by many of dire material injustices. The article develops the implications of this challenge by interpreting from Honneth’s framework a duty to question international policies which tend to reify and objectify the least well off in the world, whilst remaining cognizant of the limits of de-reification to the more extensive, meaningful alleviation of poverty globally. (shrink)

"This book gathers together eighteen of the most important and influential scholarly articles of the last 60-70 years (three of which are translated into..

Cet article vise à situer les notions de sujet, de corps et de vie chez Foucault à partir du passage d’un cadre conceptuel basé sur les notions de corps-pouvoir à un centré sur celles de vie-gouvernement. Mon hypothèse est que ce mouvement caractérise le développement de ses recherches entre les années 1970 et les années 1980. Le problème central est la difficulté de penser le statut ontologique des rapports de pouvoir (au sens physique) sans attribuer au corps une sorte de (...) qualité ontologique du même type (comme dans tous les formes de vitalisme), ce qui conduit Foucault à privilégier la thèmatique de la vie à celle du corps dans le développement de sa « question du sujet ». (shrink)

Gadamer's Ethics of Play examines the ethical dimensions of understanding by focusing on the concept of dialogical "play" in Hans-Georg Gadamer's Truth and Method. The book is accessible to an undergraduate audience, while also being relevant to ongoing debates among Gadamer scholars.