The Global Burden of Disease Study is one of the largest-scale research collaborations in global health, producing critical data for researchers, policy-makers, and health workers about more than 350 diseases, injuries, and risk factors. Such an undertaking is, of course, extremely complex from an empirical perspective. But it also raises complex ethical and philosophical questions. In this volume, a group of leading philosophers, economists, epidemiologists, and policy scholars identify and discuss these philosophical questions. Better appreciating the philosophical dimensions (...) of a study like the GBD can make possible a more sophisticated interpretation of its results, and it can improve epidemiological studies in the future, so that they are better suited to produce results that help us to improve global health. (shrink)

Identifying the necessary and sufficient conditions for individuating and classifying diseases is a matter of great importance in the fields of law, ethics, epidemiology, and of course, medicine. In this paper, I first propose a means of achieving this goal, ensuring that no two distinct disease-types could correctly be ascribed to the same disease-token. I then posit a metaphysical ontology of diseases—that is, I give an account of what a disease is. This is essential to providing (...) the most effective means of interfering with disease processes. Following existing work in the philosophy of medicine and epidemiology (primarily Christopher Boorse; Caroline Whitbeck; Alexander Broadbent), philosophy of biology (Joseph LaPorte; D.L. Hull), conditional analyses of causation (J.L. Mackie; David Lewis), and recent literature on dispositional essentialism (Stephen Mumford and Rani Anjum; Alexander Bird), I endorse a dispositional conception of disease. Following discussion of various conceptions of disease-identity, their relations to the clinical and pathological effects of the diseases in question, and how diseases are treated, I conclude (i) that diseases should be individuated by their causes, and (ii) that diseases are causal processes best seen as simultaneously acting sequences of mutually manifesting dispositions. (shrink)

Background Scientific and technological advancements in mapping and understanding the interrelated pathways through which biological and environmental exposures affect disease development create new possibilities for detecting disease risk factors. Early detection of such risk factors may help prevent disease onset or moderate the disease course, thereby decreasing associated disease burden, morbidity, and mortality. However, the ethical implications of screening for disease risk factors are unclear and the current literature provides a fragmented and case-by-case (...) picture. Methods To identify key ethical considerations arising from the early detection of disease risk factors, we performed a systematic scoping review. The Scopus, Embase, and Philosopher’s Index databases were searched for peer-reviewed, academic records, which were included if they were written in English or Dutch and concerned the ethics of (1) early detection of (2) disease risk factors for (3) disease caused by environmental factors or gene-environment interactions. All records were reviewed independently by at least two researchers. Results After screening 2034 titles and abstracts, and 112 full papers, 55 articles were included in the thematic synthesis of the results. We identified eight common ethical themes: (1) Reliability and uncertainty in early detection, (2) autonomy, (3) privacy, (4) beneficence and non-maleficence, (5) downstream burdens on others, (6) responsibility, (7) justice, and (8) medicalization and conceptual disruption. We identified several gaps in the literature, including a relative scarcity of research on ethical considerations associated with environmental preventive health interventions, a dearth of practical suggestions on how to address expressed concerns about overestimating health capacities, and a lack of insights into preventing undue attribution of health responsibility to individuals. Conclusions The ethical concerns arising with the early detection of risk factors are often interrelated and complex. Comprehensive ethical analyses are needed that are better embedded in normative frameworks and also assess and weigh the expected benefits of early risk factor detection. Such research is necessary for developing and implementing responsible and fair preventive health policies. (shrink)

Identifying the necessary and sufficient conditions for individuating and classifying diseases is a matter of great importance in the fields of law, ethics, epidemiology, and of course medicine. In this paper I first propose a means of achieving this goal, ensuring that no two distinct disease-types could correctly be ascribed to the same disease-token. I then posit a metaphysical ontology of diseases - that is, I give an account of what a disease is. This is essential (...) to providing the most effective means of interfering with disease processes. Following existing work in the philosophy of medicine and epidemiology, philosophy of biology, conditional analyses of causation, and recent literature on dispositional essentialism, I endorse a dispositional conception of disease whereby diseases are individuated by their causes, and diseases are causal processes best seen as simultaneously acting sequences of mutually manifesting dispositions - this, I claim, follows from the assumption that diseases should be classified by consideration of both their clinical and pathological effects, and importantly, events that can lead to the cessation of these symptoms. (shrink)

The Neurological Disease Ontology (ND) is being developed to provide a comprehensive framework for the representation of neurological diseases (Diehl et al., 2013). ND utilizes the model established by the Ontology for General Medical Science (OGMS) for the representation of entities in medicine and disease (Scheuermann et al., 2009). The goal of ND is to include information for each disease concerning its molecular, genetic, and environmental origins, the processes involved in its etiology and realization, as well as (...) its clinical presentation including signs and symptoms. (shrink)

Environmental historians are not sufficiently aware of the extent to which mid twentieth-century thinkers turned to medical geography—originally a nineteenth-century area of study—in order to think through ideas of ecology, environment, and historical reasoning. This article outlines how the French–Croatian Mirko D. Grmek, a major thinker of his generation in the history of medicine, used those ideas in his studies of historical epidemiology. During the 1960s, Grmek attempted to provide, in the context of the Annales School’s research program under the (...) leadership of Fernand Braudel, a new theoretical framework for a world history of disease. Its development was inspired by several sources, most notably the French–American Jacques M. May, who was then pioneering an opening up of medical geography and movement towards the concept of disease ecology. The cornerstone of Grmek’s “synthetic approach” to the field was the notion of “pathocenosis”. The diverse uses of this notion in the course of time—from his early agenda focused on a longue durée history of diseases in Western Antiquity to his last, relating to the new epidemiological threat of emerging infectious diseases, specifically HIV/aids—enables us firstly, to note how concepts of ecology sat uneasily alongside those of medical geography; secondly, to assess the reach and limits of his theoretical contribution to historical epidemiology; and thirdly, to understand better the uneven fortunes of his concept of pathocenosis at the end of the twentieth and beginning of the twenty-first centuries. (shrink)

Philosophical debates about the concept of disease, particularly of mental disease, might benefit from reconsideration and a closer look at the established terminology and conceptual structure of contemporary medical pathology and clinical nosology. The concepts and principles of medicine differ, to a considerable extent, from the ideas and notions of philosophical theories of disease. In medical theory, the concepts of disease entity and pathologicity are, besides the concept of disease itself, of fundamental importance, and they (...) are essentially connected to the concepts cause of disease or etiological factor, natural course or natural history of disease, and pathological disposition. It is the concept of disease entity that is of key importance for understanding medical pathology and theory of disease. Its central role is shown by a short reconstruction of its main features and its intrinsic connection to the concept of pathologicity. The meaning of pathologicity is elucidated by explicating the underlying criteria. (shrink)

Objective: To examine changes in patients’ desired control of the deep brain stimulator and perception of global life control throughout DBS.Methods: A consecutive cohort of 52 patients with Parkinson’s disease was recruited to participate in a prospective longitudinal study over three assessment points. Semi-structured interviews assessing participants’ desire for stimulation control and perception of global control were conducted at all three points. Qualitative data were coded using content analysis. Visual analog scales were embedded in the interviews to quantify participants’ (...) perceptions of control over time.Results: Participants reported significant increases in their perception of global control over time and significant declines in their desired control of the stimulation. These changes were unrelated to improvements in motor symptoms. Improvements in global control were negatively correlated with a decline in desired stimulation control. Qualitative data indicate that participants have changed, nuanced levels of desired control over their stimulators. Increased global life control following DBS may be attributed to increased control over PD symptoms, increased ability to engage in valued activities, and increased overall self-regulation, while other domains related to global control remained unaffected by DBS.Conclusions: There are few empirical data documenting patients’ desire for stimulation control throughout neuromodulation and how stimulation control is related to other aspects of control despite the growing application of neuromodulation devices to treat a variety of disorders. Our data highlight distinctions in different types of control and have implications for the development of patient-controlled neurostimulation devices. (shrink)

During the course of the COVID-19 pandemic, a wide range of digital technologies and data analytics have been incorporated into pandemic response models globally, in the hope of better detecting, tracking, monitoring and containing outbreaks. This increased digital involvement in disease control has offered the prospect of heightened effectiveness in all of the above, but not without raising other concerns. This paper contributes to ongoing discussions of the digital transformation in disease control by proposing a materialist analysis (...) of how such control has become operative and what its effects may be, both now and in the future. Using Taiwan's digital pandemic response as a case study, the paper explores specific ways in which material processes and arrangements have shaped digital measures, as well as the actions that rendered such measures operable, with their ensuing consequences. This analysis illustrates the importance of historical, material and technological specificities and contingencies to our understanding of how digital disease control takes a particular shape. It also demonstrates how shifting regimes of practice continually reconfigure the ways in which digital disease control functions. The paper argues that paying greater attention to the materialities of digital disease control can provide a more nuanced understanding of the complex ways in which society may be protected or harmed by its use, possibly simultaneously. It is hoped that such increased attentiveness may inform more considered and careful preparation for subsequent pandemics. (shrink)

Several states, including the United Kingdom, the United States, and France, have recently engaged in the high-profile supporting of foreign rebel fighters, providing them with training, weapons, and financial resources. Justifications for providing this assistance usually invoke, at least in part, our obligations to prevent harm to the citizens of oppressive and violent regimes. Providing such assistance is often presented as a morally safe ‘middle ground’ between doing nothing and putting one’s own troops at risk. Yet this assistance typically enables (...) rebels to cause unjust harms, since armed uprisings almost invariably cause harm to innocent people. I argue that enabling these unjust harms can render the provision of assistance unjustified. When a state could prevent at least as much harm by using its resources in other ways, such as preventing disease, without thereby causing comparable unjust harm and without incurring a (significantly greater) supererogatory cost, the state acts unjustifiably if it nonetheless funds the rebellion. When assistors unjustifiably enable unjust harms, they are morally liable to bear costs for the sake of people who suffer those harms. This is true even if the rebels act justifiably in directly inflicting those harms. (shrink)

Causation is important when considering how an organism maintains health, why disease arises in a healthy person, and how one may intervene to change the course of a disease. This paper explores the form of causative relationships in health, disease and intervention, with particular regard to the pathological and biopsychosocial models. Consistent with the philosophical view of dispositionalism, we believe that objects are the fundamental relata of causation. By accepting the broad scope of the biopsychosocial model, (...) we argue that psychological and social constructs be considered objects. We think that this 'biopsychosocial dispositionalism' offers the flexibility required to describe causation throughout health, disease and intervention pathways. When constructing mechanistic chains to describe causative pathways, we argue that an object will causally connect with others through actions; transfers of energy from one object to another, initiated by the manifestation of one or more dispositional property. Finally, our analysis of causative interactions utilises the concept that a common form of interaction exists between disease and intervention pathways. This common form will always be an object, but the mode of interaction will vary with each disease. We describe how intervention may act through objects being shared between converging mechanistic chains, or through the removal and/or insertion of objects in such chains. We believe that this analysis provides novel insight to the forms of causative transactions that can occur. In addition, we hope that the findings of this analysis represent the first step towards developing a framework for appraising the composition of mechanistic theories. (shrink)

This paper evaluates the content of the syllabi of postgraduate courses on public health ethics within accredited schools and programs of public health in the United States in order to gain an awareness of the topics addressed within these courses. Methods: Data was gathered via the analysis of syllabi of courses on PHE. In 2012, information was requested by e-mail from the 48 schools and 86 PH programs accredited by the U.S. Council on Education for Public Health for 2012. The (...) “Epidemiology and PHE Syllabi” project of the University of Miami also was consulted. A table of topics was drawn up in order to carry out content analysis of the documents. Results: Data was obtained from 25 schools and 36 accredited programs ; 36 syllabi were gathered and 75 different topics were found. Of these, 38 topics were addressed in six or more syllabi and can be grouped as follows: foundations of PHE; autonomy and its limits; infectious disease control; justice; research ethics; health education and promotion; environmental and occupational health; screening; genetics; privacy and confidentiality; and community-based practice and vulnerable populations. Conclusions: The analyzed syllabi show high variability in curricular content. The debate with regard to whether a core curriculum on PHE should be established is ongoing. The results of this work might be of interest for schools and programs of PH in other countries or regions of the world in order to develop or ameliorate their own PHE syllabi. (shrink)

We have begun work on two separate but related ontologies for the study of neurological diseases. The first, the Neurological Disease Ontology (ND), is intended to provide a set of controlled, logically connected classes to describe the range of neurological diseases and their associated signs and symptoms, assessments, diagnoses, and interventions that are encountered in the course of clinical practice. ND is built as an extension of the Ontology for General Medical Sciences — a high-level candidate OBO Foundry (...) ontology that provides a set of general classes that can be used to describe general aspects of medical science. ND is being built with classes utilizing both textual and axiomatized definitions that describe and formalize the relations between instances of other classes within the ontology itself as well as to external ontologies such as the Gene Ontology, Cell Ontology, Protein Ontology, and Chemical Entities of Biological Interest. In addition, references to similar or associated terms in external ontologies, vocabularies and terminologies are included when possible. Initial work on ND is focused on the areas of Alzheimer’s and other diseases associated with dementia, multiple sclerosis, and stroke and cerebrovascular disease. Extensions to additional groups of neurological diseases are planned. The second ontology, the Neuro-Psychological Testing Ontology (NPT), is intended to provide a set of classes for the annotation of neuropsychological testing data. The intention of this ontology is to allow for the integration of results from a variety of neuropsychological tests that assay similar measures of cognitive functioning. Neuro-psychological testing is an important component in developing the clinical picture used in the diagnosis of patients with a range of neurological diseases, such as Alzheimer’s disease and multiple sclerosis, and following stroke or traumatic brain injury. NPT is being developed as an extension to the Ontology for Biomedical Investigations. (shrink)

The oncological disease experience is counted as a wound in the body and mind attributable to a traumatic experience that fragments and disorients the person’s biography. The neoplasia leaves marks and scars in both somatic and existential level. The illness experience suggests to patient to look for meaning that cannot be unheard. The literature associating the concept of liminality in oncological disease to understand the process of meaning making. The definition of new horizons of meaning, generated by crossing (...) the limen, opens up a new self-awareness and worldview. The autopoietic dimension present in oncological disease reveals new scenarios of generativity and existential planning in the direction of self-realization in the cipher of the possible. The contribution presents the story of Anastasia, a 41-years-old nurse. A few months after her new marriage and close to a professional promotion, she receives the diagnosis of cholangiocarcinoma: a very aggressive, low-incidence, neoplasia, without specific therapeutic lines and with a negative prognosis. Anastasia’s words, thoughts and emotions, collected in the course of some testimonies in a university classroom, are analyzed and deciphered within the pedagogical paradigm, refering to the perspective of pedagogical problematicism and phenomenological pedagogy. (shrink)

Over the course of the year 2020, the global scientific community dedicated considerable effort to understanding COVID-19. In this review, we discuss some of the findings accumulated between the onset of the pandemic and the end of 2020, and argue that although COVID-19 is clearly a biological disease tied to a specific virus, the culture–mind relation at the heart of cultural psychology is nonetheless essential to understanding the pandemic. Striking differences have been observed in terms of relative mortality, (...) transmission rates, behavioral responses, official policies, compliance with authorities, and even the extent to which beliefs about COVID-19 have been politicized across different societies and groups. Moreover, many minority groups have very different experiences of the pandemic relative to dominant groups, notably through existing health inequities as well as discrimination and marginalization, which we believe calls for a better integration of political and socioeconomic factors into cultural psychology and into the narrative of health and illness in psychological science more broadly. Finally, individual differences in, for example, intolerance of uncertainty, optimism, conspiratorial thinking, or collectivist orientation are influenced by cultural context, with implications for behaviors that are relevant to the spread and impact of COVID-19, such as mask-wearing and social distancing. The interplay between cultural context and the experience and expression of mental disorders continues to be documented by cultural-clinical psychology; the current work extends this thinking to infectious disease, with special attention to diseases spread by social contact and fought at least in part through social interventions. We will discuss cultural influences on the transmission, course, and outcome of COVID-19 at three levels: cross-society differences; within-society communities and intergroup relations; and individual differences shaped by cultural context. We conclude by considering potential theoretical implications of this perspective on infectious disease for cultural psychology and related disciplines, as well as practical implications of this perspective on science communication and public health interventions. (shrink)

ABSTRACT The objective of the study was to identify future lawyers’ and physicians’ views on testing children for Huntington’s disease (HD) against parents’ wishes. After receiving general information about HD, patient autonomy and confidentiality, law students and advanced medical students were shown an interview with a mother suffering from HD who is opposed to informing and testing her two children (aged 10 and 16) for HD. Students then filled out questionnaires concerning their agreement with testing. No significant differences were (...) found between medical and law students or between students from different courses concerning the adolescent son. Three quarters of students thought that he should be told about his mother’s disease, and 91% thought the adolescent son should have the opportunity of genetic testing for HD for himself. However, significant differences were found concerning the 10‐year old son, with 44% of law students and 30% of medical students in favour of testing the child for HD. Students raised some important ethical issues in their elective comments. In conclusion, we found highly positive attitudes towards informing a 16‐year old of his mother’s HD and offering to test him. These attitudes were not in tune with guidelines. Students did not consider several practical and ethical issues of genetic testing of children and adolescents. Specific education should ensure that attitudes are based on sufficiently detailed knowledge about all aspects of genetic testing of children to discourage pressures on persons at risk of HD. (shrink)

It has been argued that complex subjective sense of self is linked to the brain default-mode network (DMN). Recent discovery of heterogeneity between distinct subnets (or operational modules - OMs) of the DMN leads to a reconceptualization of its role for the experiential sense of self. Considering the recent proposition that the frontal DMN OM is responsible for the first-person perspective and the sense of agency, while the posterior DMN OMs are linked to the continuity of ‘I’ experience (including autobiographical (...) memories) through embodiment and localization within bodily space, we have tested in this study the hypothesis that heterogeneity in the operational synchrony strength within the frontal DMN OM among patients who are in a vegetative state (VS) could inform about a stable self-consciousness recovery later in the course of disease (up to six years post-injury). Using EEG operational synchrony analysis we have demonstrated that among the three OMs of the DMN only the frontal OM showed important heterogeneity in VS patients as a function of later stable clinical outcome. We also found that the frontal DMN OM was characterized by the process of active uncoupling (stronger in persistent VS) of operations performed by the involved neuronal assemblies. (shrink)

This paper examines the characteristics of infectious diseases that raise special medical and social ethical issues, and explores ways of integrating both current bioethical and classical public health ethics concerns. Many of the ethical issues raised by infectious diseases are related to these diseases’ powerful ability to engender fear in individuals and panic in populations. We address the association of some infectious diseases with high morbidity and mortality rates, the sense that infectious diseases are caused by invasion or attack on (...) humans by foreign micro‐organisms, the acute onset and rapid course of many infectious diseases, and, in particular, the communicability of infectious diseases. The individual fear and community panic associated with infectious diseases often leads to rapid, emotionally driven decision making about public health policies needed to protect the community that may be in conflict with current bioethical principles regarding the care of individual patients. The discussion includes recent examples where dialogue between public health practitioners and medical‐ethicists has helped resolve ethical issues that require us to consider the infected patient as both a victim with individual needs and rights and as a potential vector of disease that is of concern to the community. (shrink)

Minamata disease was first officially recognized in May 1956. Its earliest victims were small children. Environmental contamination most rapidly and seriously affected the physiologically weak among the residents. However, the outbreak of the disease in humans was preceded by abnormalities in the natural environment such as massive death of fish and shellfish, and the abnormal behavior and death of cats. It used to be considered that poisoning was caused by direct exposure to a toxic substance, and that toxic (...) substances did not pass the placenta. Minamata disease is an indirect poisoning by methyl mercury through the food chain as a result of environmental contamination, and is the first known disease to cause abnomalities in the fetus due to a toxic agent passing through the placenta. Minamata disease, therefore, had implications in various fields. Namely it also stirred up legal, ethical, and eugenic arguments concerning fetal protection. This report reviews the course of Minamata disease, and evaluates its impacts. “Minamata Studies” has three intellectual and scientific missions to change the social systems that caused the disease; to pursue environmental justice; and to explore the possibility of an environment that permits coexistence not only of all humans, but of all living things. (shrink)

Technological developments have resulted in tremendous increases in the volume and diversity of the data and information that must be processed in the course of biomedical and clinical research and practice. Researchers are at the same time under ever greater pressure to share data and to take steps to ensure that data resources are interoperable. The use of ontologies to annotate data has proven successful in supporting these goals and in providing new possibilities for the automated processing of data (...) and information. In this chapter, we describe different types of vocabulary resources and emphasize those features of formal ontologies that make them most useful for computational applications. We describe current uses of ontologies and discuss future goals for ontology-based computing, focusing on its use in the field of infectious diseases. We review the largest and most widely used vocabulary resources relevant to the study of infectious diseases and conclude with a description of the Infectious Disease Ontology (IDO) suite of interoperable ontology modules that together cover the entire infectious disease domain. (shrink)

Primary progressive multiple sclerosis (PPMS) shows a highly variable disease progression with poor prognosis and a characteristic accumulation of disabilities in patients. These hallmarks of PPMS make it difficult to diagnose and currently impossible to efficiently treat. This study aimed to identify plasma metabolite profiles that allow diagnosis of PPMS and its differentiation from the relapsing-remitting subtype (RRMS), primary neurodegenerative disease (Parkinson’s disease, PD), and healthy controls (HCs) and that significantly change during the disease course (...) and could serve as surrogate markers of multiple sclerosis (MS)-associated neurodegeneration over time. We applied untargeted high-resolution metabolomics to plasma samples to identify PPMS-specific signatures, validated our findings in independent sex- and age-matched PPMS and HC cohorts and built discriminatory models by partial least square discriminant analysis (PLS-DA). This signature was compared to sex- and age-matched RRMS patients, to patients with PD and HC. Finally, we investigated these metabolites in a longitudinal cohort of PPMS patients over a 24-month period. PLS-DA yielded predictive models for classification along with a set of 20 PPMS-specific informative metabolite markers. These metabolites suggest disease-specific alterations in glycerophospholipid and linoleic acid pathways. Notably, the glycerophospholipid LysoPC(20:0) significantly decreased during the observation period. These findings show potential for diagnosis and disease course monitoring, and might serve as biomarkers to assess treatment efficacy in future clinical trials for neuroprotective MS therapies. (shrink)

Technological developments have resulted in tremendous increases in the volume and diversity of the data and information that must be processed in the course of biomedical and clinical research and practice. Researchers are at the same time under ever greater pressure to share data and to take steps to ensure that data resources are interoperable. The use of ontologies to annotate data has proven successful in supporting these goals and in providing new possibilities for the automated processing of data (...) and information. In this chapter, we describe different types of vocabulary resources and emphasize those features of formal ontologies that make them most useful for computational applications. We describe current uses of ontologies and discuss future goals for ontology-based computing, focusing on its use in the field of infectious diseases. We review the largest and most widely used vocabulary resources relevant to the study of infectious diseases and conclude with a description of the Infectious Disease Ontology (IDO) suite of interoperable ontology modules that together cover the entire infectious disease domain. (shrink)

The intensity and prevalence of viral infections are typically higher in males, whereas disease outcome can be worse for females. Females mount higher innate and adaptive immune responses than males, which can result in faster clearance of viruses, but also contributes to increased development of immunopathology. In response to viral vaccines, females mount higher antibody responses and experience more adverse reactions than males. The efficacy of antiviral drugs at reducing viral load differs between the sexes, and the adverse reactions (...) to antiviral drugs are typically greater in females than males. Several variables should be considered when evaluating male/female differences in responses to viral infection and treatment: these include hormones, genes, and gender‐specific factors related to access to, and compliance with, treatment. Knowledge that the sexes differ in their responses to viruses and to treatments for viral diseases should influence the recommended course of action differently for males and females.Editor's suggested further reading in BioEssays X‐chromosome‐located microRNAs in immunity: Might they explain male/female differences Abstract. (shrink)

Free will has been the object of debate in the context of addiction given that addiction could compromise an individual’s ability to choose freely between alternative courses of action. Proponents of the brain-disease model of addiction have argued that a neuroscience perspective on addiction reduces the attribution of free will because it relocates the cause of the disorder to the brain rather than to the person, thereby diminishing the blame attributed to the person with an addiction. Others have worried (...) that such displacement of free will attribution would make the person with a drug addiction less responsible. Using the paradigmatic literature on the seductive allure of neuroscience explanations, we tested whether neuroscience information diminishes attributions of free will in the context of addiction and whether respondent characteristics influence these attributions and modulate the effect of neuroscience information. We performed a large-scale, web-based experiment with 2,378 German participants to explore how attributions of free will in the context of addiction to either alcohol or cocaine are affected by: (1) a text with a neurobiological explanation of addiction, (2) a neuroimage showing effects of addiction on the brain, and (3) a combination of a text and a neuroimage, in comparison to a control group that received no information. Belief in free will was measured using the FAD-Plus scale and was, subsequent to factor analysis, separated into two factors: responsibility and volition. The investigated respondent characteristics included gender, age, education, self-reported knowledge of neuroscience, substance-use disorder (SUD), and having a friend with SUD. We found that attributions of volition (in the cocaine-subsample) were reduced in the text and neuroimage-treatment compared to the control group. However, respondent characteristics such as education and self-reported knowledge of neuroscience were associated with lower attributions of responsibility for both substances, and education was associated with lower attribution of volition for the alcohol sub-sample. Interaction analyses showed that knowledge of neuroscience was found to generally decrease attribution of responsibility. Further research on attribution of free will should consider the effects of context and respondent characteristics, which appeared surprisingly larger than those induced by experimental treatments. (shrink)

Patients with end-stage renal disease experience significant mortality and morbidity, including cognitive decline. Advance care planning has been emphasized as a responsibility and priority of physicians caring for patients with chronic kidney disease in order to align with patient values before decision-making capacity is lost and to avoid suffering. This emphasis has proven ineffective, as illustrated in the case of a patient treated in our hospital. Is this ineffectiveness a consequence of failure in the courtroom or the clinic? (...) Through our own experience we affirm what has been written before: that legal precedent favors intensive treatment in virtually all cases without ‘clear and convincing evidence’ of a patient’s previously declared wishes to the contrary. Equally clear is that more than 20 years of support in the clinical literature suggesting advance care planning early in the course of disease can address challenges in the legal system for those lacking capacity. However, many physicians fail t... (shrink)

Chronic diseases represent the major illness burden of developed nations. A chronic disease databank system consists of parallel longitudinal data sets from diverse locations describing the courses of thousands of patients with chronic illness over many years. Illustrated by ARAMIS (The American Rheumatism Association Medical Information System), such data resources facilitate analysis of long term health outcomes and the factors associated with particular outcomes. A model for clinical investigation of contemporary disease is presented, based on the overwhelming prevalence (...) of chronic illness, the variability, complexity, and uniqueness of the individual patient course, the difficulties of traditional univariate reductionist approaches, and the time span required for study. In this model, data are systematically accrued and continually analyzed, and the data collected are gradually modified based upon evolving anticipation of future needs. The strategies underlying the development of ARAMIS are described, investigational results summarized, and future directions outlined. Keywords: ARAMIS, Chronic Disease Databanks, Prognosis, Health Outcomes CiteULike Connotea Del.icio.us What's this? (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Diseased Body Politic, Athenian Public Finance, and the Massacre at Mykalessos (Thucydides 7.27–29)Lisa KalletIn the midst of his account of the Sicilian expedition Thucydides pauses to describe the economic and financial effects of the Spartan fortification of Dekeleia in Attica in 413 (7.27–28); one result of signal importance for the empire was Athens' decision to abolish tribute, and in its place to levy a harbor tax, the eikostē. (...) Following this digression the historian relates an episode emblematic of the atrocity of war, the wholesale slaughter of the inhabitants of the defenseless Boiotian town of Mykalessos by 1,300 Thracian mercenaries. Most scholars would not adhere to Eduard Schwartz's view that the financial/economic digression has nothing to do with the representation of the Thracians' savagery;1 nevertheless, the two sections have tended to be examined separately, the former by historians of the Athenian empire and finance2 or by Thucydidean scholars looking at the passage historiographically but as distinct from 7.29,3 and the latter by Thucydidean scholars exploring its function in the History.4 There are, however, strong grounds for reading them together: in particular, a degree of detail in each not otherwise warranted by the narrative, a framing device, and the shared use of language common to the description of disease, all suggest that Thucydides was intentionally linking the two sections. By this linkage, I propose, Thucydides not only draws a connection between Athenian public finance and human suffering, but also develops themes central to the work as a whole, namely, those of moral responsibility, human nature, [End Page 223] the conflict between reason and passion, and the nexus of finances, leadership, and military power.First, the detail in both the fiscal digression and the episode at Mykalessos immediately stands out, given their placement within the Sicilian account, the most self–contained and focused part of the History.5 Much of the substance of 7.27–28 concerns a gradual process of fiscal and economic deterioration, yet Thucydides is prompted to embed a diachronic, thematic account in the context of an event utterly trivial to the expedition and the entire course of the war, namely, the tardy arrival of Thracian mercenaries in Athens and the decision to send them home. Moreover, shocking atrocity that the massacre at Mykalessos was, it was peripheral to the war, a minor event that could have been easily omitted, or relegated to a sentence. It is relevant to note in this connection the differing treatments of Skione and Melos. What happened in those places, in 422 and 416 respectively, was identical—a siege and subsequent massacre of the males and enslavement of the women and children—yet Thucydides relates the information about Skione as a passing mention in one sentence (5.32.1), whereas he devotes pages to Melos (5.84–116).The prominence given to the fiscal digression and to what happened at Mykalessos, through such detailed narrative and especially the juxtaposition of the two sections, is in itself a sign that Thucydides intended a larger significance—through their interrelation—to be accorded to these events. The comparative example of Melos is again relevant, for its significance lies partly in its juxtaposition to the Sicilian books (which would explain why Thucydides chose to highlight it, rather than the identical case of Skione's treatment), as is similarly the case with the juxtaposition of the Funeral Oration and the plague (and Perikles' last speech).Thucydides constructs a second link between the two sections by using the subject of the Thracian mercenaries as a framing device for his digression on the economic effects of Dekeleia: in 27.1–2, the Thracians arrive in Athens too late for the expedition for which they had been intended, that of reinforcing the army in Sicily. The Athenians, Thucydides continues, decided to send them home, because "to keep them for the Dekeleian War seemed very costly; for each received a drachma a day" ( [End Page 224] ).6 Yet rather than immediately return to Sicilian events, or continue with the Thracian narrative, he instead undertakes a lengthy analysis of what was a gradual process of fiscal deterioration that could have... (shrink)

Definition of the problem The eleventh version of the International Classification of Diseases (ICD-11), which became effective in 2022, has raised a number of issues associated with medical ethics. Arguments In this context the paper explores the normative view of grief as a disease. ICD-11 contains the new diagnosis of “prolonged grief disorder” with a definition that fails to aid its clear distinction from the normal course of grief. The article discusses the philosophical and ethical implications of this (...) diagnosis and explores the risks of medicalizing and pathologizing grief which may lead to an undermining of its value. Conclusions and further perspectives The paper’s specific focus is the particular case of parental grief. We show that pediatric palliative care counteracts many risk factors for difficult grief reactions and may therefore serve as a valuable instrument for their prevention. We propose in this context the concept of “advance bereavement planning” as a potentially beneficial extension of advance care planning and palliative care in general. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Diseased Body Politic, Athenian Public Finance, and the Massacre at Mykalessos (Thucydides 7.27–29)Lisa KalletIn the midst of his account of the Sicilian expedition Thucydides pauses to describe the economic and financial effects of the Spartan fortification of Dekeleia in Attica in 413 (7.27–28); one result of signal importance for the empire was Athens' decision to abolish tribute, and in its place to levy a harbor tax, the eikostē. (...) Following this digression the historian relates an episode emblematic of the atrocity of war, the wholesale slaughter of the inhabitants of the defenseless Boiotian town of Mykalessos by 1,300 Thracian mercenaries. Most scholars would not adhere to Eduard Schwartz's view that the financial/economic digression has nothing to do with the representation of the Thracians' savagery;1 nevertheless, the two sections have tended to be examined separately, the former by historians of the Athenian empire and finance2 or by Thucydidean scholars looking at the passage historiographically but as distinct from 7.29,3 and the latter by Thucydidean scholars exploring its function in the History.4 There are, however, strong grounds for reading them together: in particular, a degree of detail in each not otherwise warranted by the narrative, a framing device, and the shared use of language common to the description of disease, all suggest that Thucydides was intentionally linking the two sections. By this linkage, I propose, Thucydides not only draws a connection between Athenian public finance and human suffering, but also develops themes central to the work as a whole, namely, those of moral responsibility, human nature, [End Page 223] the conflict between reason and passion, and the nexus of finances, leadership, and military power.First, the detail in both the fiscal digression and the episode at Mykalessos immediately stands out, given their placement within the Sicilian account, the most self–contained and focused part of the History.5 Much of the substance of 7.27–28 concerns a gradual process of fiscal and economic deterioration, yet Thucydides is prompted to embed a diachronic, thematic account in the context of an event utterly trivial to the expedition and the entire course of the war, namely, the tardy arrival of Thracian mercenaries in Athens and the decision to send them home. Moreover, shocking atrocity that the massacre at Mykalessos was, it was peripheral to the war, a minor event that could have been easily omitted, or relegated to a sentence. It is relevant to note in this connection the differing treatments of Skione and Melos. What happened in those places, in 422 and 416 respectively, was identical—a siege and subsequent massacre of the males and enslavement of the women and children—yet Thucydides relates the information about Skione as a passing mention in one sentence (5.32.1), whereas he devotes pages to Melos (5.84–116).The prominence given to the fiscal digression and to what happened at Mykalessos, through such detailed narrative and especially the juxtaposition of the two sections, is in itself a sign that Thucydides intended a larger significance—through their interrelation—to be accorded to these events. The comparative example of Melos is again relevant, for its significance lies partly in its juxtaposition to the Sicilian books (which would explain why Thucydides chose to highlight it, rather than the identical case of Skione's treatment), as is similarly the case with the juxtaposition of the Funeral Oration and the plague (and Perikles' last speech).Thucydides constructs a second link between the two sections by using the subject of the Thracian mercenaries as a framing device for his digression on the economic effects of Dekeleia: in 27.1–2, the Thracians arrive in Athens too late for the expedition for which they had been intended, that of reinforcing the army in Sicily. The Athenians, Thucydides continues, decided to send them home, because "to keep them for the Dekeleian War seemed very costly; for each received a drachma a day" ( [End Page 224] ).6 Yet rather than immediately return to Sicilian events, or continue with the Thracian narrative, he instead undertakes a lengthy analysis of what was a gradual process of fiscal deterioration that could have... (shrink)

Applying a necessary condition communication theory formalism roughly similar to that of Dretske, but focused entirely on the statistical properties of long sequences of signals emitted by the interacting cognitive modules of human biology, we explore the regularities apparent in comorbid psychiatric and chronic physical disorders using an extension of recent perspectives on autoimmune disease. We find that structured psychosocial stress can literally write a distorted image of itself onto child development, resulting in a life course trajectory to (...) characteristic forms of comorbid mind/body dysfunction affecting both dominant and subordinate populations within a pathogenic social hierarchy. (shrink)

Sir Austin Bradford Hill’s ‘aspects of causation’ represent some of the most influential thoughts on the subject of proximate causation in health and disease. Hill compiled a list of features that, when present and known, indicate an increasing likelihood that exposure to a factor causes—or contributes to the causation of—a disease. The items of Hill’s list were not labelled ‘criteria’, as this would have inferred every item being necessary for causation. Hence, criteria that are necessary for causation in (...) health, disease and intervention processes, whether known, knowable, or not, remain undetermined and deserve exploration. To move beyond this position, this paper aims to explore factors that are necessary in the constitution of causative relationships between health, disease processes, and intervention. To this end, disease is viewed as a causative pathway through the often overlapping stages of aetiology, pathology and patho-physiology. Intervention is viewed as a second, independent causative pathway, capable of causing changes in health for benefit or harm. For the natural course of a disease pathway to change, we argue that intervention must not only occupy the same time and space, but must also share a common form; the point at which the two pathways converge and interact. This improved conceptualisation may be used to facilitate the interpretation of clinical observations and inform future research, particularly enabling predictions of the mechanistic relationship between health, disease and intervention. (shrink)

In, I argued that Boorse's biostatistical theory of health is unable to accommodate diseases that are the normal result of harmful environments. Hausman disagrees: if the BST compares normal dispositional function against the whole population or reference class, rather than against organisms in similar circumstances as I proposed, then my challenge can be avoided. In this paper, I argue that Hausman's response fails: his proposal cannot accommodate a series of common physiological processes, such as sleep and those involved in reproduction. (...) In the course of this argument, I also offer a detailed discussion of the concept of functional efficiency, and reveal a link between the problem of environments and that of reference classes. 1 Introduction2 Kingma on Boorse3 Hausman on Kingma4 Response to Hausman5 Three Possible Replies5.1 Reference classes5.2 Temporary pathologies5.3 Adequacy of function6 Concluding Discussion. (shrink)

Patients with advanced Alzheimer's disease experience cognitive impairment and physical disabilities in daily life. Currently, there are no treatments available to slow down the course of the disease, and limited treatments exist only to treat symptoms. However, deep brain stimulation of the nucleus basalis of Meynert has been reported to improve cognitive function in individuals with AD. Here, we report the effects of NBM-DBS on cognitive function in a subject with severe AD. An 80-year-old male with severe (...) AD underwent surgery for bilateral NBM-DBS electrode placement. After 10 weeks of stimulation, Mini-Mental State Examination assessment improved from a score of 5 to 9 points, and assessment using the Alzheimer's Disease Assessment Scale–Cognitive Subscale showed a marked reduction in total score from 43 to 33 points, suggesting cognitive benefits from NBM-DBS. The patient's postoperative course was complicated by a subdural effusion that occurred several days after surgery, with complete recovery. Interestingly, the subject also displayed abnormal thermoregulation with stimulation initiation and stimulation parameter modifications. NBM-DBS may serve as a potential therapy for severe AD patients.Clinical Trial Registration: ChiCTR1900022324. (shrink)

The conventional approach to developing disease‐modifying treatments for neurodegenerative conditions has been to identify drivers of pathology and inhibit such pathways. Here we discuss the possibility that the efficacy of such approaches may be increasingly attenuated as disease progresses. This is based on experiments using mouse models of spinocerebellar ataxia type 1 and Huntington's disease (HD), where expression of the dominantly acting mutations could be switched off, as well as studies in human HD, which suggest that the (...) primary genetic driver of age‐of‐onset of disease is a much weaker determinant of disease progression in affected individuals. The idea that one may approach a point in the disease course where such rational therapeutic strategies based on targets which determine onset of disease have minimal efficacy, suggests that one needs to consider other approaches to therapies and clinical trial design, including initiation of therapies in presymptomatic individuals. (shrink)

This review discussed the effects of the impact of the Coronavirus Disease 2019 pandemic on the psychological wellbeing of people with Parkinson's disease focusing specifically on depressive symptoms, anxiety levels, sleep, and quality of life. Together with motor symptoms, psychological symptoms are common and disabling conditions in the clinical course of PD becoming a relevant topic as a result of the lockdown measure due to alter their everyday life. We searched on PubMed online electronic databases for English (...) articles published between January 2020 and 31 December 2021. Twenty-eight relevant studies were found and included in the review. Heterogeneous data emerged from the topics analyzed. Overall, data from depression studies showed significant depressive symptoms if the patient was analyzed longitudinally or vs. a control group consisting in healthy subjects, while these differences become minimal when the control group is a family member. Differently, in most of the studies reviewed there is no evidence of a statistically significant impact on anxiety disorders, nor on the quality of sleep. Conversely, PD patients showed a statistically significant negative impact of QoL compared with control groups or other neurological conditions. Although these findings must be interpreted carefully in the light of the studies' limitations, both in methodology and design, collectively our review showed that COVID-19 pandemic has had negative effects on the mental health of people with PD, due to disruption of healthcare services, loss of usual activities and supports and reduction in physical activity. (shrink)

One distinctive phenomenon in which Christianity differs from all other religions is the custom of naming and honoring those considered blessed and saints. Generally, they are real people, whose lives were characterized by Christian virtues and who “died in sanctity,” and also the people who, in the course of their lives and after their deaths, performed miracles. Consequently, specific protective capabilities are attributed to most of them and they are thus considered to be patrons by certain groups. One hundred (...) and fifty of them are established as patrons of certain diseases or as aids in certain critical situations. The reasons why the pious people accepted individual saints as patrons of certain .. (shrink)

Cornell University and Zamorano (ThePanamerican School of Agriculture) facilitatedworkshops that provided Honduran and Nicaraguanfarmers new experience with plant diseases and helpedfarmers assimilate information and identify diseasemanagement alternatives. After learning about thebiology of plant diseases, farmers were able toidentify disease problems in their field, enablingthem to use pesticides more selectively. Furthermore,participants of seven courses conceived 273 pathogen-specificmanagement alternatives, and they identifiedon average 66 percent of the common recommendations by plantpathologists for the control of general disease types.Many ideas were novel (...) and may represent newopportunities for improving the practice of diseasemanagement. (shrink)

The COVID-19 pandemic has had a significant impact on education worldwide. The disease first hit China and numerous Chinese cities then started to conduct online courses. Therefore, this study aims to explore the effect of the Shanghai students’ emotional intelligence, learning motivation, and self-efficacy on their academic achievement when they participated in online English classes during the latter phase of the pandemic in China. Furthermore, the research also examines whether the students’ emotional intelligence can influence their academic achievement through (...) the mediation effect of their learning motivation and self-efficacy. Social Cognitive Theory and the social cognitive Expectancy-Value Model were employed to build the research framework, and the method of structural equation modeling was utilized to conduct the model verification. Ten universities in Shanghai, China were selected for sampling. In total, 450 students were surveyed of which 404 questionnaires were valid. The results show that the students’ emotional intelligence did not directly affect their academic achievement. Nevertheless, the students’ emotional intelligence had a positive effect on their learning motivation and self-efficacy. In addition, mediation analysis showed that the relation between emotional intelligence and academic achievement was sequentially mediated by learning motivation and self-efficacy. (shrink)

The carer of the person with dementia is enjoined to maintain respect, and to reinforce this a bill of rights has been established . Of course, talk of rights does not guarantee respectful behaviour. In this paper it is argued that the discovery that the sufferer continues to be a person, with a unique lifeworld, can assist the carer to conform willingly to the demand that they act respectfully.The current research project makes central the idiographic description of the individual (...) case. (shrink)

Tourism, as an industry, has become one of the most dynamic sectors of the world economy these days and has specific features that are different from other industries. In the tourism industry, production and consumption points occur spatially at the same time. In addition, the tourism industry contributes to the economic growth of developed regions and can simultaneously distribute the wealth created geographically. It is notable that the coronavirus disease 2019 (COVID-19) pandemic has caused many challenges in the tourism (...) industry regarding the presence of tourists in tourism centres and the closing of all tourism service chains, including food, entertainment, transportation and travel services worldwide. Tourism-related businesses, which are considered as invisible export and one of the engines of development and occupation, have been rendered obsolete. In other words, the businesses, as well as multiple units and activities in the related chain, have been damaged and employees of this industry have lost their jobs. This has led to the recession and regressive course of the developing and large industry of tourism in the world. It is worth noting that the tourism industry includes various sections, the most important of which is religious tourism. All religions in the world have different religious places, works, traditions and customs, which have become amongst the most important tourist attractions. Meanwhile, Muslims and the religion of Islam play a significant role in this branch of tourism. The Hajj, pilgrimage to holy places and the existence of mourning ceremonies or religious celebrations of Muslims are amongst the largest religious tourism events in the world. Given the importance of this issue, the present study aimed to evaluate the impact of the COVID-19 pandemic on religious tourism in Iraq in 2021. This field study was conducted on 4500 Muslim managers and staff of restaurants, hotels, grocery stores, clothing stores and souvenir shops around the holy shrines of imams and religious places in Karbala, Najaf, Kufa, Samarra and Kazemi. According to the results, the tourism of Iraq, which is mainly limited to Muslim religious sites in several major Iraqi cities, has also seen a decline in the number of religious tourists. The negative effects of COVID-19 on religious tourism have also been proved statistically by the Statistical Package for the Social Sciences (SPSS), as µ ≥ 3 has been counted in all indices.Contribution: Our findings offered new insights into the impact of COVID-19 on tourism, based on statistical analysis. In this study, the authors showed how COVID-19 affects various aspects of religious tourism, which has not been addressed in previous researches. (shrink)

The 2001 Foot and Mouth Diseaseoutbreak in the UK has had widespread adverseeffects – on the farming community, thetourist industry, millions of farm animals, theenvironment, and citizens'' quality of life.This report summarizes the course of theepidemic and then questions the ethicalvalidity of the procedure chosen to eradicatethe disease, namely, the slaughter of millionsof animals. It is argued that the utilitarianbasis of the mass slaughter program isunjustified even in its own terms, and thatrespect for certain deontological principlesmerits increased attention (...) in public policy.The long-term interests of UK citizens, theviability of British farming, and theconservation of the countryside all depend onurgent, critical decisions that should beinformed by a broader conception of the role ofethics in agriculture. (shrink)

BackgroundHealth screening is undertaken to identify individuals who are deemed at higher risk of disease for further diagnostic testing so that they may possibly benefit from interventions to modify the natural course of disease. In Singapore, screening tests are widely available in the form of a package, which bundles multiple tests in one session and commonly includes non-recommended tests. There are various ethical issues associated with such testing as they may not be clinically appropriate and can result (...) in more harm than benefit. This article describes the practice of health screening packages, identifies the ethical issues arising from such packages and discusses the implications of these ethical issues on policy and practice of screening in Singapore.MethodsA content analysis of the websites of providers offering general health screening packages to individuals was conducted. A total of 14 health screening package providers were analysed for how packages were conducted and promoted, how clinically appropriate screening tests were, and the price range and composition of screening packages. A normative ethical analysis based on the four principles approach of beneficence, non-maleficence, autonomy and justice in biomedical ethics was used.ResultsTwelve of the 14 providers included non-recommended tests such as tumour markers, treadmill stress tests and MRI scans in their general health screening packages. Package prices ranged from S$26 to S$10,561, with providers charging higher when more tests were included. Health screening packages were broadly conducted in three stages: the offer and selection of a health screening package; medical assessment and performance of screening tests; a post-screening review. While material provided by all providers was factual, there was no information on the potential risks or harms of screening.ConclusionSeveral ethical issues were identified that should be addressed with regard to health screening packages in Singapore. A key issue was the information gap between providers and patients, which may result in patients undergoing inappropriate testing that may be more harmful than beneficial. Health screening packages can stimulate unnecessary demand for healthcare and contribute to an inequitable distribution of healthcare resources. (shrink)

The first single-author text on the philosophical issues in bioethics, this book offers a systematic and comprehensive introduction to the philosophical principles underlying this discipline. It examines the ways in which facts, theories, and values are intertwined in concepts of disease and health, and covers a wide range of issues, including abortion, in vitrofertilization, sexual deviance, and organ transplantation. The discussion of these issues is critical and often controversial, and the distinguished author includes his own provocative views on topics (...) of current debate. Highly readable and challenging, this is an excellent text for advanced bioethics courses, as well as a thought-provoking study of considerable interest for physicians and philosophers. (shrink)

Many microbes responsible for infectious diseases are known to run an asymptomatic course in a significant portion of the population. By highlighting the conceptual complexities of host-microbe interactions, this paper elucidates the fact that while many infections remain asymptomatic, this does not necessarily mean that such infections are of no concern for health. The paper builds on the so-called damage-response framework and considers several developments required to gain a more comprehensive perspective on infections and their relationship to diseases. Irrespective (...) of their (short-term) clinical manifestation, infections leave an imprint with consequences for health. Finally, these considerations regarding host-microbe interactions must be incorporated into policy decisions and public understanding of health if we hope to handle future pandemics such as Covid-19 better. (shrink)

With the aid of the Cahiers de laboratoire, the Correspondance and, of course, the Oeuvre de Pasteur, this work reconstructs the extraordinary scientific undertakings of the great French scientist in his study of silkworm diseases. The focus of this study consists in the attempt to explain the initial perplexing behaviour of Pasteur, even in the presence of correct interpretations regarding the causes of these diseases (cfr. the results obtained by Béchamp); for a good three years he insisted on maintaining (...) that the aetiology of silkworm diseases could not be attributed to pathogenetic germs from outside. And this was in spite of the fact that previously (through fermentation and spontaneous generation) he had been able to demonstrate the importance of micro-organisms in biological processes. Finally it is intended to highlight the extraordinary methodological depth of that initial 'error', which was capable of paving the way for the future conquests of Pasteur in the field of aetiology and the prevention of infectious diseases. (shrink)

Biotechnology marks a new scientific revolution. It holds the promise of generating resources to meet our needs in the fight against hunger, disease and environmental disasters.

Over the course of the 20th century the sex differential in life expectancy at birth in the industrialized countries has widened considerably in favour of women. Starting in the early 1970s, the beginning of a reversal in the long-term pattern of this differential has been noted in some high-income countries. This study documents a sustained pattern of narrowing of this measure into the later part of the 1990s for six of the populations that comprise the G7 countries: Canada, France, (...) Germany, Italy, England and Wales (as representative of the United Kingdom) and USA. For Japan, a persistence of widening sex differences in survival is noted. The sex differences in life expectancy are decomposed over roughly three decades (early 1970s to late 1990s) from the point of view of four major cause-of-death categories: circulatory diseases, cancers, accidents/violence/suicide, and (residual) causes. In the six countries where the sex gap has narrowed, this has resulted primarily from reduced sex differences in circulatory disease mortality, and secondarily from reduced differences in male and female death rates due to accidents, violence and suicide combined. In some of the countries sex differentials in cancer mortality have been converging lately, and this has also contributed to a narrowing of the difference in life expectancy. In Japan, males have been less successful in reducing their survival disadvantage in relation to Japanese women with regard to circulatory disease and cancer; and in the case of accidents/violence/suicide, male death rates increased during the 1990s. These trends explain the divergent pattern of the sex difference in life expectation in Japan as compared with the other G7 nations. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 10.2 (2000) 171-174 [Access article in PDF] Bioethics Inside the Beltway The Oversight of Human Gene Transfer Research LeRoy Walters Jesse Gelsinger's death last September in a gene transfer study being conducted at the University of Pennsylvania has helped to spark a national debate. In part, this debate parallels the broader discussion of how human subjects research should be reviewed and regulated in the (...) United States. However, human gene transfer research is one of a handful of biomedical technologies that seem to deserve special attention, at least in the early years of their development.The major participants in the national debate on human gene transfer include the National Institutes of Health (NIH), the Food and Drug Administration (FDA), the National Bioethics Advisory Commission, members of Congress, biotechnology and pharmaceutical companies, disease-oriented advocacy groups, reporters, and academics. At the December 1999 meeting of the NIH Recombinant DNA Advisory Committee (RAC), the protocol that involved Jesse Gelsinger was a central focus of discussion, but other topics emerged as well. One ad hoc panel reviewed adverse events that had occurred in other research protocols using adenovirus vectors, while a second proposed changes in the general system for reporting adverse events to NIH and the RAC.During the first several months of the year 2000, the United States Congress also became involved in the human gene transfer debate. In February, Senator Bill Frist (R-TN) convened a hearing to which Jesse Gelsinger's father, representatives of NIH and FDA, and several other witnesses were invited. At approximately the same time, the House Commerce Committee and its Subcommittee on Oversight and Investigations initiated their own inquiries, asking the Office of Inspector General at the Department of Health and Human Services to review the oversight roles of NIH and FDA. In March and April, the House committee also wrote directly to the NIH Director, the FDA Commissioner, and the President of the University of Pennsylvania, requesting extensive documentation on gene transfer, in general, and the trial in which Jesse Gelsinger was involved, in particular. Congressman Henry Waxman (D-CA) and Senator Edward Kennedy (D-MA) have also raised questions and proposed solutions in multiple letters to the NIH Director and the Secretary of Health and Human Services. [End Page 171]The major general questions that have emerged from this discussion are the following:(1) What kinds of information about adverse events should be reported by researchers or sponsors during the course of human gene transfer trials?(2) To what group or groups should adverse-event information be reported? How often and in what ways should the information be analyzed?(3) Should the information about adverse events remain confidential, or should it be discussed publicly?(4) How can the disclosure and consent process in gene transfer trials be improved?(5) Which federal agency should have primary responsibility for overseeing human gene transfer research, and how can it best fulfill its oversight role?How these questions are answered will have immediate relevance to the field of human gene transfer research as it enters into its next phase. At the same time, the models that are created for this important cutting-edge field also may be useful in other complex or controversial arenas of biomedical research, for example, xenotransplantation or human embryonic stem-cell research. In addition, the lessons learned from this one important area of human subjects research may suggest ways to improve protections for all the volunteers who make clinical research--and medical progress--possible.In the remainder of this article, I will turn from reporting, in as objective a way as possible, on the status of the public policy debate about human gene transfer research to suggesting measures for improving the current oversight system for such research. My initial general recommendation is that we should not expect a single regulatory agency to be solely responsible for a field as large and dynamic as human gene transfer research. Rather, there should be some helpful redundancy or, to change the metaphor, checks and balances in the public oversight of this field. Thus, an... (shrink)