In this issue of the Journal, Dundas et al. (Am J Epidemiol. 2014;180(2):197–207) apply a hitherto infrequent multilevel analytical approach: multiple membership multiple classification (MMMC) models. Specifically, by adopting a life-course approach, they use a multilevel regression with individuals cross-classified in different contexts (i.e., families, early schools, and neighborhoods) to investigate self-reported health and mental health in adulthood. They provide observational evidence suggesting the relevance of the early family environment for launching public health interventions in childhood in order to improve (...) health in adulthood. In their analyses, the authors distinguish between specific contextual measures (i.e., the association between particular contextual characteristics and individual health) and general contextual measures (i.e., the share of the total interindividual heterogeneity in health that appears at each level). By doing so, they implicitly question the traditional probabilistic risk factor epidemiology including classical “neighborhood effects” studies. In fact, those studies use simple hierarchical structures and disregard the analysis of general contextual measures. The innovative MMMC approach properly responds to the call for a multilevel eco-epidemiology against a widespread probabilistic risk factors epidemiology. The risk factors epidemiology is not only reduced to individual-level analyses, but it also embraces many current “multilevel analyses” that are exclusively focused on analyzing contextual risk factors. (shrink)

NIH's fogarty international Center has provided grants for the development of training programs in international research ethics for low- and middle-income (LMIC) professionals since 2000. Drawing on 12 years of research ethics training experience, a group of Fogarty grantees, trainees, and other ethics experts sought to map the current capacity and need for research ethics in LMICs, analyze the lessons learned about teaching bioethics, and chart a way forward for research ethics training in a rapidly changing health research landscape. This (...) collection of papers is the result. (shrink)

In response to the increasing need for research ethics expertise in low and middle income countries (LMICs), the NIH's Fogarty International Research Ethics Education and Curriculum Development Program has provided grants for the development of training programs in international research ethics for LMIC professionals since 2000. This collection of papers draws upon the combined expertise of Fogarty grantees, trainees, and other experts to assess the state of research ethics in LMICs, and the lessons learned over 12 years of international research (...) ethics education; to assess future needs; and to chart a way forward to meet those needs. In this introductory paper we briefly sketch the evolution of research ethics as applied to LMIC research, the underpinning and evolution of the Fogarty bioethics program, and summarize key conclusions from the other papers in the collection. (shrink)

On September 26th, 2023, the National Institute on Minority Health and Health Disparities (NIMHD) officially designated disabled people as a health disparity population, marking the most significant event for disabled people's health as it relates to the NIH. In this paper, I discuss the larger socio-political context as well as the clinical import of this historic decision.

Francis Collins had an impressive track record as a gene hunter (cystic fibrosis, neurofibromatosis, Huntington’s disease) when he was appointed Director of the Human Genome Project (HGP) in 1993. In June 2000, together with Craig Venter and President Bill Clinton, he presented the draft version of the human genome sequence to a worldwide audience during a famous press conference. And in 2009, President Barack Obama nominated him as director of the National Institutes of Health (NIH), the largest Tfunding agency for (...) biomedical research in the world. s The In 2006, Collins published his book The Language of God,3 an autobiographical account of the HGP and its scientific, historical, and societal significance, with special attention paid to the impact of the human sequence on the way we see our world and ourselves.4 Now, by way of a sequel, he has written The Language of Life. Wherea Language of God focused on the genome sequence of mankind in general, and on the HGP as a “revolution” in biomedicine, the new book, as indicated by its subtitle, is oriented towards “the revolution in personalized medicine”, the impact of the genomics revolution on the personal lives of individuals. Before subjecting Collins’ book to a closer reading, I first of all would like to explain how I will read it and from what perspective. Why is genomics in general, and the HGP and its aftermath in particular, a subject of interest to a philosopher like me? Why did I become interested in assessing the HGP and in studying the work and views of some of its key contributors? (shrink)

Anxiety is a main contributor to human psychological sufferings. Its evolutionary sources are generally related to alert signals for coping with adverse or unexpected situations [Steiner, 2002] or to hunter-gatherer emotions mismatched with today environments [Horwitz & Wakefield, 2012]. We propose here another evolutionary perspective that links human anxiety to an evolutionary nature of self-consciousness. That approach introduces new relations between mental health and human mind. The proposed evolutionary scenario starts with the performance of primate identification with conspecifics [de Waal (...) 1998, 2008]. It is assumed that the evolution of that identification brought our ancestors to represent themselves as entities existing in the environment, like conspecifics were represented as existing in the environment. We consider that this process has implemented in the mind of our ancestors some first elements of self-consciousness [Menant 2014a]. But the same process has also produced new sufferings coming from identification with suffering or endangered conspecifics. In addition, the emerging performance of self-focus brought in the new feeling of being a suffering entity. We consider that all these new sufferings have created in the mind of our primate ancestors a huge anxiety increase, unbearable if not limited. Among the options available to limit that anxiety increase we focus on two of them that may have taken place. The first was a withdrawal from the process. Some primates may have simply rejected the evolution of identification (and with it self-consciousness). This may have led them to an ecological niche resulting in our today great apes. The second option was about limiting the causes of sufferings and taking advantage of possible resulting evolutionary benefits. This may have been achieved by developing performances like imitation, communication, simulation, synergy and ToM. Added to a positive feedback on identification these performances may have initiated an evolutionary engine that has accelerated the evolution toward human self-consciousness. That option is characterized by an early build up of anxiety limitation processes in an evolutionary nature of our human self-consciousness. This option corresponds to a human specificity and introduces anxiety management and self-consciousness as sharing a same evolutionary story. The build up of these anxiety management processes is now buried in the evolutiony story of our human mind. But these processes are still present in our minds at an unconscious level and participate to many of our human mental states and behaviors. Such positioning of anxiety management as part of the nature of human mind is new and makes available entry points for new understandings of human emotion, motivations and mental disorders. The proposed evolutionary scenario has been introduced in philosophy of mind [Menant 2011, 2014a, b] but it has not been so far explicitly part of primatology nor of psychology/psychiatry/ethics. We present here a drawing of the scenario with highlights on corresponding key points. More work is needed on these new evolutionary links between human mind and anxiety management. References: de Waal, F B.M. (1998). No imitation without identification. Behavioral and Brain Sciences (1998) 21:89. http://cogweb.ucla.edu/Abstracts/deWaal_98.html de Waal, F B.M. (2008). Putting the Altruism Back into Altruism: The Evolution of Empathy. Annu. Rev. Psychol. 2008, 59. http://www.life.umd.edu/faculty/wilkinson/BIOL608W/deWaalAnnRevPsych2008.pdf Horwitz, A. V. and Wakefield, J. C. (2012). All We Have to Fear: Psychiatry’s Transformation of Natural Anxieties into Mental Disorders. Oxford Univ. Press. 2012. Menant, C. (2011). Computation on Information, Meaning and Representations. An Evolutionary Approach. https://philpapers.org/rec/MENCOI Menant, C. (2014a). Proposal for an evolutionary approach to self-consciousness. https://philpapers.org/rec/MENPFA-3 Menant, C. (2014b). Consciousness of oneself as object and as subject. Proposal for an evolutionary approach. https://philpapers.org/rec/MENCOO Steiner, T. (2002). The biology of fear- and anxiety-related behaviors. Dialogues Clin Neurosci. 2002 Sep; 4(3): 231–249. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181681/. (shrink)

Tamamlayıcı ve alternatif tıp (TAT) uygulamaları temel tıbbi tedaviye ek ya da temel tıbbi tedavinin yerine kullanılan, uygulamaları genelde konvansiyonel tıp tarafından tedavi olarak kabul edilmeyen çeşitli tıbbi ve sağlık bakım sistemi, pratikleri ve ürünleri olarak tanımlanmaktadır (Hossein et al., 2014, Amira ve Okubadejo, 2007; National Institutes of Health [NIH], 2018). TAT konusunda yapılan araştırmalar Afrika, Asya ve Latin Amerika gibi gelişmemiş ya da gelişmekte olan ülkelerde hastaların bazı tedavi ihtiyaçlarını karşılamak amacıyla geleneksel uygulamalara başvurmaları doğrultusunda geleneksel tıp teriminin tamamlayıcı (...) ve alternatif tıpa karşılık gelecek şekilde kullanıldığını da göstermektedir. (shrink)