The concepts of placebos and placebo effects refer to extremely diverse phenomena. I recommend dissolving the concepts of placebos and placebo effects into loosely related groups of specific mechanisms, including (potentially among others) expectation-fulfillment, classical conditioning, and attentional-somatic feedback loops. If this approach is on the right track, it has three main implications for the ethics of informed consent. First, because of the expectation-fulfillment mechanism, the process of informing cannot be considered independently from the potential (...) class='Hi'>effects of treatment. Obtaining informed consent influences the effects of treatment. This provides support for the authorized concealment and authorized deception paradigms, and perhaps even for outright deceptive placebo use. Second, doctors may easily fail to consider the potential benefits of conditioning, leading them to misjudge the trade-off between beneficence and autonomy. Third, how attentional-somatic feedback loops play out depends not only on the content of the informing process but also on its framing. This suggests a role for libertarian paternalism in clinical practice. (shrink)

There are a number of competing psychological accounts of the placebo effect, and much of the recent debate centers on the relative importance of classical conditioning and conscious beliefs. In this paper, I discuss apparent problems with these accounts and with?disjunctive? accounts that deny that placebo effects can be given a unified psychological explanation. The fact that some placebo effects seem to be mediated by cognitive states with content that is consciously inaccessible and inferentially isolated (...) from a subject's beliefs motivates an account of the placebo effect in terms of subdoxastic cognitive states. I propose that aliefs, subdoxastic cognitive states that are associative, automatic, and arational, can provide a unified psychological account of the placebo effect. This account also has the potential to illuminate interesting connections to other psychological phenomena. (shrink)

Reactivity, or the phenomenon by which subjects tend to modify their behavior in virtue of their being studied upon, is often cited as one of the most important difficulties involved in social scientific experiments, and yet, there is to date a persistent conceptual muddle when dealing with the many dimensions of reactivity. This paper offers a conceptual framework for reactivity that draws on an interventionist approach to causality. The framework allows us to offer an unambiguous definition of reactivity and distinguishes (...) it from placebo effects. Further, it allows us to distinguish between benign and malignant forms of the phenomenon, depending on whether reactivity constitutes a danger to the validity of the causal inferences drawn from experimental data. (shrink)

1: Placebo effect sometimes plausibly has powerful effects. 2: Buddhism philosophy holds that every living animal is sentient, and has a consciousness and killing them is bad for the killer and freeing them is good somehow. Consciousness may involve some aspects of quantum mechanism as Roger Penrose’s Orch OR' theory of consciousness pointed out. -/- 3: Although previous studies show that there is no “demonstrable effects of distant intercessory prayer. Anecdotal cases of a special kind of Buddhist (...) activity of freeing captive animals in huge amount seem to have powerful therapeutic effects on severe and terminal patients. We want test it experimentally. 4: The cunning point that exceeds previous stuies is, it’s reasonable to consider there may be collective and superpositional effects of this activity due to the likely quantum mechanism of consciousness, and it may play as a sort of magnifying glass that shows a discernible placebo effect. -/- 5:We recruit a considerable number of patients that are terminally ill and the doctors said they can not help them anymore and have double-blind experiments of the above idea.The statistics may show some anomalous distribution. Ethical concerns shall take into consideration. (shrink)

In this paper, Isuggest that placebo effects, as we know them today, should be understood as experimental phenomena, low-level regularities whose causal structure is grasped through particular experimental designs with little theoretical guidance. Focusing on placebo interventions with needles for pain reduction -one of the few placebo regularities that seems to arise in meta-analytical studies- I discuss the extent to which it is possible to decompose the different factors at play through more fine-grained randomized clinical trials. (...) My sceptical argument is twofold. On the one hand, I argue that experiments alone are not enough to standardize interventions, and that it is necessary to include theories. On the other hand, I argue that the social interactions that seem to be part of placebo effects are difficult, if not impossible, to blind. Therefore, the measurement biases arising from the participants’ reactivity to the experimental setup cannot be controlled for. Further decomposition of placebo effects requires a theoretical account of the existing experimental regularities that may guide further tests. (shrink)

Objectives -/- Surveys in various countries suggest 17% to 80% of doctors prescribe ‘placebos’ in routine practice, but prevalence of placebo use in UK primary care is unknown. Methods -/- We administered a web-based questionnaire to a representative sample of UK general practitioners. Following surveys conducted in other countries we divided placebos into ‘pure’ and ‘impure’. ‘Impure’ placebos are interventions with clear efficacy for certain conditions but are prescribed for ailments where their efficacy is unknown, such as antibiotics for (...) suspected viral infections. ‘Pure’ placebos are interventions such as sugar pills or saline injections without direct pharmacologically active ingredients for the condition being treated. We initiated the survey in April 2012. Two reminders were sent and electronic data collection closed after 4 weeks. Results -/- We surveyed 1715 general practitioners and 783 (46%) completed our questionnaire. Our respondents were similar to those of all registered UK doctors suggesting our results are generalizable. 12% (95% CI 10 to 15) of respondents used pure placebos while 97% (95% CI 96 to 98) used impure placebos at least once in their career. 1% of respondents used pure placebos, and 77% (95% CI 74 to 79) used impure placebos at least once per week. Most (66% for pure, 84% for impure) respondents stated placebos were ethical in some circumstances. Conclusion and implications -/- Placebo use is common in primary care but questions remain about their benefits, harms, costs, and whether they can be delivered ethically. Further research is required to investigate ethically acceptable and cost-effective placebo interventions. (shrink)

Is there a response, which is not accounted for by regression to the mean, natural history, the Hawthorne effect?The term placebo comes to us from the Latin for "I shall please," indicating that the phenomenon known as the "placebo effect" or "placebo response" has been familiar to medical practitioners for a number of centuries, at least. As we reached the mid-20th century and randomized controlled trials became a central feature of medical research, the use of controls and (...) blinding in those trials allowed for the isolation of the placebo effect in ways that made it much clearer that there... (shrink)

Several authors have recently argued that psychotherapy, as it is commonly practiced, is deceptive and undermines patients’ ability to give informed consent to treatment. This ‘deception’ claim is based on the findings that some, and possibly most, of the ameliorative effects in psychotherapeutic interventions are mediated by therapeutic common factors shared by successful treatments, rather than because of theory-specific techniques. These findings have led to claims that psychotherapy is, at least partly, likely a placebo, and that practitioners of (...) psychotherapy have a duty to ‘go open’ to patients about the role of common factors in therapy ; to not ‘go open’ is supposed to unjustly restrict patients’ autonomy. This paper makes two related arguments against the ‘go open’ claim. While therapies ought to provide patients with sufficient information to make informed treatment decisions, informed consent does not require that practitioners ‘go open’ about therapeutic common factors in psychotherapy, and clarity about the mechanisms of change in psychotherapy shows us that the common-factors findings are consistent with, rather than undermining of, the truth of many theory-specific forms of psychotherapy; psychotherapy, as it is commonly practiced, is not deceptive and is not a placebo. The call to ‘go open’ should be resisted and may have serious detrimental effects on patients via the dissemination of a false view about how therapy works. (shrink)

Placebos are often used by clinicians, usually deceptively and with little rationale or evidence of benefit, making their use ethically problematic. In contrast with their typical current use, a provocative line of research suggests that placebos can be intentionally exploited to extend analgesic therapeutic effects. Is it possible to extend the effects of drug treatments by interspersing placebos? We reviewed a database of placebo studies, searching for studies that indicate that placebos given after repeated administration of active (...) treatments acquire medication-like effects. We found a total of 22studies in both animals and humans hinting of evidence that placebos may work as a sort of dose extender of active painkillers. Wherever effective in relieving clinical pain, such placebo use would offer several advantages. First, extending the effects of a painkiller through the use of placebos may reduce total drug intake and side effects. Second, dose-extending placebos may decrease patient dependence. Third, using placebos along with active medication, for part of the course of treatment, should limit dose escalation and lower costs. Importantly, provided that nondisclosure is pre-authorized in the informed consent process and that robust evidence indicates therapeutic benefit comparable to that of standard full-dose therapeutic regimens, introducing dose-extending placebos into the clinical arsenal should be considered. This novel prospect of placebo use has the potential to change our general thinking about painkiller treatments, the typical regimens of painkiller applications, and the ways in which treatments are evaluated. (shrink)

The use of placebo controls in clinical trials remains controversial. Ethical analysis and international ethical guidance permit the use of placebo controls in randomized trials when scientifically indicated in four cases: (1) when there is no proven effective treatment for the condition under study; (2) when withholding treatment poses negligible risks to participants; (3) when there are compelling methodological reasons for using placebo, and withholding treatment does not pose a risk of serious harm to participants; and, more (...) controversially, (4) when there are compelling methodological reasons for using placebo, and the research is intended to develop interventions that can be implemented in the population from which trial participants are drawn, and the trial does not require participants to forgo treatment they would otherwise receive. The concept of methodological reasons is essential to assessing the ethics of placebo controls in these controversial last two cases. This article sets out key considerations relevant to considering whether methodological reasons for a placebo control are compelling. (shrink)

Side effects are ubiquitous in medicine and they often play a role in treatment decisions for patients and clinicians alike. Philosophers and health researchers often use side effects to illustrate issues with contemporary medical research and practice. However, technical definitions of ‘side effect’ differ among health authorities. Thus, determining the side effects of an intervention can differ depending on whose definition we assume. Here I review some of the common definitions of side effect and highlight their issues. (...) In response, I offer an account of side effects as jointly (i) unintended and (ii) effects due to the causal capacities or invariances of an intervention. I discuss (i) by examining the intentions or reasons behind therapeutic interventions, and I discuss (ii) by appealing to a manipulationist model of causation. The analysis here highlights that side effects are conceptually distinct from related outcomes like adverse events, adverse drug reactions, and placebo effects. The analysis also allows for reflection on the utility of ‘side effect’ as a technical term in medical research and practice. (shrink)

Current hypothesis claims that language plays a significant role in regulating the placebo effect and begins by discussing the concept of the placebo effect and its potential impact on clinical trials and medical treatments. The paper describes the findings of a study on the Spanish language and its potential relationship in affecting the placebo effect through the known "Hispanic paradox". The paper goes on to discuss the Sapir-Whorf hypothesis and its potential implications for the relationship between language, (...) thought, and the placebo effect. We suggest that the way in which information is communicated to patients, including the choice of language and the specific words and phrases used, may play a role in the effectiveness of the placebo effect. We make further investigation and advise on how a new language model with logical rules may interpret the language - placebo effect in Non-euclidean formalism. -/- The paper proposes that further research could be conducted to investigate the relationship between language and the placebo effect, with the aim of developing more effective methods for predicting and regulating the placebo effect in clinical trials. (shrink)

Many extant theories of placebo focus on their causal structure wherein placebo effects are those that originate from select features of the therapy (e.g., client expectations or “incidental” features like size and shape). Although such accounts can distinguish placebos from standard medical treatments, they cannot distinguish placebos from everyday occurrences, for example, when positive feedback improves our performance on a task. Providing a social-epistemological account of a treatment context can rule out such occurrences, and furthermore reveal a (...) new way to distinguish clinical placebos from standard medical treatments. (shrink)

Recent studies have explored the effectiveness of open-label placebos for a variety of conditions, including chronic pain, cancer-related fatigue and irritable bowel syndrome. OLPs are thought to sidestep traditional ethical worries about placebos because they do not involve deception: with an OLP, patients or subjects are told outright that they are not given an active substance. As deception is framed as the primary hurdle to ethical placebo use, the door is ostensibly opened to ethical studies of OLPs. In this (...) article, I suggest that even though OLPs seemingly do not involve deception, there are other ethical considerations in their clinical investigation and subsequent use. Research ethics often focusses on informed consent—of which, deception and honesty are a piece—as a means to justify research practices with human subjects. Yet, it is but one of the ethical considerations that should be taken into account. With research into placebo effects in particular, I argue that the history of clinical placebo use grounds special considerations for OLP research that go beyond respect for the autonomy of individual patients through informed consent and encompass structural concerns about the type of patient for whom a placebo has historically been thought appropriate. (shrink)

Using placebos in day-to-day practice is an ethical problem. This paper summarises the available epidemiological evidence to support this difficult decision. Based on these data we propose to differentiate between placebo and “knowledge framing”. While the use of placebo should be confined to experimental settings in clinical trials, knowledge framing — which is only conceptually different from placebo — is a desired, expected and necessary component of any doctor-patient encounter. Examples from daily practice demonstrate both, the need (...) to investigate the effects of knowledge framing and its impact on ethical, medical, economical and legal decisions. (shrink)

In this paper, I argue that deceptive placebo use can be morally permissible, on the grounds that the deception involved in the prescription of deceptive placebos can differ in kind to the sorts of deception that undermine personal autonomy. In order to argue this, I shall first delineate two accounts of why deception is inimical to autonomy. On these accounts, deception is understood to be inimical to the deceived agent’s autonomy because it either involves subjugating the deceived agent’s will (...) to another’s authority or because it precludes the agent from acting effectively in pursuit of their ends. I shall argue that providing an agent with false beliefs is not inimical to their autonomy if they are only able to effectively pursue their autonomously chosen ends by virtue of holding those particular false beliefs. Finally, I show that deceptive placebo use need only involve this latter sort of deception. (shrink)

Unlike its friendly cousin the placebo effect, the nocebo effect (the effect of expecting a negative outcome) has been almost ignored. Epistemic and ethical confusions related to its existence have gone all but unnoticed. Contrary to what is often asserted, adverse events following from taking placebo interventions are not necessarily nocebo effects; they could have arisen due to natural history. Meanwhile, ethical informed consent (in clinical trials and clinical practice) has centred almost exclusively on the need to (...) inform patients about intervention risks with patients to preserve their autonomy. Researchers have failed to consider the harm caused by the way in which the information is conveyed. In this paper, I argue that the magnitude of nocebo effects must be measured using control groups consisting of untreated patients. And, because the nocebo effect can produce harm, the principle of non-maleficence must be taken into account alongside autonomy when obtaining (ethical) informed consent and communicating intervention risks with patients. (shrink)

Hundreds of evaluative studies of psychotherapy still leave the issue of its effectiveness unsettled. The author argues that such studies have ignored the major determinant of therapeutic effectiveness, the role of a patient’s belief in the successful outcome in therapy. Psychiatrist Thomas Szasz, one of the foremost critics of psychiatry, wrote of this paper: "It is one of the best, if not the best, that I have read on this subject.” It makes little sense to claim that a certain therapy (...) is effective or ineffective in itself; rather, there is a relation of mutual interaction among three terms: a patient’s ability to learn in a psychological context, a therapist’s ability to teach, and the capacity of an approach to therapy to engender in the patient the necessary belief in its effectiveness. -/- The paper is followed by a 4-page 2014 Afterword. (shrink)

We will show with examples that all results of modern science are based on or derived from assumptions. Since assumptions cannot be valid for nature and engineering, modern science therefore cannot represent the nature, and be applicable to nature and engineering. For the same reason results of modern science can never be demonstrated. On the other hand the Vedic science is entirely based on observations, just like what Galileo observed. Vedic science does not therefore has any assumptions, and it is (...) a record of what you see is happening in nature. The Vedic science also has another very crucial difference – it observed two types of causes: (a) efficient cause and (b) material cause, behind every phenomenon. As a result Vedic science is universal and eternal. We will illustrate all results of Vedic science with observations in nature. Such examples will be beyond comprehension of modern science. (shrink)

In ‘Psychotherapy, Placebos and Informed Consent’, I argued that the minimal standard for informed consent in psychotherapy requires that ‘patients understand that there is currently no consensus about the mechanisms of change in psychotherapy, and that the therapy on offer…is based on disputed theoretical foundations’, and that the dissemination of this information is compatible with the delivery of many theory-specific forms of psychotherapy (including cognitive behavioural therapy [CBT]). I also argued that the minimal requirements for informed consent do not include (...) information about the role of therapeutic common factors in healing (e.g., expectancy effects and therapist effects); practitioners may discuss the common factors with patients, but they are not part of the ‘core set’ of information necessary to obtain informed consent. In a recent reply, Charlotte Blease criticises these two arguments by claiming they are not supported by empirical findings about the therapeutic common factors. Blease’s response is based on serious misunderstandings of both CBT and what the common factor findings actually find. Nevertheless, addressing the reasons for these misunderstandings is instructive and gives us an opportunity to clarify what, exactly, needs to be explained to patients in order to obtain informed consent for psychotherapy. (shrink)

Psychotherapy is effective. Since the 1970’s, meta-analyses, and meta-analyses of meta-analyses, have consistently shown a significant effect size for psychotherapeutic interventions when compared to no treatment or placebo treatments. This effectiveness is normally taken as a sign of the scientific legitimization of clinical psychotherapy. A significant problem, however, is that most psychotherapies appear to be equally effective. This poses a problem for specific psychotherapies: they may work, but likely not for the reasons that ground their theoretical explanations for their (...) effectiveness. A prominent explanation for the findings of common efficacy in psychotherapy is to postulate that all successful therapies work by altering maladaptive meanings and providing patients with new, more adaptive meanings. This paper argues that the ‘meaning view’ of psychological change is likely mistaken; psychological problems are not normally problems of meaning nor are they directly ameliorated by changes in meaning. This paper then outlines a skill-based explanation for the findings of the common efficacy of psychotherapy. (shrink)

Starting from the importance of the figure of the parrhesiastes — the political and therapeutic truth- teller— for Foucault’s understanding of the care of the self, this paper traces the political figuration of the analogy between philosophers and physicians on the one hand, and rhetors and disease on the other in Plato’s Gorgias. I show how rhetoric, in the form of ventriloquism, infects the text itself, and then ask how we account for the effect of the “ contaminated ” philosophical (...) dialogue on our readerly health. Is the text placebo, vaccine, or virus? All of these options, I argue, complicate Foucault’s prescription for parrhesia, requiring us to think anew the continuing political ramifications of the metaphor of care. (shrink)

An abundance of data unequivocally shows that exercise can be an effective tool in the fight against obesity and its associated co-morbidities. Indeed, physical activity can be more effective than widely-used pharmaceutical interventions. Whilst metformin reduces the incidence of diabetes by 31% (as compared with a placebo) in both men and women across different racial and ethnic groups, lifestyle intervention (including exercise) reduces the incidence by 58%. In this context, it is notable that a group of prominent medics and (...) exercise scientists recently sent a well-publicised letter to the General Medical Council and Medical Schools Council calling for the introduction of evidence-based lifestyle education into all medical curricula. The letter warns that there is a lack of understanding of the impact that exercise and nutrition can have on physical health amongst doctors. In the absence of an educational overhaul, the signatories warn that the government is likely to fail to reach its goal of preventing tens of thousands of premature deaths from heart disease and cancer by 2020. Whilst we agree with the need to address this apparent lack of understanding, we argue that the ethical justification of doing so is not limited to this broadly beneficence-based justification. There is also a justification grounded in the duty of non-maleficence, that is, the duty to avoid unreasonably harming patients. This duty requires that doctors refrain from (i) preventing patients from undergoing beneficial treatment without good reason, (ii) exposing patients to unreasonable risks and (iii) reducing the therapeutic effect of an effective medical intervention. This requires an understanding of the physical impact of exercise. (shrink)

Eyal Shahar’s essay review [1] of James Penston’s remarkable book [2] seems more inspired playful academic provocation than review or essay, expressing dramatic views of impossible validity. The account given of modern biostatistical causation reveals the slide from science into the intellectual confusion and non-science RCTs have created: “…. the purpose of medical research is to estimate the magnitude of the effect of a causal contrast, for example the probability ratio of a binary outcome …” But Shahar’s world is simultaneously (...) not probabilistic, but of absolute uncertainty: “We should have no confidence in any type of evidence ….. We should have no confidence at all”. Shahar’s "Causal contrast" is attractive. It seems to make sense, but bypasses in two words the means of establishing causation by the scientific method. This phrase assumes a numeric statistically significant “contrast” is causal rather than a potential correlation requiring further investigation. The concept of “causal contrast” is a slippery slope from sense into biostatistical non-science. This can be illustrated with an hypothetical RCT where 100% of interventions exhibit a posited treatment effect and 0% of placebo controls. Internal validity is seemingly quite reasonably assumed satisfied (common-sense dictating the likelihood of an awesome magnificent fraud, bias or plain error of the magnitude required is infinitesimal). Scientific method appears satisfied. The RCT demonstrates: (1) strict regularity of outcome in the presence of posited cause; (2) the absence of outcome in its absence and (3) an intervention (experiment) showing the direction of causation is from posited cause to posited effect. Now travel further down the slope from science. Assume 50% of interventions and 0% of controls are positive. We compromise scientific method, but justify this by assuming a large subgroup which we say surely must on these figures be exhibiting the posited treatment effect. But what of 10% of interventions and 9% of placebo controls exhibiting the posited treatment effect? Our biostatistician says the 1% “causal contrast” is statistically significant. But we have: (1) minimal evidence of regularity; (2) the posited outcome irrespective of presence of posited cause and (3) our intervention is at the highest equivocal in demonstrating any form of causation. This is not science. It is, however, where biostatistics has unthinkingly taken us, as Penston has shown comprehensively [2]. We, the audience of published medical research, are now for the 10% / 9% example well down the slope from science. An unattractive hypothesis results requiring numerous assumptions similar to these:- "There is a 'contrast' which is ‘causal’, albeit the method employed is not scientific. An effect of the intervention has been observed in a very small subgroup. This subgroup is susceptible to treatment. The similar number of placebo controls exhibiting the outcome sought is irrelevant, because the 1% difference between intervention and controls is statistically significant. The statistical analysis is valid and reliable. The RCT’s internal validity is sufficiently satisfied. No funding or bias or fraud has affected the results or their analysis.” As Penston notes: “Confirming and refuting the results of research is crucial to science …. But … there’s no way of testing the results of any particular large-scale RCT or epidemiological study. Each study … is left hanging in the air, unsupported.” It gets worse. To identify a rare serious adverse reaction of a frequency of 1:10,000 can require a trial of 200,000 or larger split between controls and interventions. This is not done. But for every 100 who prospectively benefit from the intervention, 9,900 also receive it. And for every 100 benefiting one person (who likely gains no benefit) will suffer a serious unidentified adverse reaction. This is also without taking account of more common adverse reactions whether serious or otherwise. References [1] Shahar, E. (2011) Research and medicine: human conjectures at every turn. International Journal of Person Centered Medicine 1 (2), 250-253. [2] Penston, J. (2010). stats.con: How we’ve been fooled by statistics-based research in medicine. London: The London Press, UK. (shrink)

Philosophical debates about how best to explain emotion or placebo are debates about how best to characterise and explain the distinctive form of human responsiveness to the world that is the object of interest for each of those domains of inquiry. In emotion research, the cognitive theory of emotion faces several intractable problems. I discuss two of these: the problem of epistemic deficit and the problem of recalcitrant emotions. Cognitive explanations in Placebo Studies, such as response-expectancy and belief-based (...) explanations, also face the problem of epistemic deficit in addition to the problem of logically self-destructive true belief. While such considerations might motivate a retreat to affect, this brings its own problems. I argue that it is a particular version of cognitivism, representational cognitivism (Rep-Cog), that generates the paradoxes we encounter in emotion and placebo research. I propose that turning to nonrepresentational accounts of cognition will dissolve these paradoxes. As I move toward conclusion, I propose drawing on the ethnomethodological tradition to respecify human responsiveness to loci of significance in the lifeworld by undertaking ethnographies of members’ own situated methods for making intelligible and accountable their attitudinal and nonattitudinal responsiveness to loci of significance in their environment. (shrink)

Placebo-trials on HIV-infected pregnant women in developing countries like Thailand and Uganda have provoked recent controversy. Such experiments aim to find a treatment that will cut the rate of vertical transmission more efficiently than existing treatments like zidovudine. This scenario is first stated as generally as possible, before three ethical principles found in the Belmont Report, itself a sharpening of the Helsinki Declaration, are stated. These three principles are the Principle of Utility, the Principle of Autonomy and the Principle (...) of Justice. These are taken as voices of moral imperative. But although each has intuitive appeal, it can be shown that there are possible scenarios in which they give conflicting prescriptions. To achieve consistency, one must be subordinate to the others. The voice of utility is taken as subordinate to those of justice and autonomy and it is shown that given plausible assumptions about the level of poverty and education in the developing country targeted, the experiment is ruled morally wrong in the name of both justice and autonomy. Moreover, it is argued that no justification can be found for the inclusion of a placebo group, when strictly defined. By contrast, a ‘no- treatment’ control arm might be justified, but only when the demands of autonomy are satisfied, demands that are more stringent than they might appear. A utilitarian defence of the experiment is examined, namely that the would-be participants are in a no-loss situation, and it is shown that this defence is seriously flawed. Finally, it is concluded that there is no justification for amending the Declaration of Helsinki. (shrink)

abstract Is it permissible for a doctor or nurse to knowingly administer a placebo in a clinical setting? There is certainly something suspicious about it: placebos are typically said to be ‘sham’ treatments, with no ‘active’ properties and so giving a placebo is usually thought to involve tricking or deceiving the patient who expects a genuine treatment. Nonetheless, some physicians have recently suggested that placebo treatments are sometimes the best way to help their patients and can be (...) administered in an honest way. These physicians conclude that placebo treatments are a perfectly acceptable, and ethically unproblematic, mode of treatment. While I grant the common idea that placebos are deceptive is correct, I argue that widespread misunderstandings concerning why this is so has led proponents of placebo treatments to respond to the charge of deception in a way that misses the mark entirely. My goal in this paper, then, is to develop a precise conception of what makes something a placebo, which in turn will clarify the central charge concerning the ethics of placebo treatment, viz. that it is deceptive. (shrink)

Consider the following patient: a 40-year-old man who has had back pain that radiates down his left leg, on and off for 2 months. He performs his normal activities and does not have any “red flag”...

Measuring the effectiveness of medical interventions faces three epistemological challenges: the choice of good measuring instruments, the use of appropriate analytic measures, and the use of a reliable method of extrapolating measures from an experimental context to a more general context. In practice each of these challenges contributes to overestimating the effectiveness of medical interventions. These challenges suggest the need for corrective normative principles. The instruments employed in clinical research should measure patient-relevant and disease-specific parameters, and should not be sensitive (...) to parameters that are only indirectly relevant. Effectiveness always should be measured and reported in absolute terms (using measures such as 'absolute risk reduction'), and only sometimes should effectiveness also be measured and reported in relative terms (using measures such as 'relative risk reduction')-employment of relative measures promotes an informal fallacy akin to the base-rate fallacy, which can be exploited to exaggerate claims of effectiveness. Finally, extrapolating from research settings to clinical settings should more rigorously take into account possible ways in which the intervention in question can fail to be effective in a target population. (shrink)

To be effective, a medical intervention must improve one's health by targeting a disease. The concept of disease, though, is controversial. Among the leading accounts of disease-naturalism, normativism, hybridism, and eliminativism-I defend a version of hybridism. A hybrid account of disease holds that for a state to be a disease that state must both (i) have a constitutive causal basis and (ii) cause harm. The dual requirement of hybridism entails that a medical intervention, to be deemed effective, must target either (...) the constitutive causal basis of a disease or the harms caused by the disease (or ideally both). This provides a theoretical underpinning to the two principle aims of medical treatment: care and cure. (shrink)

The study investigated Meta-analysis on the effects of financial status on nutrigenomics and personalized diet in Nigeria. The study was guided by four research questions and three null hypotheses tested at 0.05 level of significance. The designs for this study were systematic review and meta-analytic. The study has infinite population. However, 53 studies on the effects of financial status on nutrigenomics and personalized diet in Nigeria were identified. Out of the 53 studies identified, only 31 studies which met (...) the requirements for meta-analysis were used as the sample. The sampling techniques were purposive and snowballing. A pro-forma was used for data collection. The instrument was validated by experts and the internal consistency reliability value of 0.97 was obtained using inter-rater agreement. Data collected with the instrument were analyzed with effect size, average weighted mean Z, Winer combined test and Fisher statistical transformation tables. The findings of the study revealed: moderate effect size on lower and upper financial status on nutrigenomics and personalized diet, small effect size on upper financial status on nutrigenomics and personalized diet, large effect size on lower financial status on nutrigenomics and personalized diet and variation on effect sizes of lower and upper financial status on nutrigenomics and personalized diet and significant effect sizes on upper, lower and consequently on lower and upper financial status on nutrigenomics and personalized diet 464 at Z-critical value of 1.96 at the 0.05 level of significance. (shrink)

Disintegration is the most important step for drug bioavailability because after, the disintegration process, the ingredients of solid dosage forms dissolve and become bioavailable. Generally, the tablets and capsules should be taken with a glass of water otherwise the manufacturer gives instructions to use the proper beverage. Several drugs are taken with different forms of beverages to ensure easy swallowing of the tablet, masking the bad taste of the drug and overcoming the drug aftertaste, these beverages can influence the disintegration (...) of the solid dosage form. The most common cold beverages consumed by the Libyan population are juice, milk, and Coca-Cola. These beverages are consumed without awareness of the possible effect of these beverages on drugs, especially over-the-counter drugs such as analgesic, antipyretic, and anti-inflammatory drugs that are taken without a prescription. This study aimed to evaluate the influence of three beverages, namely: orange juice, milk, and Coca-Cola on the disintegration time of four over-the-counter-drugs: Panadol, Congestal, Brufen, and Reality Extra using disintegration test of drugs in 0.1 N HCL and in hybrid medium prepared by combination of 150 ml 0.1 N HCL and 550 ml of beverage to simulate in vivo condition. The findings show that the orange juice significantly increases the disintegration time of all the investigated drugs. Coca-Cola significantly increases the disintegration time of Reality Extra, and slightly increases the disintegration time of Brufen, Congestal, and Panadol and the full-fat milk significantly increases the disintegration time of Reality Extra and Panadol while slightly increasing the disintegration time for Brufen and Congestal. It is concluded that commonly used beverages affect the disintegration time of the examined over-the-counter drugs. Patients should be advised to take these medications without beverages which may delay the disintegration and the onset of action of the drug. (shrink)

Experiments are presented showing that visual search for Mueller-Lyer (ML) stimuli is based on complete configurations, rather than component segments. Segments easily detected in isolation were difficult to detect when embedded in a configuration, indicating preemption by low-level groups. This preemption—which caused stimulus components to become inaccessible to rapid search—was an all-or-nothing effect, and so could serve as a powerful test of grouping. It is shown that these effects are unlikely to be due to blurring by simple spatial filters (...) at early visual levels. It is proposed instead that they are due to more sophisticated processes that rapidly bind contour fragments into spatially-extended assemblies. These results support the view that rapid visual search cannot access the primitives formed at the earliest stages of visual processing; rather, it can access only higher-level, more ecologically-relevant structures. (shrink)

One of the main objections against effective altruism is the so-called institutional critique, according to which the EA movement neglects interventions that affect large-scale institutions. Alexander Dietz has recently put forward an interesting version of this critique, based on a theoretical problem affecting act-utilitarianism, which he deems as potentially conclusive against effective altruism. In this article I argue that his critique is not as promising as it seems. I then go on to propose another version of the institutional critique. In (...) contrast to Dietz's version, it targets not the core principles of effective altruism but rather some important methodological assumptions made in EA research, namely diminishing marginal returns and low-hanging fruits. One key conclusion is that it may be time for critics of effective altruism to shift their attention from the theoretical core principles of effective altruism towards the methodological tools actually employed in practice by the EA movement. (shrink)

This article evaluates the effects of two types of rewards (performance-contingent versus engagement-contingent) on self-regulation, intrinsic motivation and creativity. Forty-two undergraduate students were randomly assigned to three conditions; i.e. a performance-contingent reward group, an engagement-contingent reward group and a control group. Results provide little support for the negative effects of performance rewards on motivational components. However, they do indicate that participants in the engagement-contingent reward group and the control group achieved higher rated creativity than participants in the performance-contingent (...) reward group. Alternative explanations for this finding are discussed. (shrink)

In a series of ten preregistered experiments (N=2043), we investigate the effect of outcome valence on judgments of probability, negligence, and culpability – a phenomenon sometimes labelled moral (and legal) luck. We found that harmful outcomes, when contrasted with neutral outcomes, lead to increased perceived probability of harm ex post, and consequently to increased attribution of negligence and culpability. Rather than simply postulating a hindsight bias (as is common), we employ a variety of empirical means to demonstrate that the outcome-driven (...) asymmetry across perceived probabilities constitutes a systematic cognitive distortion. We then explore three distinct strategies to alleviate the hindsight bias and its downstream effects on mens rea and culpability ascriptions. Not all are successful, but at least some prove promising. They should, we argue, be taken into consideration in criminal jurisprudence, where distortions due to the hindsight bias are likely considerable and deeply disconcerting. (shrink)

I argue against the Doctrine of Double Effect’s explanation of the moral difference between terror bombing and strategic bombing. I show that the standard thought-experiment of Terror Bomber and Strategic Bomber which dominates this debate is underdetermined in three crucial respects: (1) the non-psychological worlds of Terror Bomber and Strategic Bomber; (2) the psychologies of Terror Bomber and Strategic Bomber; and (3) the structure of the thought-experiment, especially in relation to its similarity with the Trolley Problem. (1) If the two (...) worlds are not identical, then it may be these differences between the two worlds and not the Doctrine of Double Effect to explain the moral difference; (2a) if Terror Bomber and Strategic Bomber have the same causal beliefs, then why does Terror Bomber set out to kill the children? It may then be this unwarranted and immoral choice and not the Doctrine of Double Effect that explains the moral difference; (2b) if the two have different causal beliefs, then we can’t rule out the counterfactual that, had Strategic Bomber had the same beliefs as Terror Bomber, she would have also acted as Terror Bomber did. Finally, (3) the Strategic Bomber scenario could also be constructed so as to be structurally equivalent to the Fat Man scenario in the Trolley Problem: but then the Doctrine of Double Effect would give different answers to two symmetrical cases. (shrink)

This paper is an examination of the ethical principles of effective altruism as they are articulated by Peter Singer in his book The Most Good You Can Do. It discusses the nature and the plausibility of the principles that he thinks both guide and ought to guide effective altruists. It argues in § II pace Singer that it is unclear that in charitable giving one ought always to aim to produce the most surplus benefit possible and in § III that (...) there is a more attractive set of principles than the ones Singer outlines that ought to guide effective altruists in their philanthropic practices and in their lives more generally. These principles fit better with his practical ambitions and with plausible attitudes about the limits of beneficence. (shrink)

Effective altruists either believe they ought to be, or strive to be, doing the most good they can. Since they’re human, however, effective altruists are invariably fallible. In numerous situations, even the most committed EAs would fail to live up to the ideal they set for themselves. This fact raises a central question about how to understand effective altruism. How should one’s future prospective failures at doing the most good possible affect the current choices one makes as an effective altruist? (...) This question is important to answer not only because every effective altruist will face this question due to typical human akrasia, but also because how the question is answered will determine just how demanding effective altruism can be. I argue that no matter how effective altruists answer this question, they will have to take on some commitments seemingly antithetical to their movement. More precisely, I argue that effective altruism is subject to a dilemma. Effective altruists’, at times, implicit actualist assumptions (i) commit them to conclusions seemingly antithetical to what typical effective altruists actually believe, as well as the spirit of the movement and (ii) undermine effective altruists’ arguments against moral offsetting and giving to charities close to the heart. Yet, effective altruists’, at times, implicit possibilist assumptions (iii) also commit them to conclusions seemingly antithetical to what typical effective altruists actually believe, as well as the spirit of the movement and (iv) undermine typical responses to demandingness worries for the normative conception of effective altruism. I argue that the best way out of the dilemma is to accept hybridism, though even hybridism won’t preserve every commitment of effective altruism. (shrink)

Coastal protection is crucial to human development since the ocean has many values associated with the economy, ecosystem, and culture. However, most ocean protecting efforts are currently ineffective due to the burdens of finance, lack of appropriate management, and international cooperation regimes. For aiding bottom-up initiatives for ocean protection support, this study employed the Mindsponge Theory to examine how the public’s perceived economic and cultural values influence their willingness to support actions to protect the ocean. Analyzing the European-Union-Horizon-2020-funded dataset of (...) 709 respondents from 42 countries, we discovered that perceived economic values have negative effects on the tendency of ocean protection supports (i.e., food, transportation, renewable energy, oil and gas, and recreation). In contrast, certain perceived cultural values can help increase the willingness to do so (i.e., mental well-being and sense of identity). However, the effects of perceived cultural values are only moderately reliable. These findings suggest that designing cultural information delivery campaigns can help promote coastal reserve supports, such as fundraisings and preserving the oceans from the community. (shrink)

The modifier effect is the reduction in perceived likelihood of a generic property sentence, when the head noun is modified. We investigated the prediction that the modifier effect would be stronger for mutable than for central properties, without finding evidence for this predicted interaction over the course of five experiments. However Experiment 6, which provided a brief context for the modified concepts to lend them greater credibility, did reveal the predicted interaction. It is argued that the modifier effect arises primarily (...) from a general lack of confidence in generic statements about the typical properties of unfamiliar concepts. Neither prototype nor classical models of concept combination receive support from the phenomenon. 2010 Elsevier Inc. All rights reserved. (shrink)

This paper addresses issues regarding perceptions of surveillance technologies in Europe. It analyses existing studies in order to explore how perceptions of surveillance affect and are affected by the negative effects of surveillance and how perceptions and effectiveness of surveillance technologies relate to each other. The paper identifies 12 negative effects of surveillance including, among others, privacy intrusion, the chilling effect and social exclusion, and classifies them into three groups. It further illustrates the different ways in which perceptions (...) and effectiveness of surveillance interact with each other, distinguishing between perceived security and perceived effectiveness. Finally, the paper advances a methodology to take into account perception issues when designing new surveillance technologies. By doing so, it rejects manipulative measures aiming at improving perceptions only and suggests measures that address the background conditions affecting perceptions. (shrink)

Information technology (IT) is continuously making astounding progress in technical efficiency. The time, space, material and energy needed to provide a unit of IT service have decreased by three orders of magnitude since the first personal computer (PC) was sold. However, it seems difficult for society to translate IT’s efficiency progress into progress in terms of individual, organizational or socio-economic goals. In particular it seems to be difficult for individuals to work more efficiently, for organizations to be more productive and (...) for the socio-economic system to be more sustainable by using increasingly efficient IT. This article provides empirical evidence and potential explanations for this problem. Many counterproductive effects of IT can be explained economically by rebound effects. Beyond that, we conclude that the technological determinism adopted by decision-makers is the main obstacle in translating IT’s progress into non-technical goals. (shrink)

Whereas there is extensive documentation that attribute framing influences the content of peoples thought, we generally know less about how it affects the processes assumed to precede those thoughts. While existing explanations for attribute framing effects rely completely on valence-based associative processing, the results obtained in the present study are also consistent with the notion that negative framing stimulates more effortful and thorough information processing than positive framing. Specifically, results from a simulated business decision-making experiment showed that decision makers (...) receiving negatively framed information had significantly better recall than those receiving positively framed information. Furthermore, decision makers in the negative framing condition were less confident than decision makers in the positively framed condition. Finally, compared to a no-framing condition, decision makers receiving positive framing deviated significantly more in evaluation than decision makers receiving negative framing did. (shrink)

Critics of private charity often claim that the well-off should instead assist the disadvantaged through political reform. The present article explores this idea with reference to effective altruism, a powerful new paradigm in the ethics of philanthropy. Effective altruism presses the relatively affluent not only to give generously, but also to subject their practical deliberations to rigorous evaluations of impartiality and cost-effectiveness. The article contends that the movement’s sophisticated methods are not sufficient to overcome the worries of institutionalist critics. At (...) the same time, it shows that a transition from assistance to advocacy faces underappreciated and serious limitations. The measurement-based methods that allow effective altruists to identify promising assistance programs do not carry over well to political reform. In addition, unleashing greater private wealth into politics may exacerbate unequal opportunities for political influence. The article closes with preliminary suggestions for overcoming these concerns and connects them to broader developments in the politics of philanthropy. (shrink)

Effective altruism sounds so innocuous—who could possibly be opposed to doing good more effectively? Yet it has inspired significant backlash in recent years. This paper addresses some common misconceptions and argues that the core “beneficentric” ideas of effective altruism are both excellent and widely neglected. Reasonable people may disagree on details of implementation, but all should share the basic goals or values underlying effective altruism.

Effective altruism has a strategy problem. Overreliance on a strategy of donating to the most effective charities keeps us on the firefighter's treadmill, continually pursuing the next-highest quantifiable marginal gain. But on its own, this is politically shortsighted. Without any long-term framework within which these individual rescues fit together to bring about the greatest overall impact, we are almost certainly leaving a lot of value on the table. Thus, effective altruists' preferred means undercut their professed aims. Alongside the charity framework, (...) the more effective altruist ought to consider a mutual aid framework, which better acknowledges and honors the unavoidably political commitments of effective altruism to reimagine and remake the world. (shrink)

The effective altruism movement (EA) is one of the most influential philosophically savvy movements to emerge in recent years. Effective Altruism has historically been dedicated to finding out what charitable giving is the most overall-effective, that is, the most effective at promoting or maximizing the impartial good. But some members of EA want the movement to be more inclusive, allowing its members to give in the way that most effectively promotes their values, even when doing so isn’t overall-effective. When we (...) examine what it means to give according to one’s values, I argue, we will see that this is both inconsistent with what EA is like now and inconsistent with its central philosophical commitment to an objective standard that can be used to critically analyze one’s giving. While EA is not merely synonymous with act utilitarianism, it cannot be much more inclusive than it is right now. (shrink)

Two experiments with undergraduates as subjects were carried out with the aim of replicating and extending previous results showing that the implication of the behavioral life-cycle hypothesis (H. M. Shefrin & R. H. Thaler, 1988) that people classify assets in different mental accounts (current income, current assets, and future income) may explain how consumption choices are influenced by temporary income changes. In both experiments subjects made fictitious choices between paying for a good in cash or according to a more expensive (...) installment plan after they had received an income which was either less, the same, or larger than usual. In Experiment 1 subjects were supposed to have savings so that the total assets were equal, whereas in Experiment 2 the total assets varied. The results of both experiments supported the role of mental accounts in demonstrating that subjects were unwilling to pay in cash after an income decrease even though they had access to saved money. Thus, in effect they chose to pay more for the good than they had to. Indicating a need for further refinement of the concept of mental account, choices to pay in cash after an income decrease tended to be more frequent when the consumption and savings motives were compatible than when they were incompatible. Furthermore, increasing the total assets made subjects more willing to pay in cash after an income decrease. (shrink)