The moral justification of intellectual property is often called into question when placed in the context of pharmaceutical patents and global health concerns. The theoretical accounts of both John Rawls and Robert Nozick provide an excellent ethical framework from which such questions can be clarified. While Nozick upholds an individuals right to intellectual property, based upon its conformation with Lockean notions of property and Nozicks ideas of just acquisition and transfer, Rawls emphasizes the importance of basic liberties, such as an (...) individuals right to health, superceding such secondary rights as intellectual property rights. From a policy perspective, patent protection for pharmaceutical products necessarily entails the balancing of corporate intellectual property interests and public interests in healthcare. The moral dilemma that occurs when these two interests clash is not easily resolved. Aside from corporate and public interests, the state maintains an interest in creating and preserving policies that regulate the moral dilemma itself. This paper analyzes the economic and ethical factors surrounding the production and distribution of the anti-HIV medication, AZT. Potential policy implications and recommendations are also discussed. (shrink)

Risk communication has been generally categorized as a warning act, which is performed in order to prevent or minimize risk. On the other side, risk analysis has also underscored the role played by information in reducing uncertainty about risk. In both approaches the safety aspects related to the protection of the right to health are on focus. However, it seems that there are cases where a risk cannot possibly be avoided or uncertainty reduced, this is for instance valid for the (...) declaration of side effects associated with pharmaceutical products or when a decision about drug approval or retirement must be delivered on the available evidence. In these cases, risk communication seems to accomplish other tasks than preventing risk or reducing uncertainty. The present paper analyzes the legal instruments which have been developed in order to control and manage the risks related to drugs – such as the notion of “development risk” or “residual risk” – and relates them to different kinds of uncertainty. These are conceptualized as epistemic, ecological, metric, ethical, and stochastic, depending on their nature. By referring to this taxonomy, different functions of pharmaceutical risk communication are identified and connected with the legal tools of uncertainty management. The purpose is to distinguish the different functions of risk communication and make explicit their different legal nature and implications. (shrink)

Pharmaceutical paternalism is the normative stance upheld by pharmaceutical regulatory agencies like the US Food and Drug Administration. These agencies prevent patients from accessing treatments declared safe and ineffective for the patient’s good without their consent. Libertarian critics of the FDA have shown a number of significant flaws in regulatory paternalism. Against these objections, I will argue that, in order to make an informed decision about treatments, a libertarian patient should request full disclosure of the uncertainty about an experimental treatment. (...) But pharmaceutical markets, on their own, are not a reliable source of information about such uncertainty. And companies have the power to capture any independent expert who may assess it. Therefore, the libertarian is better off deferring on an independent regulatory body the assessment of the pharmaceutical risks, constraining access to treatments until tested. (shrink)

The International Bill of Rights enshrines a right to health, which includes a right to access essential medicines. This right frequently appears to conflict with the intellectual property regime that governs pharmaceutical patents. However, there is also a human right that protects creative works, including scientific productions. Does this right support intellectual property protections, even when they may negatively affect health? -/- This article examines the recent attempt by the Committee on Economic, Social and Cultural Rights to resolve this issue (...) and argues that it fails. This is problematic because it means defenders of the present patent regime can continue using human rights documents to support their position. I offer a new framework for resolving the problem by examining the values that underlie human rights. (shrink)

As a result of the doctoral research developed by the main author (Vargas-Chaves, 2017), it was identified the evolution and perspectives of the pharmaceutical patent in the international trade system, as well as it future legal research needs in this topic, both immediate and long-term. Furthermore, a number of problems of public health were highlighted in which the patent-term-extension mechanisms have produced a lack of access to medicines.

Abstract: To improve the countries’ pharmaceutical situation and to monitor the progress, the World Health Organization (WHO) and member states developed a system of indicators to measure the respective important aspects as a prerequisite step. Level I indicators to assess the country’s pharmaceutical situation include the national drug policy; legislation and regulations; drug accessibility and affordability; essential drug list; quality control; pharmacovigilance; storage and distribution; information and rational use. This study is aimed to document the professional opinion of 20 pharmacy (...) practice professionals on Libya’s current pharmaceutical situation, utilizing WHO indicator-based approach. The core indicators measure the most important information needed to understand the pharmaceutical situation in a country. A closed-end questionnaire was distributed to ten practicing pharmacists and ten pharmacy teaching staff members who practice pharmacy. The questionnaires were handed over personally and collected on the same day. The responses were analyzed using simple statistics. The results were argued in the light of the first author’s observation and view, being expert in this field, with reference to the other experts’ views, relevant publications’ findings and WHO reports’ conclusions on these indicators. Suggestions and recommendations for a proper situation assessment, planning and action taking are presented. Primarily, government’s commitment towards appropriate restructuring, management and monitoring of the pharmaceutical sector is crucial. That is to enhance the country’s pharmaceutical situation, to provide and sustain efficient pharmaceutical services and to improve the overall health care system’s performance. (shrink)

A number of concerns have been raised about the possible future use of pharmaceuticals designed to enhance cognitive, affective, and motivational processes, particularly where the aim is to produce morally better decisions or behavior. In this article, we draw attention to what is arguably a more worrying possibility: that pharmaceuticals currently in widespread therapeutic use are already having unintended effects on these processes, and thus on moral decision making and morally significant behavior. We review current evidence on the (...) moral effects of three widely used drugs or drug types: propranolol, selective serotonin reuptake inhibitors, and drugs that effect oxytocin physiology. This evidence suggests that the alterations to moral decision making and behavior caused by these agents may have important and difficult-to-evaluate consequences, at least at the population level. We argue that the moral effects of these and other widely used pharmaceuticals warrant further empirical research and ethical analysis. (shrink)

The objective of the paper is to analyze whether that the pharmaceutical companies producing HIV drugs have moral obligation(s) towards the HIV victims in developing countries who don‟t have access to get drug to reduce their risks. The primary assessment is that the pharmaceutical companies have minimum moral obligation(s) to the HIV patients especially in developing countries. It is because they are human beings and hence they are the subject of moral considerations. The paper argues that from the sense of (...) benevolence, there may be an obligation that will tend pharmaceutical companies to make an opportunity of the concerned HIV patients of developing countries to get drugs. The discussion will be made from the utilitarian point of view. Though it is assumed that, utilitarianism is too demanding, I will show that the too demanding ness of utilitarianism can be minimized and it will not be contradictory with the main theme of utilitarian morality. In this respect the counter examples and arguments will also be analyzed to make the claim stronger. The paper also argues that though the primary aim of the pharmaceutical companies is to make money, the actions that might be taken by the pharmaceutical companies for the welfare of HIV victims will not hamper them in making money for which they are deployed. (shrink)

All parties involved in researching, developing, manufacturing, and distributing COVID-19 vaccines need guidance on their ethical obligations. We focus on pharmaceutical companies' obligations because their capacities to research, develop, manufacture, and distribute vaccines make them uniquely placed for stemming the pandemic. We argue that an ethical approach to COVID-19 vaccine production and distribution should satisfy four uncontroversial principles: optimising vaccine production, including development, testing, and manufacturing; fair distribution; sustainability; and accountability. All parties' obligations should be coordinated and mutually consistent. For (...) instance, companies should not be obligated to provide host countries with additional booster shots at the expense of fulfilling bilateral contracts with countries in which there are surges. Finally, any satisfactory approach should include mechanisms for assurance that all parties are honouring their obligations. This assurance enables countries, pharmaceutical companies, global organisations, and others to verify compliance with the chosen approach and protect ethically compliant stakeholders from being unfairly exploited by unethical behaviour of others. (shrink)

Purpose: The research explored empirical evidence to assess the impact of cyber security and supply chain risk on digital operations in the UAE pharmaceutical industry. Methodology/Design/Approach: Based on responses from 243 personnel working at 14 pharmaceutical manufacturing companies in Dubai, data were examined for normality, instrument validity and regression analysis. Cyber security and SC risk on digital operations were explored by applying convenient sampling and descriptive and analytical research design. Findings: The findings validated the significant positive association between cyber security (...) and supply chain risk with digital operations. Research implications and Limitations: The research model was developed with three variables evaluated only on the pharmaceutical industry in Dubai. Future research should focus on multiple manufacturing industries by covering a larger geographic area. Practical implications: When suppliers are highly concentrated, customer-focused organisations with uncertain levels of digital transformation could improve their ability to manage supply chain risk by diversifying their clients. Pharmaceutical firms may require a greater focus on technology-based manufacturing firms to build and maintain customer trust. Originality Value: To illustrate how the pharmaceutical industry has explored the relationship between cyber security, supply chain risk and digital operations, the research highlights the significant and convoluted consequences of the relationship model that have not been previously considered. (shrink)

Many people believe that the research-based pharmaceutical industry has a ‘special’ moral obligation to provide lifesaving medications to the needy, either free-ofcharge or at a reduced rate relative to the cost of manufacture. In this essay, I argue that we can explain the ubiquitous notion of a special moral obligation as an expression of emotionally charged intuitions involving sacred or protected values and an aversive response to betrayal in an asymmetric trust relationship. I then review the most common arguments used (...) to justify the claim that the pharmaceutical industry has a special moral obligation and show why these justifications fail. Taken together, these conclusions call into question the conventional ideologies that have traditionally animated the debate on whether the pharmaceutical industry has special duties of beneficence and distributive justice with respect to the impoverished in dire need of their products. (shrink)

This study presented the policy of functional integration of the product planning team as a strategy for the development of the pharmaceutical industry in Palestine. The study population consists of all the workers in companies operating in the field of medicine in Palestine, which are (5) companies producing in the West Bank only for pharmaceuticals used by these companies, which are (296) employees, and was used a simple random sample to choose the sample and size (87) employees of the (...) study population, and to achieve the objectives of the study (87) questionnaires were distributed. The descriptive analytical method was used, and SPSS was used to answer and discuss the study's questions. The results showed that there is a significant relationship between the effectiveness of the policy of product development and the competitiveness of pharmaceutical companies in Palestine (West Bank), where the policy of product development efficiency accounts for 56.6% of the total change in the competitiveness of companies. The product quality component was most influential at all levels of product development effectiveness policy, followed by product identification, product cost reduction, packaging and product deletion. The weakest areas of strategic direction in pharmaceutical companies in Palestine (West Bank) are 67%. The weakest aspects of job integration are: non-regular meetings of representatives of different positions to participate in any project related to product development, to achieve spatial convergence of members of the product planning policy team in offices, laboratories and workplaces. (shrink)

Limitless is a movie (released in 2011) as well as a novel (published in 2001) about a tormented author who (plagued by a writer’s block) becomes an early user of an experimental designer drug. The wonder drug makes him highly productive overnight and even allows him to make a fortune on the stock market. At the height of his career, however, the detrimental side-effects become increasingly noticeable. In this article, Limitless is analysed from two perspectives. First of all, building on (...) the views of the French novelist Emile Zola, the novel is seen as the report of a closely monitored experiment. Subsequently, building on the phenomenology of Ludwig Binswanger, I will show how the cognitive enhancement drug not only boosts the protagonist’s information processing capacities, but also modifies his experience of space and time, his sense of spatiality, his way of being-in-the-world. On the basis of these (complementary) analyses I will indicate how genres of the imagination (such as movies and novels) may play a significant role in assessing the societal implications of emerging technological developments such as neuro-enhancement, especially during the preparatory or anticipatory stage. (shrink)

The controversy over the old ideal of “value-free science” has cooled significantly over the past decade. Many philosophers of science now agree that even ethical and political values may play a substantial role in all aspects of scientific inquiry. Consequently, in the last few years, work in science and values has become more specific: Which values may influence science, and in which ways? Or, how do we distinguish illegitimate from illegitimate kinds of influence? In this paper, I argue that this (...) problem requires philosophers of science to take a new direction. I present two case studies in the influence of values on scientific inquiry: feminist values in archaeology and commercial values in pharmaceutical research. I offer a preliminary assessment of these cases, that the influence of values was legitimate in the feminist case, but not in the pharmaceutical case. I then turn to three major approaches to distinguish legitimate from illegitimate influences of values, including the distinction between epistemic and non-epistemic values and Heather Douglas’ distinction between direct and indirect roles for values. I argue that none of these three approaches gives an adequate analysis of the two cases. In the concluding section, I briefly sketch my own approach, which draws more heavily on ethics than the others, and is more promising as a solution to the current problem. This is the new direction in which I think science and values should move. (shrink)

Recently, dramatic price increases by several pharmaceutical companies have provoked public outrage. These scandals raise questions both about how pharmaceutical firms should be regulated and about how pharmaceutical executives ethically ought to make pricing decisions when drug prices are largely unregulated. Though there is an extensive literature on the regulatory question, the ethical question has been largely unexplored. This article defends a Kantian approach to the ethics of pharmaceutical pricing in an unregulated market. To the extent possible, pharmaceutical companies must (...) price drugs so that those who genuinely need them can get them without financial ruin. This requirement is an ethical side constraint, like the moral prohibitions on deception and theft, that takes precedence over a business’s interest in maximizing profit. That said, the requirement’s application is sensitive to the need to recoup the costs of research and to produce a return that financially justifies the original investment. It may not be either feasible or desirable for government to attempt to enforce the ethical requirements concerning just pharmaceutical pricing. Either price regulation or subsidy could fulfill government’s obligation to protect patients from being objectionably vulnerable to pricing decisions by private companies. (shrink)

Lifelong learning is becoming part of the philosophy of professional education. Continuing medical education is the responsibility of all personnel who are responsible for the delivery of components of the healthcare delivery system. Continuing education is becoming increasingly obvious for medical universities, hospitals, and health care providers. Pharmacists who practice in a community pharmacy and hospital, and who are participating in residency recognize that the traditional role of the pharmacist is changing. Over the last decades, a host of new services (...) have been identified as a function of the pharmacist [1]. A review of these services revealed a personal commitment to continuing education. It is the absolute need to develop a level of competence that will improve patient care. In Libya, pharmacists working in the community practice setting are pharmacists with a diploma of pharmacy or with a Bachelor of Pharmaceutical Science, Master of Science, and Doctor of Pharmacy (Pharm D). The main objective is that the graduates possess the knowledge and skills needed to optimally mange the pharmaceutical services [1, 2]. Patient's expectations from pharmacists are that the medicine should be effective, safe and affordable. (shrink)

Medical ghostwriting is the practice in which pharmaceutical companies engage an outside writer to draft a manuscript submitted for publication in the names of “honorary authors,” typically academic key opinion leaders. Using newly-posted documents from paroxetine litigation, we show how the use of ghostwriters and key opinion leaders contributed to the publication of a medical journal article containing manipulated outcome data to favor the proprietary medication. The article was ghostwritten and managed by SmithKline Beecham, now GlaxoSmithKline (GSK) and Scientific Therapeutics (...) Information, Inc. without acknowledging their contribution in the published article. The named authors with financial ties to GSK, had little or no direct involvement in the paroxetine 352 bipolar trial results and most had not reviewed any of the manuscript drafts. The manuscript was originally rejected by peer review; however, its ultimate acceptance to the American Journal of Psychiatry was facilitated by the journal editor who also had financial ties to GSK. Thus, GSK was able to take an under-powered and non-informative trial with negative results and present it as a positive marketing vehicle for off-label promotion of paroxetine for bipolar depression. In addition to the commercial spin of paroxetine efficacy, important protocol-designated safety data were unreported that may have shown paroxetine to produce potentially harmful adverse events. (shrink)

Pharmaceuticals or other emerging technologies could be used to enhance (or diminish) feelings of lust, attraction, and attachment in adult romantic partnerships. While such interventions could conceivably be used to promote individual (and couple) well-being, their widespread development and/or adoption might lead to “medicalization” of human love and heartache—for some, a source of serious concern. In this essay, we argue that the “medicalization of love” need not necessarily be problematic, on balance, but could plausibly be expected to have either (...) good or bad consequences depending upon how it unfolds. By anticipating some of the specific ways in which these technologies could yield unwanted outcomes, bioethicists and others can help direct the course of love’s “medicalization”—should it happen to occur—more toward the “good” side than the “bad.”. (shrink)

The need to better balance the promotion of scientific and technological innovation with risk management for consumer protection has inspired several recent reforms attempting to make regulations more flexible and adaptive. The pharmaceutical sector has a long, established regulatory tradition, as well as a long history of controversies around how to balance incentives for needed therapeutic innovations and protecting patient safety. The emergence of disruptive biotechnologies has provided the occasion for regulatory innovation in this sector. This article investigates the regulation (...) of advanced biotherapeutics in the European Union and shows that it presents several defining features of an adaptive regulation regime, notably institutionalized processes of planned adaptation that allow regulators to gather, generate, and mobilize new scientific and risk evidence about innovative products. However, our in-depth case analysis highlights that more attention needs to be paid to the consequences of the introduction of adaptive regulations, especially for critical stakeholders involved in this new regulatory ecosystem, the capacity and resource requirements placed on them to adapt, and the new tradeoffs they face. In addition, our analysis highlights a deficit in how we currently evaluate the performance and public value proposition of adaptive regulations vis-à-vis their stated goals and objectives. (shrink)

According to a common assumption, truthfulness cannot have an intrinsic value in business. Instead, it is considered only instrumentally valuable for business, because it contributes to successful trust-building. Some authors deny truthfulness even this limited role by claiming that truth-telling is not an essential part of business, which is a sui generis practice like poker. In this article, I argue that truthfulness has indeed an intrinsic value in business and identify the conceptual confusions underlying the opposite view. My account of (...) truthfulness as a virtue shows that truthfulness is both valuable for its own sake and instrumental to further valuable goals. It helps pinpoint the implicit contradiction in claiming that truthfulness has an instrumental value only. I then challenge the reasons for considering business exempt from the constraints of truthfulness and elaborate on the analogy between game and business, which in fact supports instead of undermining my claim that business is a truthful practice. Finally, I illustrate my argument with a case study of the current crisis of trust faced by the pharmaceutical industry. (shrink)

When you type the word “serendipity” in a word-processor application such as Microsoft Word, the autocorrection engine suggests you choose other words like “luck” or “fate”. This correcting act turns out to be incorrect. However, it points to the reality that serendipity is not a familiar English word and can be misunderstood easily. Serendipity is a very much scientific concept as it has been found useful in numerous scientific discoveries, pharmaceutical innovations, and numerous humankind’s technical and technological advances. Therefore, there (...) have been many books written around the concept. So why do we need this additional book? This is not just another book about serendipity. It has evolved from the Editor’s question lingering for a decade after finishing his widely cited article (coauthored with Prof. Nancy K. Napier of Boise State University, ID, USA) “Serendipity as a strategic advantage?” in T. Wilkinson’s edited volume Strategic Management in the 21st Century, published by Praeger. The Editor and contributing authors have tried to achieve the following in this title. Demystifying the Serendipity Myth The phenomenon of serendipity has always been thought of as a “miracle”. It is the mystery of human innovation and one of the ultimate secrets of our society. But serendipity is not just a lucky coincidence nor any hidden conspiracy. This book explores the science of the information process behind this seemingly miraculous phenomenon. It connects human society with nature, going back to the root of our existence and looking at the flame of survival to discover the harmony in making creativity. Presenting the nuts and bolts of being an adventurer of science The authors present their conceptual investigations into serendipity’s nature and its mechanism by examining interesting real events and stories. The content is thought-provoking, and readers are led to question and explore their own life stories and problems along the journey of reading this book. Catching an elusive high-value target requires great strategies and efforts. But there are no dark secrets here because this is the “way of nature” – how we humans have always strived for innovation without realizing the blueprints behind such processes. Unlike other books on serendipity, this book will show you that a powerful “secret” is closer than you think. Delivering practical uses for different audiences By understanding the conditionality and survival drivers of serendipity, individuals or organizations can make better decisions on creating the right environment to facilitate the encounter and attainment of this valuable phenomenon. For scientists: With clear explanations of the information processes underlying serendipity, flexible theoretical frameworks of mindsponge and the 3D principle of creativity, researchers are provided with the tools they need to dig deeper into their own fields of study and find practical applications, be it psychology, economics, sociology, or anything that involves innovation (which is, in fact, every scientific discipline). For curious casual readers: Everybody needs innovation to make breakthroughs or spice up one’s life. If you think great ideas come to people randomly from an unknown fairy place, this book will convince you otherwise without taking away that awe and wonder. But above all, you will know how to become more creative, scientifically and straightforwardly, with no snake oil and no weird tricks. For ambitious business people: The flame that brought about great successes throughout human history is within you. But you can only use it if you understand it. While others wait for serendipity to come, you will be able to actively hunt for those precious moments. As it has always been: the best hunters triumph, not the passive wanderers. And in this age of information chaos, finding the golden fruits is not easy. Those from information technology know this problem well, and this book is the treasure map that they have been seeking to navigate that stormy ocean looking for jewels. Like a kingfisher tracking its prey through the water, waiting to gracefully strike, with serendipity, a person seizes the prize of creativity amid the chaos of life. ¤ ¤ ¤ Official introduction: The book explores the nature, underlying causes, and the information processing mechanism of serendipity. It proposes that natural or social survival demands drive serendipity, and serendipity is conditional on the environment and the mindset, on both individual and collective levels. From Darwin's evolution theory to Sun Tzu's war tactics, major innovations throughout human history are unified by this key concept. In the rapidly changing world, information is abundant but rather chaotic. The adaptive power of serendipity allows people to notice treasures within this wild sea, but only for those who understand how it works. To increase the probability of encountering and attaining serendipity, one should employ the mindsponge mechanism and the 3D process of creativity, for without these frameworks, serendipity is truly an elusive target. The book also discusses methods to build environments and cultures rich in navigational and useful information to maximize the chance of finding and capitalizing on serendipity. As a skill, serendipity has a resemblance to how kingfishers observe and hunt their prey. (shrink)

Throughout the COVID-19 pandemic, shortages of scarce healthcare resources consistently presented significant moral and practical challenges. While the importance of vaccines as a key pharmaceutical intervention to stem pandemic scarcity was widely publicized, a sizable proportion of the population chose not to vaccinate. In response, some have defended the use of vaccination status as a criterion for the allocation of scarce medical resources. In this paper, we critically interpret this burgeoning literature, and describe a framework for thinking about vaccine-sensitive resource (...) allocation using the values of responsibility, reciprocity, and justice. Although our aim here is not to defend a single view of vaccine-sensitive resource allocation, we believe that attending critically with the diversity of arguments in favor (and against) vaccine-sensitivity reveals a number of questions that a vaccine-sensitive approach to allocation should answer in future pandemics. (shrink)

Crime-preventing neurointerventions (CPNs) are increasingly being used or advocated for crime prevention. There is increasing use of testosterone-lowering agents to prevent recidivism in sexual offenders, and strong political and scientific interest in developing pharmaceutical treatments for psychopathy and anti-social behaviour. Recent developments suggest that we may ultimately have at our disposal a range of drugs capable of suppressing violent aggression, and it is not difficult to imagine possible applications of such drugs in crime prevention. But should neurointerventions be used in (...) crime prevention, and may the state ever permissibly impose CPNs as part of the criminal justice process? It is widely thought that preventing recidivism is one of the aims of criminal justice, yet existing means of pursuing this aim are often poorly effective, restrictive of basic freedoms, and harmful. Incarceration, for example, tends to be disruptive of personal relationships and careers, detrimental to physical and mental health, highly restrictive of freedom of movement and association, and rarely more than modestly effective at preventing recidivism. Neurointerventions hold the promise of preventing recidivism in ways that are more effective and more humane, but the use of CPNs in criminal justice raises several ethical concerns. CPNs could be highly intrusive and may threaten fundamental human values, such as bodily integrity and freedom of thought, and humanity has a track record of misguided, harmful, and unwarrantedly coercive use of neurotechnological ‘solutions’ to criminality. This collection brings together original contributions from emerging scholars and internationally renowned moral and political philosophers to address these issues. (shrink)

There is recent empirical evidence that personal identity is constituted by one’s moral traits. If true, this poses a problem for those who advocate for moral enhancement, or the manipulation of a person’s moral traits through pharmaceutical or other biological means. Specifically, if moral enhancement manipulates a person’s moral traits, and those moral traits constitute personal identity, then it is possible that moral enhancement could alter a person’s identity. I go a step further and argue that under the right conditions, (...) moral enhancement can constitute murder. I then argue that these conditions are not remote. (shrink)

The paper discusses some of the implications of regulatory innovation in the area of advanced biological therapies and personalised medicine. Benefits, risks and trade-offs are highlighted.

This chapter sets the scene for the subsequent philosophical discussions by surveying a number of biological interventions that have been used, or might in the future be used, for the purposes of crime prevention. These interventions are pharmaceutical interventions intended to suppress libido, treat substance abuse or attention deficit-hyperactivity disorder (ADHD), or modulate serotonin activity; nutritional interventions; and electrical and magnetic brain stimulation. Where applicable, we briefly comment on the historical use of these interventions, and in each case we discuss (...) the evidence that they are effective, or might become so with further refinement. The chapter concludes with a comment on some potentially significant differences between the varieties of intervention that we canvass. (shrink)

Our goal in this paper is to articulate a precise concept of at least a certain kind of disease-mongering, showing how pharmaceutical marketing can commercially exploit certain diseases when their best definition is given through the success of a treatment in a clinical trial. We distinguish two types of disease-mongering according to the way they exploit the definition of the trial population for marketing purposes. We argue that behind these two forms of disease-mongering there are two well-known problems in the (...) statistical methodology of clinical trials (the reference class problem and the distinction between statistical and clinical significance). Overcoming them is far from simple. (shrink)

This essay develops a concept of curiotization, through which people are reduced to a curio for the fascination of others. I argue that trans people as they have appeared in media, philosophy, and narratives of history are curiotized as forever fascinating, new, titillating, and controversial. In contrast to the narrative of momentous trans progress in the mid-2010s, I point out that frameworks such as the "Transgender Tipping Point" worked to position its "trans moment" as unprecedented and always on the threshold (...) of arrival. To work through a specific example, I point to decades of renewed fascination over trans women being capable of breastfeeding and the long history of trans fascination in popular music. I conclude by emphasizing the obscured world-historical presence of transsexuality as it coincides with the history of pharmaceuticals, hormone technologies, and birth control. In contrast to a "goldfish memory optics" through which trans people become eternally new, fascinating, and debatable, I stress the importance of restoring the complexity of "trans" and its histories back into an understanding of the present. (shrink)

This paper defends the heretical view that, at least in some cases, we ought to assign legal liability based on purely statistical evidence. The argument draws on prominent civil law litigation concerning pharmaceutical negligence and asbestos-poisoning. The overall aim is to illustrate moral pitfalls that result from supposing that it is never appropriate to rely on bare statistics when settling a legal dispute.

Medicalisation is a social phenomenon in which conditions that were once under legal, religious, personal or other jurisdictions are brought into the domain of medical authority. Low sexual desire in females has been medicalised, pathologised as a disease, and intervened upon with a range of pharmaceuticals. There are two polarised positions on the medicalisation of low female sexual desire: I call these the mainstream view and the critical view. I assess the central arguments for both positions. Dividing the two (...) positions are opposing models of the aetiology of low female sexual desire. I conclude by suggesting that the balance of arguments supports a modest defence of the critical view regarding the medicalisation of low female sexual desire. (shrink)

Drug regulation is fraught with inductive risk. Regulators must make a prediction about whether or not an experimental pharmaceutical will be effective and relatively safe when used by typical patients, and such predictions are based on a complex, indeterminate, and incomplete evidential basis. Such inductive risk has important practical consequences. If regulators reject an experimental drug when it in fact has a favourable benefit/harm profile, then a valuable intervention is denied to the public and a company’s material interests are needlessly (...) thwarted. Conversely, if regulators approve an experimental drug when it in fact has an unfavourable benefit/harm profile, then resources are wasted, people are needlessly harmed, and other potentially more effective treatments are underutilized. Given that such regulatory decisions have these practical consequences, non-epistemic values about the relative importance of these consequences impact the way such regulatory decisions are made (similar to the analysis of laboratory studies on the toxic effects of dioxins presented in Douglas [2000]). To balance the competing demands of the pertinent non-epistemic values, regulators must perform what I call an “inductive risk calculus.” At least in the American context this inductive risk calculus is not well-managed. (shrink)

. Computational chemistry grew in a new era of “desktop modeling,” which coincided with a growing demand for modeling software, especially from the pharmaceutical industry. Parameterization of models in computational chemistry is an arduous enterprise, and we argue that this activity leads, in this specific context, to tensions among scientists regarding the epistemic opacity transparency of parameterized methods and the software implementing them. We relate one flame war from the Computational Chemistry mailing List in order to assess in detail the (...) relationships between modeling methods, parameterization, software and the various forms of their enclosure or disclosure. Our claim is that parameterization issues are an important and often neglected source of epistemic opacity and that this opacity is entangled in methods and software alike. Models and software must be addressed together to understand the epistemological tensions at stake. (shrink)

Most bioethicists who address questions to which global justice matters have not considered the significance of the disputes over the correct theory of global justice. Consequently, the significance of the differences between theories of global justice for bioethics has been obscured. In this paper, I consider when and how these differences are important. I argue that certain bioethical problems can be resolved without addressing disagreements about global justice. People with very different views about global justice can converge on the existence (...) of a duty to aid the very badly off — those in absolute poverty — wherever they may be. However, despite agreement on extreme cases, there should be disagreement over the extent of international obligations to those who are only relatively poor. Consequently, different theories of justice will diverge in their implications for a number of important problems in contemporary bioethics. I close by sketching in more detail two contemporary bioethical issues —concerning pharmaceutical patents and the health worker brain drain —and show how responses to them might be developed by cosmopolitan and statist liberals. (shrink)

Efforts by governments, firms, and patients to deliver pioneering drugs for critical health needs face a challenge of diminishing efficiency in developing those medicines. While multi-sectoral collaborations involving firms, researchers, patients, and policymakers are widely recognized as crucial for countering this decline, existing incentives to engage in drug development predominantly target drug manufacturers and thereby do little to stimulate collaborative innovation. In this mini review, we consider the unexplored potential within pharmaceutical regulations to create novel incentives to encourage a diverse (...) set of actors from the public and private spheres to engage in the kind of collaborative knowledge exchange requisite for fostering enhanced innovation in early drug development. (shrink)

Mainstream views of medical research tell us it should be a fact-based, value-free endeavor: what a scientist (or her funding source) wants or cares about should not influence her findings. At the same time, we also sometimes criticize medical research for failing to embody certain values, e.g. when we criticize pharmaceutical companies for largely ignoring the diseases that affect the global poor. This chapter seeks to reconcile these perspectives by distinguishing appropriate from inappropriate influences of values on medical research. It (...) divides this broad question into two narrower ones, the Role Question (at what points in the research process is value influence potentially acceptable?) and the Content Question (when value influence is potentially acceptable, what specific values should researchers use?), and then draws on the philosophical literature on values in science to explore answers to each of them. (shrink)

Since the 1990’s, the debate concerning the ethical, legal and societal aspects of ‘neuro-enhancement’ has evolved into a massive discourse, both in the public realm and in the academic arena. This ethical debate, however, tends to repeat the same sets of arguments over and over again. Normative disagreements between transhumanists and bioconservatives on invasive or radical brain stimulators, and uncertainties regarding the use and effectivity of nootropic pharmaceuticals dominate the field. Building on the results of an extensive European project (...) on responsible research and innovation in neuro-enhancement, we observe and encourage that the debate is now entering a new and, as we will argue, more realistic and societally relevant stage. This new stage concerns those technologies that enter the market as ostensibly harmless contrivances that consumers may use for self-care or entertainment. We use the examples and arguments of participants in NERRI debates to describe three case studies of such purportedly innocent ‘toys’. Based upon this empirical material, we argue that these ‘soft’ enhancement gadgets are situated somewhere in the boundary zone between the internal and the external, between the intimate and the intrusive, between the familiar and the unfamiliar, between the friendly and the scary and, in Foucauldian terms, between technologies of the self and technologies of control. Therefore, we describe their physiognomy with the help of a term borrowed from Jacques Lacan, namely as “extimate” technologies. (shrink)

In times of crises, public health leaders may claim that trials of public health interventions are unethical. One reason for this claim can be that equipoise—i.e. a situation of uncertainty and/or disagreement among experts about the evidence regarding an intervention—has been disturbed by a change of collective expert views. Some might claim that equipoise is disturbed if the majority of experts believe that emergency public health interventions are likely to be more beneficial than harmful. However, such beliefs are not always (...) justified: where high quality research has not been conducted, there is often considerable residual uncertainty about whether interventions offer net benefits. In this essay we argue that high-quality research, namely by means of well-designed randomized trials, is ethically obligatory before, during, and after implementing policies in public health emergencies (PHEs). We contend that this standard applies to both pharmaceutical and non-pharmaceutical interventions, and we elaborate an account of equipoise that captures key features of debates in the recent pandemic. We build our case by analyzing research strategies employed during the COVID-19 pandemic regarding drugs, vaccines, and non-pharmaceutical interventions; and by providing responses to possible objections. Finally, we propose a public health policy reform: whenever a policy implemented during a PHE is not grounded in high-quality evidence that expected benefits outweigh harms, there should be a planned approach to generate high-quality evidence, with review of emerging data at preset time points. These preset timepoints guarantee that policymakers pause to review emerging evidence and consider ceasing ineffective or even harmful policies, thereby improving transparency and accountability, as well as permitting the redirection of resources to more effective or beneficial interventions. (shrink)

In the monograph Philosophy and Psychedelics: Frameworks for Exceptional Experience, Hauskeller raises the important subject of individualization and alienation in psychedelic psychotherapy. Under the prevailing conditions of neoliberalism, Hauskeller contends that psychedelic-assisted psychotherapy appropriates Indigenous knowledges in an oppressive fashion, may be instrumentalised to the ends of productivity gain and symptom suppression, and may be utilised to mask societal systems of alienation. Whilst offering a valuable socio-political critique of psychedelics' clinical uptake, we suggest that Hauskeller's view does not adequately acknowledge (...) the ways in which psychedelics offer a challenge to the Western reductive bio-medical understanding of healing and wellbeing. It is contended herein that Indigenous knowledges, in alliance with a range of emerging sciences, offer both an engagement with ethnomedicines in a less harmfully appropriative fashion, and a renewed understanding of the means by which psychedelics achieve therapeutic change. With this understanding, what becomes apparent are the potential ways in which psychedelic medical usage may produce positive feedback upon the oppressive systems in which we are embedded. That is, transpersonal experience through encounters with the ineffable may offer a revisioning of Western psychology and cognitive science. Indeed, if psychedelics are approached with an understanding of the actual means by which they produce therapeutic outcomes—changing mental representations of the self, or self-insight derived through non-ordinary states of consciousness—then psychedelic psychotherapy offers a reimagining of psychiatric nosology, challenging conventional understandings of both pathology and wellbeing through an overturning of specified and discrete deficit models of psychopathology. This may provide both a critique of the prevailing categories used to describe madness and an expansion of our understanding of the mind-body relation, as well as an increased recognition of positive psychology grounded in cross-cultural contemplative traditions. This provides an implicit challenge to the pharmaceutical industrial-complex and its profit motives; and the corresponding neoliberalist, globalising tendencies which Hauskeller seeks to address. -/- . (shrink)

The article presents the advantages and limitations of adaptive clinical trials for assessing the effectiveness of medical interventions and specifies the conditions that contributed to their development and implementation in clinical practice. I advance two arguments by discussing different cases of adaptive trials. The normative argument is that responsible adaptation should be taken seriously as a new way of doing clinical research insofar as a valid justification, sufficient understanding, and adequate operational conditions are provided. The second argument is historical. The (...) development of adaptive trials can be related to lessons learned from research in cases of urgency and to the decades-long efforts to end the productivity crisis of pharmaceutical research, which led to the emergence of translational, personalized, and, recently, precision medicine movements. (shrink)

This paper focuses on invasive therapeutic procedures, defined as procedures requiring the introduction of hands, instruments, or devices into the body via incisions or punctures of the skin or mucous membranes performed with the intent of changing the natural history of a human disease or condition for the better. Ethical and methodological concerns have been expressed about studies designed to evaluate the effects of invasive therapeutic procedures. Can such studies meet the same standards demanded of those, for example, evaluating pharmaceutical (...) agents? This paper describes a research project aimed at examining the interplay and sometimes apparent conflict between ethical standards for human research and standards for methodological rigor in trials of invasive procedures. The paper discusses how the authors plan to develop a set of consensus standards that, if met, would result in substantial and much-needed improvements in the methodological and ethical quality of such trials. (shrink)

Abstract The values of the healthcare sector are fairly ubiquitous across the globe, focusing on caring and respect, patient health, excellence in care delivery, and multi-stakeholder collaboration. Many individual pharmacists embrace these core values. But their ability to honor these values is significantly determined by the nature of the system they work in. -/- The paper starts with a model of the prevailing pharmacist workforce model in Scotland, in which core roles are predominantly separated into hierarchically disaggregated jobs focused on (...) one professional ‘pillar’: Clinician /Practice Provider; Educator; Leader/Manager; and Researcher. This is the ‘Atomistic’ Model. This skills-segregation yields a workforce of individuals working in isolation rather than collaborating together, and lacking a shared information flow, purpose and identity. Key strategic flaws include suboptimal responsiveness to population and subpopulation needs, inconsistency and inequity of care, an erosion of professional agency, and lower job satisfaction. It is conjectured that this results from a lack of congruence between values, professional ethos, and organizational structure. ‘Atomism’ culminates in a syndrome of widespread professional-level cognitive dissonance. -/- The paper contrasts this with a new emerging workforce vision, The Collaborative Care Model. This new model defines a systems-first-approach, built on the principle that all jobs must include all four professional ‘pillars’. Vertical skills integration, involving education and task sharing, will support sustainability and succession planning. Horizontal skills integration (across practice, leadership and research) is included to improve responsiveness to population need and individual professional agency. The working conditions, supportive ethos, and career structure needed to make the model work are described. Moral theory and workforce theory are used to justify why the model may be more effective for population health, delivering greater job satisfaction for individuals and ultimately helping systematically realize and honor healthcare values. Finally, the paper sketches the first steps needed to implement the model at the national level, starting with the operationalization of new multi-pillar professional curricula across the career spectrum. Potential pitfalls and challenges are also discussed. -/- Co-Authors: 1. Paul Forsyth (PF) Lead Pharmacist Clinical Cardiology, Pharmacy, NHS Greater Glasgow & Clyde. Contribution: Conceptualization; Model Curation; Model Theory; Model Visualization; Writing - original draft (lead author), Writing - review & editing (lead author) 2. Andrew Radley (AR), Consultant in Public Health Pharmacy, NHS Tayside. Contribution: Conceptualization; Model curation; Model Theory; Writing - review & editing 3. Gordon Rushworth (GR), MPharm MSc FFRPS FRPharmS (Consultant). Programme Director, Highland Pharmacy Education & Research Centre, NHS Highland, Inverness. Contribution: Model curation; Writing - review & editing 4. Fiona Marra (FM) National Lead Clinician Scottish Infection and Immunology Network (SPAIIN) / Advanced Pharmacist HCV / HIV, NHS Greater Glasgow & Clyde. Contribution: Model curation; Writing - review & editing 5. Susan Roberts (SR) Associate Postgraduate Pharmacy Dean, NHS Education for Scotland. Contribution: Model curation; Writing - review & editing 6. Roisin O’Hare (RO) Lead Teacher Practitioner Pharmacist, Northern Ireland University Network, Southern Health and Social Care Trust. Contribution: Model curation; Writing - review & editing 7. Catherine Duggan (CD) Chief Executive Officer, International Pharmaceutical Federation (FIP). Contribution: Model curation; Writing - review & editing 8. Barry Maguire (BM) Senior Lecturer, School of Philosophy, Psychology and Life Sciences, The University of Edinburgh. Contribution: Conceptualization; Model Curation; Model Theory; Model Visualization; Supervision; Writing - original draft (senior academic supervisor), Writing - review & editing (senior academic supervisor) -/- . (shrink)

In this article I evaluate a resurrected French resistance movement--to biotechnological commodification. The official French view that ‘the body is the person’ has been dismissed as a ‘taboo’ by the French political scientist Dominique Memmi . Yet France has indeed resisted the models of globalised commodification adopted in US bioechnology, as, for example, when the government blocked a research collaboration between the American firm Millennium Pharmaceuticals and a leading genomics laboratory, le Centre d’Etude du Polymorphisme Humain, on the grounds (...) the ‘French DNA’ should not be given away. -/- This example, however, itself suggests why the ‘new French Resistance’ is not altogether liberating. The absolutist conception of all bodies as belonging to the French state—indeed, as constituting the body politic —is so potentially invasive that a counter-ideology of inviolability of the body is maintained assiduously. This inviolability is defended particularly strongly against commercialisation, but only at the moment when tissue is taken from the individual subject, who is not to be paid or compensated-- although commercial enterprises who subsequently use the tissue are not similarly constrained. -/- . (shrink)

Introduction: There is currently no binding, internationally accepted and successful approach to ensure global equitable access to healthcare during a pandemic. The aim of this ethical analysis is to bring into the discussion a legally regulated vaccine allocation as a possible strategy for equitable global access to vaccines. We focus our analysis on COVAX (COVID-19 Vaccines Global Access) and an existing EU regulation that, after adjustment, could promote global vaccine allocation. -/- Methods: The main documents discussing the two strategies are (...) examined with a qualitative content analysis. The ethical values reasonableness, openness and transparency, inclusiveness, responsiveness and accountability serve as categories for our ethical analysis. -/- Results: We observed that the decision-making processes in a legal solution to expand access to vaccines would be more transparent than in COVAX initiative, would be more inclusive, especially of nation states, and the values responsiveness and accountability could be easily incorporated in the development of a new regulation. -/- Discussion: A legal strategy that offers incentives to the pharmaceutical industry in return for global distribution of vaccines according to the Fair Priority Model is an innovative way to achieve global and equitable access to vaccines. However, in the long term, achieving the Sustainable Development Goals will require from all nations to work in solidarity to find durable solutions for global vaccine research and development. Interim solutions, such as our proposed legal strategy for equitable access to vaccines, and efforts to find long-term solutions must be advanced in parallel. (shrink)

One of the most attractive, but nevertheless highly controversial proposals to alleviate the negative effects of today’s international patent regime is the Health Impact Fund (HIF). Although the HIF has been drafted to facilitate access to medicines and boost pharmaceutical research, we have analysed the burdens for the global poor a similar proposal designed to promote the use and development of climate-friendly technologies would have. Drawing parallels from the access to medicines debate, we suspect that an analogous “Climate Impact Fund” (...) will increase the already very high scientific and technological supremacy of the developed world over the Global South. We advocate countering this dominance on the ground that countries with scarce research and development capacities will be in a difficult position to reject technologies and will not have a say on how such technologies should look like. Further, addressing global hazards should be an inclusive endeavour and not only a privilege reserved for the developed world. Incentivizing grassroots innovation would be a major step to promote scientific and technological inclusion. (shrink)

In response to the COVID-19 pandemic, large-scale research and pharmaceutical regulatory processes have proceeded at a dramatically increased pace with new and effective, evidence-based COVID-19 interventions rapidly making their way into the clinic. However, the swift generation of high-quality evidence and the efficient processing of regulatory authorisation have given rise to more specific and complex versions of well-known research ethics issues. In this paper, we identify three such issues by focusing on the authorisation of molnupiravir, a novel antiviral medicine aimed (...) at reducing the ability of SARS-CoV-2 to multiply in the body, for clinical use by the National Health Service in England and the concomitant testing of molnupiravir through the large-scale Platform Adaptive trial of Novel antiviRals for eArly treatMent of COVID-19 In the Community randomised control trial. By analysing the ways in which the authorisation and clinical use of molnupiravir complicate standard approaches to clinical equipoise, standard of care and participant consent in the PANORAMIC randomised control trial, we will explain some of ethical implications for clinical trials that aim to study the efficacy and safety of new COVID-19 and other therapeutics when conditional authorisation has already been granted and when such treatments have already been made available to patients by national health providers. (shrink)

There is a widespread consensus that a commodification of body parts is to be prevented. Numerous policy papers by international organizations extend this view to the blood supply and recommend a system of uncompensated volunteers in this area—often, however, without making the arguments for this view explicit. This situation seems to indicate that a relevant source of justified worry or unease about the blood supply system has to do with the issue of commodification. As a result, the current health minister (...) of Ontario is proposing a ban on compensation even for blood plasma—despite the fact that Canada can only generate 30 % of the plasma needed for fractionation into important plasma protein products and has to purchase the rest abroad. In the following, I am going to suggest a number of alternative perspectives on the debate in order to facilitate a less dogmatic and more differentiated debate about the matter. Especially in light of the often over-simplified notions of altruism and commodification, I conclude that the debate has not conclusively established that it would be morally objectionable to provide blood plasma donors with monetary compensation or with other forms of explicit social recognition as an incentive. This is especially true of donations for fractionation into medicinal products by profit-oriented pharmaceutical companies. (shrink)

Synthetic biology is a field of research that concentrates on the design, construction, and modification of new biomolecular parts and metabolic pathways using engineering techniques and computational models. By employing knowledge of operational pathways from engineering and mathematics such as circuits, oscillators, and digital logic gates, it uses these to understand, model, rewire, and reprogram biological networks and modules. Standard biological parts with known functions are catalogued in a number of registries (e.g. Massachusetts Institute of Technology Registry of Standard Biological (...) Parts). Biological parts can then be selected from the catalogue and assembled in a variety of combinations to construct a system or pathway in a microbe. Through the innovative re-engineering of biological circuits and the optimization of certain metabolic pathways, biological modules can be designed to reprogram organisms to produce products or behaviors. Synthetic biology is what is known as a “platform technology”. That is, it generates highly transferrable theoretical models, engineering principles, and know-how that can be applied to create potential products in a wide variety of industries. Proponents suggest that applications of synthetic biology may be able to provide scientific and engineered solutions to a multitude of worldwide problems from health to energy. Synthetic biology research has already been successful in constructing microbial products which promise to offer cheaper pharmaceuticals such as the antimalarial synthetic drug artemisinin, engineered microbes capable of cleaning up oil spills, and the engineering of biosensors that can detect the presence of high concentrations of arsenic in drinking water. One of the potential benefits of synthetic biology research is in its application to biofuel production. It is this application which is the focus of this entry. The term “biofuel” has referred generally to all liquid fuels that are sourced from plant or plant byproducts and are used for energy necessary for transportation vehicles (Thompson 2012). Biofuels that are produced using synthetic biological techniques re-engineer microbes into biofuel factories are a subset of these. (shrink)

Lockdowns, or modern quarantines, involve the use of novel restrictive non-pharmaceutical interventions (NPIs) to suppress the transmission of COVID-19. In this paper, I aim to critically analyze the emerging history and philosophy of lockdowns, with an emphasis on the communication of health evidence and risk for informing policy decisions. I draw a distinction between evidence-based and modeling-based decision-making. I argue that using the normative framework of evidence-based medicine would have recommended against the use of lockdowns. I first review the World (...) Health Organization’s evidence-based pandemic preparedness plans for respiratory viruses. I then provide a very brief history of COVID-19 modeling, which was cited as justification for the use of lockdowns in the U.K., the U.S., and much of the world. I focus on the so-called Imperial College model designed by Neil Ferguson et al. as well as the so-called Oxford model designed by José Lourenço et al. I analyze the evidence-based pandemic response known as ‘mitigation’, and I compare it with Ferguson et al.’s experimental strategy known as ‘suppression’. I summarize the strengths and weaknesses of these strategies based on their diametric aims and each model’s parametric assumptions. Based on my critical analysis of the suppression strategy, I attempt to expose what has been called the ‘logic of lockdowns’, which Sunetra Gupta of the Oxford model group has suggested is flawed. Finally, I consider Trisha Greenhalgh’s objection to evidence-based policy based on the precautionary principle, and I attempt to offer a response. I conclude with a brief narrative review of the emerging randomized evidence on restrictive NPIs, which seems to support my claim that mitigation was the strategy that would have been recommended by evidence-based medicine. If this is true, then COVID-19 modeling may serve as an important reminder of the enduring lesson of evidence-based medicine: that one should always ‘Trust the Evidence!’ for better health policy. (shrink)