Conflict of interest in medical research in Estonia

An area where conflicts of interest can take place in Estonia is in the conduct of clinical trials. The paper lists the main areas where such conflicts of interest can occur. The author also briefly discusses Estonia’s current position with regard to regulating genetic information and the commencement of the Estonian Genome Project. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

Conflict of interest: the importance of potential

The UK Medical Research Council (MRC) takes the issue of conflict of interest very seriously. The overall aim is to preserve a climate in which personal and organisational innovation can flourish while ensuring that potential conflicts are disclosed and identified and conflicts are either avoided or managed with integrity. The approach needs to encompass the MRC’s various responsibilities and the levels at which conflicts might arise: MRC staff (scientists and administrators); the governing Council; research Boards and committees; external peer-reviewers; and applicants for funding. To achieve its goals, the MRC has issued practical guidance on various aspects of conflict of interest. For the future, the MRC has identified the continuing commercialisation of science and the increasing involvement of lay people in scientific decision-making as special challenges in this area. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

A baldrige process for ethics?

In this paper we describe and explore a management tool called the Caux Round Table Self-Assessment and Improvement Process (SAIP). Based upon the Caux Round Table Principles for Business — a stakeholder-based, transcultural statement of business values — the SAIP assists executives with the task of shaping their firm’s conscience through an organizational self-appraisal process. This process is modeled after the self-assessment methodology pioneered by the Malcolm Baldrige National Quality Award Program. After briefly describing the SAIP, we address three topics. First, we examine similarities and differences between the Baldrige approach to corporate self-assessment and the self-assessment process utilized within the SAIP. Second, we report initial findings from two beta tests of the tool. These illustrate both the SAIP’s ability to help organizations strengthen their commitment to ethically responsible conduct, and some of the tool’s limitations. Third, we briefly analyze various dimensions of the business scandals of 2001–2002 (Enron, WorldCom, Tyco, etc.) in light of the ethical requirements articulated with the SAIP. This analysis suggests that the SAIP can help link the current concerns of stakeholders — for example, investors and the general public — to organizational practice, by providing companies with a practical way to incorporate critical lessons from these unfortunate events. An earlier version of this paper was presented at the “Ethics and Social Responsibility in Engineering and Technology” meeting, New Orleans, 2003.     

Conflicts of interest in science and medicine: the physician's perspective

The various statements and declarations of the World Medical Association that address conflicts of interest on the part of physicians as (1) researchers, and (2) practitioners, are examined, with particular reference to the October 2000 revision of the Declaration of Helsinki. Recent contributions to the literature, notably on conflicts of interest in medical research, are noted. Finally, key provisions of the American Medical Association’s Code of Medical Ethics (2000–2001 Edition) that address the various forms of conflict of interest that can arise in the practice of medicine are outlined. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002. The World Medical Association (WMA) is a global federation of National Medical Associations representing the millions of physicians worldwide. Acting on behalf of patients and physicians, the WMA endeavours to achieve the highest possible standards of medical care, ethics, education and health-related human rights for all people.     

Individual and institutional conflict of interest: policy review by research universities in the United States

This paper is a discussion of efforts to manage real and potential conflicts of interest in university research in the United States. The focus is on the report by an Association of American Universities (AAU) task force that addresses both individual and institutional conflict of interest issues. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

Warrant without truth?

This paper advances the debate over the question whether false beliefs may nevertheless have warrant, the property that yields knowledge when conjoined with true belief. The paper’s first main part—which spans Sections 2–4—assesses the best argument for Warrant Infallibilism, the view that only true beliefs can have warrant. I show that this argument’s key premise conflicts with an extremely plausible claim about warrant. Sections 5–6 constitute the paper’s second main part. Section 5 presents an overlooked puzzle about warrant, and uses that puzzle to generate a new argument for Warrant Fallibilism, the view that false beliefs can have warrant. Section 6 evaluates this pro-Fallibilism argument, finding ultimately that it defeats itself in a surprising way. I conclude that neither Infallibilism nor Fallibilism should now constrain theorizing about warrant.     

Identity as self-transformation: emotional conflicts and their metamorphosis in memory

This paper develops the thesis that personal identity is neither to be taken in terms of an unchanging self-sufficient ‘substance’ nor in terms of selfhood ‘without substance,’ i.e. as fluctuating processes of pure relationality and subject-less activity. Instead, identity is taken as self-transformation that is bound to particular embodied individuals and surpasses them as individuated entities. The paper is structured in three parts. Part I describes the experiential givenness of conflicts that support our sense of self-transformation. While the first part develops an inter-subjective topography of emotional movements, the second part pays attention to their temporal dimension. We work with conflicts and get transformed by them also in the way we remember them. Part II focuses on the process of self-understanding that accompanies conflicts and their metamorphosis in memory. Part III compares and discusses different models of a ‘relational ontology’ of the person, which question the idea that we are defined only by how we define ourselves—just as they question the idea that one’s identity is independent of how one relates to one’s having changed.     

Conflict of interest in Croatia: doctors with dual obligations

There is an emerging awareness of the possibility of conflicts of interest in the practice of medicine in Croatia. The paper examines areas within the medical profession where conflicts of interest can and have occurred, probably not only in Croatia. Particularly addressed are situations when a doctor may have dual obligations and how independent ethics committees can help in decreasing the influence of a conflict of interest. The paper also presents extracts from the Croatian Code of Ethics for the medical profession that address problems of conflict of interest. An earlier version of this paper entitled was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

Modern medicine and biotechnology: an ethical conflict of interest?

When confronting the issues related to developments in modern medicine and biotechnology, we must repeatedly ask ourselves anew what can and cannot be justified in an ethical sense. For radically new ethical questions seem to arise through innovative techniques such as stem cell research or preimplantation diagnosis — and with them new areas of conflicting interests. If one scrutinizes the previous positions related to this subject, it becomes conspicuous that a multitude of questions has quickly piled up — however, (as in the case of Germany) comprehensive and differentiated views have mostly been lacking. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

Teaching business ethics to professional engineers

Without question “business ethics” is one of the hot topics of the day. Over the past months we have seen business after business charged with improper practices that violate commonly-accepted ethical norms. This has led to a loss of confidence in corporate management, and has had severe economic consequences. From many quarters business educators have heard the call to put more emphasis on ethical practices in their business courses and curricula. Engineering educators are also heeding this call, since the practice of engineering usually involves working for (or leading) a business and/or engaging in business transactions. In the summer of 2002, Auburn University’s Engineering Professional Development program made the decision to produce—based on the author’s Executive MBA course in Business Ethics—a distance-delivered continuing education program for professional engineers and surveyors. Participants across the USA now may use the course to satisfy continuing education requirements with respect to professional licensing and certification. This paper outlines the purpose and content of the course and describes its production, distribution, application, and evaluation. An earlier version of this paper was presented at the “Ethics and Social Responsibility in Engineering and Technology” meeting, New Orleans, 2003.     

The continuing need for disinterested research

For scientific knowledge to be trustworthy, it needs to be dissociated from material interests. Disinterested research also performs other important non-instrumental roles. In particular, academic science has traditionally provided society with reliable, imaginative public knowledge and independent, self-critical expertise. But this type of science is not compatible with the practice of instrumental research, which is typically proprietary, prosaic, pragmatic and partisan. With ever-increasing dependence on commercial or state funding, all modes of knowledge production are merging into a new, ‘post-academic’ research culture which is dominated by utilitarian goals. Growing concern about conflicts of interest is thus a symptom of deep-seated malaise in science and medicine. An expanded version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

Feyerabend, Pseudo-Dionysius, and the Ineffability of Reality

This paper explores the influence of the fifth-century Christian Neoplatonist Pseudo-Dionysius the Areopagite (Denys) on the twentieth-century philosopher of science Paul Feyerabend. I argue that the later Feyerabend took from Denys a metaphysical claim—the ‘doctrine of ineffability’—intended to support epistemic pluralism. The paper has five parts. Part one introduces Denys and Feyerabend’s common epistemological concern to deny the possibility of human knowledge of ultimate reality. Part two examines Denys’ arguments for the ‘ineffability’ of God as presented in On the Divine Names. Part three then explores how Feyerabend imported Denys’ account of divine ineffability into his own metaphysics to provide a novel argument for epistemic pluralism. Part four explains the significance of an appreciation of Dionyius’ influence for our understanding of Feyerabend. I conclude that Denys was a significant and neglected influence upon the later Feyerabend.     

The impact of conflict of interest on trust in science

Conflicts of interest have an erosive effect on trust in science, damaging first the attitude of the public toward scientists and their research, but also weakening the trusting interdependence of scientists. Disclosure is recognized as the key tool for management of conflicts, but rules with sanctions must be improved, new techniques for avoidance of financial conflicts by alternative funding of evaluative research must be sought, and there must be new thinking about institutional conflicts of interest. Our profession is education, and both the public and research professionals of all ages would benefit from greater understanding of how science should and does work. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

A New Form of Agent-Based Virtue Ethics

In Morals From Motives, Michael Slote defends an agent-based theory of right action according to which right acts are those that express virtuous motives like benevolence or care. Critics have claimed that Slote’s view— and agent-based views more generally— cannot account for several basic tenets of commonsense morality. In particular, the critics maintain that agent-based theories: (i) violate the deontic axiom that “ought” implies “can”, (ii) cannot allow for a person’s doing the right thing for the wrong reason, and (iii) do not yield clear verdicts in a number of cases involving “conflicting motives” and “motivational over-determination”. In this paper I develop a new agent-based theory of right action designed to avoid the problems presented for Slote’s view. This view makes morally right action a matter of expressing an optimal balance of virtue over vice and commands agents in each situation to improve their degree of excellence to the greatest extent possible.     

Phenomenological immanence,normativity, and semantic externalism

This paper argues that transcendental phenomenology (here represented by Edmund Husserl) can accommodate the main thesis of semantic externalism, namely, that intentional content is not simply a matter of what is ‘in the head,’ but depends on how the world is. I first introduce the semantic problem as an issue of how linguistic tokens or mental states can have ‘content’—that is, how they can set up conditions of satisfaction or be responsive to norms such that they can succeed or fail at referring. The standard representationalist view—which thinks of the problem in first-person terms—is contrasted with Brandom’s pragmatic inferentialist approach, which adopts a third-person stance. The rest of the paper defends a phenomenological version of the representationalist position (seeking to preserve its first-person stance) but offers a conception of representation that does not identify it with an entity ‘in the head.’ The standard view of Husserl as a Cartesian internalist is undermined by rejecting its fundamental assumption—that Husserl’s concept of the ‘noema’ is a mental entity—and by defending a concept of ‘phenomenological immanence’ that has a normative, rather than a psychological, structure. Finally, it is argued that phenomenological immanence cannot be identified with ‘consciousness’ in Husserl’s sense, though consciousness is a necessary condition for it.     

Misplaced Priorities: Gutmann’s Democratic Theory,Children’s Autonomy,and Sex Education Policy

This paper offers a critique of the “democratic state of education” proposed by Amy Gutmann in her influential book Democratic Education. In the democratic state of education, educational authority is shared among the state, parents and educational professionals; and educational objectives are geared toward equipping future citizens to participate in what Gutmann calls “conscious social reproduction”—the collective shaping of the future of society through democratic deliberation. Although I agree with some of Gutmann’s broad recommendations for civic education, I have misgivings about the centrality that she gives to conscious social reproduction in her theory of education. I argue that in focusing so intently on the facilitation of conscious social reproduction, Gutmann’s theory makes insufficient room for the basic interests of individual children, and in particular, their prospective interest in autonomy. Gutmann’s considered position on sex education policy—specifically, her willingness to allow local communities to deny their children access to sex education—exemplifies the shortcomings of her theory. Ultimately, her democratic state of education fails to acknowledge the fundamental moral importance of individual flourishing, and the contribution that education can and should make to it.     

Managing financial conflicts of interest in clinical research

Upholding public trust in clinical research necessitates that human subjects be protected from avoidable harm and that the design, interpretation and reporting of research results be shielded from avoidable bias. On both counts, managing financial conflicts of interest is critically important, especially in the modern era when the opportunities for investigators to benefit personally from the commercialization of their intellectual property are overtly encouraged and rapidly expanding. Efforts are underway in the United States to provide more useful guidance to universities and medical schools for purposes of strengthening the oversight and management of financial conflicts of interest in clinical research. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

Analog and digital,continuous and discrete

Representation is central to contemporary theories regarding the mind/brain. But the nature of representation—both in the mind/brain and more generally—is a source of ongoing controversy. One way of categorizing representational types is to distinguish between the analog and the digital: the received view is that analog representations vary smoothly, while digital representations vary in a step-wise manner. In other words, ‘digital’ is synonymous with ‘discrete’, while ‘analog’ is synonymous with ‘continuous’. I argue that this characterization is inadequate to account for the ways in which representation is (and should be) used in cognitive science; in its place, I suggest an alternative taxonomy. I will defend and extend David Lewis’s account of analog and digital representation, distinguishing analog from continuous representation, as well as digital from discrete representation. I will argue that the distinctions available in this fourfold account better accord with representational features of interest in cognitive science than the received analog/digital dichotomy.     

Conflict or harmony? Clinical research and the medical press in Russia

The author relates conditions for conducting clinical trials in Russia, current experiences of ethics committees, areas where conflicts of interest can occur regarding publishing the results of clinical trials in medical journals and the state of medical journalism in Russia today. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002. The author is a science editor of Meditsynskaya Gazeta.     

Message Framing,Normative Advocacy and Persuasive Success

In a recent article in Argumentation, O’Keefe (Argumentation 21:151–163, 2007) observed that the well-known ‘framing effects’ in the social psychological literature on persuasion are akin to traditional fallacies of argumentation and reasoning and could be exploited for persuasive success in a way that conflicts with principles of responsible advocacy. Positively framed messages (“if you take aspirin, your heart will be more healthy”) differ in persuasive effect from negative frames (“if you do not take aspirin, your heart will be less healthy”), despite containing ‘equivalent’ content. This poses a potential problem, because people might be unduly (and unsuspectingly) influenced by mere presentational differences. By drawing on recent cognitive psychological work on framing effects in choice and decision making paradigms, however, we show that establishing whether two arguments are substantively equivalent—and hence, whether there is any normative requirement for them to be equally persuasive—is a difficult task. Even arguments that are logically equivalent may not be information equivalent. The normative implications of this for both speakers and listeners are discussed.