On the fragility of medical virtue in a neoliberal context: the case of commercial conflicts of interest in reproductive medicine

Social, political, and economic environments play an active role in nurturing professional virtue. Yet, these environments can also lead to the erosion of virtue. As such, professional virtue is fragile and vulnerable to environmental shifts. While physicians are often considered to be among the most virtuous of professional groups, concern has also always existed about the impact of commercial arrangements on physicians’ willingness and capacity to enact their professional virtues. This article examines the ways in which commercial arrangements have been negotiated to secure medical virtue from real or perceived threats of erosion. In particular, we focus on the concern surrounding conflicts of interest arising from commercial arrangements that have developed as a result of neoliberal economic and social policies. The deregulation of medical markets and privatization of services have produced new commercial relationships that are often misunderstood by patients, publics, and physicians themselves. ‘Conflicts of interest’ policies have been introduced in an attempt to safeguard ethical conduct and medical practice. However, a number of virtue ethicists have critiqued these policies as inadequate for securing virtue. We examine the ways in which commercial arrangements have been seen to impact upon medical virtue, both historically and in the context of modern medicine (using the example of fertility services in Australia). We then describe and critique current efforts to restore clinical virtue through both conflict of interest policies and through virtue ethics. Finally, we suggest some possible ways of addressing the corrosive effects of neoliberalism on medical virtue.     

Evidence for a boundary effect in roll vection

Large circular displays rotating around the line of sight produce an illusion in which the seen orientation of the true vertical is shifted in a direction opposite to the display’s motion. Two experiments were performed to determine whether the magnitude of this illusory tilt is a function of the area of display elements, of their boundary length, or of their spatial frequency. In Experiment 1, 12 subjects viewed each of nine displays across which the number and area of the circular elements were independently varied. Three of the displays were equated for the area of their elements. The results suggested that tilt magnitude and onset latency could be explained by a boundary length effect. A second experiment tested eight subjects on two displays, equated for element boundary length but differing in the spatial frequency of the elements. The displays produced closely similar illusory trite corroborating the view that, within broad limits, element boundary length—and not spatial frequency or area—determines the size and onset latency of illusory tilt. A third experiment confirmed previous research in finding greater tilt and more rapid onset with more peripherally projected displays.     

The child-psychoanalytic play interview: a technique for studying thematic content.

Child psychoanalysts have long viewed play as a reflection of children's inner lives and have used the themes children represent in play for diagnostic and therapeutic work. Given the central role children's play has for clinical work, few studies have addressed play empirically. This paper presents a technique for studying the thematic content of children's play as it emerges during a play session with a child analyst. We report the steps involved in developing this investigative technique and describe the interobserver agreement among four rates using the technique with videotaped play sessions. Implications for future research using such an approach are discussed.     

The nomological validity of the Type A personality among employed adults

The nomological validity of the Type A behavior pattern was explored. The Structured Interview (SI) and a battery of personality trait, physical health, and strain measures were administered to an occupationally diverse sample of 568 workers. Ss were also monitored for physiological reactivity and recovery (blood pressure, heart rate, skin temperature, and electrodermal response) to the SI and a subsequent Stroop Color-Word Conflict Task. A confirmatory factor analysis demonstrated that SI scores can be factored into three distinct dimensions. There was considerable overlap in the patterns of personality traits that characterized the Type A components, but only a Hostility dimension was significantly related to physiological reactivity and recovery. The results have implications for distinguishing coronary-proneness from the more traditional Type A conceptualization.     

Chicks' responses to familiar stimuli in unfamiliar environments

The aim of the present experiments was to find out how imprinted chicks respond to familiar figures in unfamiliar settings. Experiment I showed that chicks individually imprinted with a coloured stationary disc did not readily approach it when later confronted with it in a larger pen—a confirmation of an earlier finding. Experiment II showed a similar disruptive effect when the chicks were individually presented with a stationary object (a ball) in a pen differing in colour from the original one. Experiment III, however, in which chicks were imprinted to a moving ball, showed unattenuated imprinting when testing took place in a strange environment. It was concluded that the disruptive effect of neophobia can be overcome when a high degree of figure salience ensures powerful imprinting.     

Resisting Explanation

Although explanation is widely regarded as an important concept in the study of rational inquiry, it remains largely unexplored outside the philosophy of science. This, I believe, is not due to oversight as much as to institutional resistance. In analytic philosophy it is basic that epistemic rationality is a function of justification and that justification is a function of argument. Explanation, however, is not argument nor is belief justification its function. I argue here that the task of incorporating explanation into the theory of rational inquiry poses a serious challenge to our basic concept of epistemic rationality as well as the a priori method of inquiry that still lies at the heart of analytic philosophy. Specifically, it pushes us toward a much stronger form of naturalism than is generally thought necessary, one in which argument and explanation are recognized as distinct and equally fundamental cognitive processes whose dynamic relationship is one of the central issues in the theory of rationality.     

Neurobiology of prenatal cocaine exposure effect on developing monoamine systems

Cocaine and crack belong to a broad category of agents that act primarily as central nervous system stimulants at the level of the monoaminergic neurotransmitter system (dopamine, norepinephrine, and serotonin). These neurotransmitters are involved in the regulation of a number of basic psychological functions including attention and arousal and play a crucial role in the defining of brain structure and neuronal formation. This paper outlines what is currently known about the direct effects of cocaine on the mature and developing central nervous system. Three general points are reviewed: (1) Cocaine has differing effects on structural and functional brain development throughout gestation (e.g., there is not a single, all or none effect); (2) No one area of the brain is singularly affected. Areas related by the monoaminergic system are differentially influenced and affecting one area may result in a functional change in another; and (3) Because substantial brain growth, synaptic formation, and remodeling occur in the first months after birth, ongoing postnatal exposure to cocaine also carries risk for direct effects on brain function. Understanding the developmental neurobiological effects of cocaine provides data to guide studies in infants and young children of how prenatal cocaine exposure may contribute to specific, biologically based areas of neurological vulnerability that will be expressed behaviorally and developmentally in the first 3 to 5 years of life.     

Visuospatial working memory in school-aged children exposed in utero to cocaine.

OBJECTIVE: Among the neurocognitive impairments reported as associated with prenatal cocaine exposure, slower response time, and less efficient learning in school-aged children are common to findings from several laboratories. This study presents performance data on a spatial working memory task in 75 prenatally cocaine exposed (CE) and 55 nondrug-exposed (NDE) 8- to 10-year-old children. METHODS: Children were administered a novel neuropsychological measure of immediate- and short-term memory for visuospatial information, the Groton Maze Learning Test (GMLT), a computer-based hidden maze learning test that consists of a "timed chase test" (a simple measure of visuomotor speed), eight learning trials followed by a delayed recall trial after an 8-minute delay and a reverse learning trial. Performance is expressed as correct moves per second and number of errors per trial. RESULTS: Across all trials, the cocaine-exposed group showed significantly slower correct moves per second and made significantly more errors. There were no significant main effects for amounts of alcohol, tobacco, or marijuana exposure. After an 8-minute delay and compared to the eighth trial, cocaine-exposed children showed less consolidation in learning compared to nonexposed children. When asked to complete the maze in reverse, cocaine-exposed children showed a greater decrement in performance (decreased correct moves per second and increased errors) compared to the eighth learning trial. CONCLUSIONS: Children exposed in utero to cocaine exhibit a possible impairment in procedural learning and diminished efficiency in creating and accessing an internal spatial map to master the hidden maze.     

Substance use and mothers’ neural responses to infant cues

Substance use may influence mothers’ responsiveness to their infants and negatively impact the parent–infant relationship. Maternal substance use may co-opt neural circuitry involved in caregiving, thus reducing the salience of infant cues and diminishing the sense of reward experienced by caring for infants. Gaps in understanding exist with regard to the mechanisms by which substance use operates to influence mothers’ processing of infant cues and how this translates to caregiving. Therefore, we examined how substance use might relate to maternal neural responses to infant cues using event-related potentials (ERPs). Substance-using (n = 29) and nonsubstance-using (n = 29) mothers viewed photographs of infant faces and heard recordings of infant vocalizations while electroencephalography was recorded simultaneously. Three specific ERP components were used to examine initial processing of infant faces (N170) and cries (N100), and attentional allocation to infant faces and cries (P300). Substance-using mothers did not discriminate facial affect at early encoding stages (N170), were generally slower to orient to infant cries (N100), showed heightened responses to neutral faces (P300), and failed to adaptively differentiate between high-distress versus low-distress cries (P300). These differences may be important to caregiving behaviors associated with the formation of mother–child attachment. Implications are discussed, as are limitations and future directions.