Dien Ho

Antibiotic-resistant bacteria pose a serious threat to our health. Our ability to destroy deadly bacteria by using antibiotics have not only improved our lives by curing infections, it also allows us to undertake otherwise dangerous treatments from chemotherapies to invasive surgeries. The emergence of antibiotic resistance, I argue, is a consequence of various iterations of prisoner’s dilemmas. To wit, each participant (from patients to nations) has rational self-interest to pursue a course of action that is suboptimal for all of us. The standard solutions to prisoner’s dilemma look to realign cost-benefit such that individuals’ interests match those of the collective. However, the lack of a global organization to enforce an effective carrot-and-stick system makes it unlikely that we can solve the antibiotic resistance problem this way. I argue that our best chance might be an attempt to teach altruism and convince individuals to act not out of their self-interests.

Rationale and objectives: Medical humanities are becoming increasingly recognized as positively impacting medical education and medical practice. However, the extent of medical humanities teaching in medical schools is largely unknown. We reviewed medical school curricula in Canada, the UK and the US. We also explored the relationship between medical school ranking and the inclusion of medical humanities in the curricula. Methods: We searched the curriculum websites of all accredited medical schools in Canada, the UK and the US to check which medical humanities topics were taught, and whether they were mandatory or optional. We then noted rankings both by Times Higher Education and U.S. News and World Report and calculated the average rank. We formally explored whether there was an association between average medical school ranking and medical humanities offerings using Spearman's correlation and inverse variance weighting meta-analysis. Results: We identified 18 accredited medical school programmes in Canada, 41 in the UK, and 154 in the US. Of these, nine (56%) in Canada, 34 (73%) in the UK and 124 (80%) in the US offered at least one medical humanity that was not ethics. The most common medical humanities were medical humanities (unspecified), history, and literature (Canada); sociology and social medicine, medical humanities (unspecified), and art (UK); and medical humanities (unspecified), literature and history (US). Higher ranked medical schools appeared less likely to offer medical humanities. Conclusions: The extent and content of medical humanities offerings at accredited medical schools in Canada, the UK and the US varies, and there appears to be an inverse relationship between medical school quality and medical humanities offerings. Our analysis was limited by the data provided on the Universities' websites. Given the potential for medical humanities to improve medical education and medical practice, opportunities to reduce this variation should be exploited.

Students with recent immigrant roots disproportionately choose educational trajectories in STEM. In addition to the perception that STEM represents the "path of least racism," many students assume the responsibility of contributing to their families' financial wellbeing. In this talk, I share my experience teaching at a pre-professional healthcare university with a large percentage of 1st and 2nd-generation Asian immigrant students. Many of them seek advice on how to negotiate the social and familial pressure to pursue STEM against their interests in the humanities. The reply "Follow your heart" might be inappropriate when familial obligations and perceived bigotry are legitimate deterrents. By recognizing the grand tradition of one immigrant generation trying to improve the lot for the next, we strive not merely for financial freedom but freedom in general. As such, we ought to consider how we can spend our lives to best dismantle the barriers that limit our life choices.

ABSTRACT A number of philosophers have argued that alcoholics should receive lower priority for liver transplantations because they are morally responsible for their medical conditions. In this paper, I argue that this conclusion is false. Moral responsibility should not be used as a criterion for the allocation of medical resources. The reason I advance goes further than the technical problem of assessing moral responsibility. The deeper problem is that using moral responsibility as an allocation criterion undermines the functioning of medicine.

This anthology provides a collection of new essays on ethical and philosophical issues that concern the development, dispensing, and use of pharmaceuticals. It brings together critical ethical issues in pharmaceutics that have not been included in any collection (e.g., the ethics of patients as researchers). In addition, it includes philosophical issues that are not within the traditional domain of applied ethics. For example, a game-theoretic approach to combating the emergence of antibiotic-resistent pathogens by spreading altruism. A tripartite distinction provides an organized series of discussions that shows the interrelatedness of philosophical issues from the creation of pharmaceuticals, the creation of demand for them, through their delivery to their ultimate consumption.

This book sheds light on important philosophical assumptions made by professionals working in clinical and research medicine. In doing so, it aims to make explicit how active philosophy is in medicine and shows how this awareness can result in better and more informed medical research and practice. It examines: what features make something a scientific discipline; the inherent tensions between understanding medicine as a research science and as a healing practice; how the “replication crisis” in medical research asks us to rethink the structure of knowledge production in our modern world; whether explanations have any real scientific values; the uncertainties about probabilistic claims; and whether it is possible for evidence-based medicine to truly be value free. The final chapter argues that the most important question we can ask is not, “How can we separate values from science?” but, “In a democratic society, how can we decide in a politically and morally acceptable way what values should drive science?”

In his "Let the drugs lead the way! On the unfolding of a research program in psychiatry," Shai Mulinari nicely lays out the evolution of theories of depression since the late 1950s; that is, understanding depression as ultimately a brain disorder centering on the functioning of monoamine neurotransmitters. Moreover, the emergence of various psychotropic drug treatments have provided researchers with a "pharmacological bridge" to gain a more precise understanding of depression by observing the effects of these drugs on patients' monoamines and mood. This evolution, Mulinari argues, fits Imre Lakatos's concept of a research program. Mulinari's narrative is clear, compelling, and informative and it generates some...

Many clinical ethicists have argued that ethics expertise is impossible. Their skeptical argument usually rests on the assumptions that to be an ethics expert is to know the correct moral conclusions, which can only be arrived at by having the correct ethical theories. In this paper, I argue that this skeptical argument is unsound. To wit, ordinary ethical deliberations do not require the appeal to ethical or meta-ethical theories. Instead, by agreeing to resolve moral differences by appealing to reasons, the participants agree to the Default Principle—a substantive rule that tells us how to adjudicate an ethical disagreement. The Default Principle also entails a commitment to arguments by parity, and together these two methodological approaches allow us to make genuine moral progress without assuming any deep ethical principles. Ethical expertise, in one sense, is thus the ability and knowledge to deploy the Default Principle and arguments by parity.

Placebo effects raise some fundamental questions concerning the nature of clinical and medical research. This Element begins with an overview of the different roles placebos play, followed by a survey of significant studies and dominant views about placebo mechanisms. It then critically examines the concept of placebo and offers a new definition that avoids the pitfalls of other attempts. The main philosophical lesson is that background medical theories provide the ontology for clinical and medical research. Because these theories often contain incoherent and arbitrary classifications, the concept of placebo inherits the same messiness. The Element concludes by highlighting some impending challenges for placebo studies.

Nocebo effects occur when an individual experiences undesirable physiological reactions caused by doxastic states that are not a treatment’s core or characteristic features.1 As Scott Gelfand2 points out, there are numerous studies that have shown that the disclosure of a treatment’s side effects to a patient increases the risk of the side effects. From an ethical point of view, nocebo effects caused by the disclosures of side effects present a challenging problem. On the one hand, clinicians’ duty to inform patients of the consequences (including possible side effects) of their treatments is critical in ensuring that patients’ autonomy is respected. Patients cannot act autonomously if relevant information is withheld from them (without their consent, perhaps). On the other hand, clinicians also ought to minimize harm to patients.

The ubiquitous presence of pharmaceuticals in our lives is underappreciated. In the United States between 2009 and 2012, almost half the population used at least one prescription drug and more than one in ten Americans used five or more prescription drugs within a 30-day period. The use of pharmaceuticals is so widespread that runoffs from incorrect disposal of drugs have become a pollutant in our drinking water. In 2009, researchers found 51 different pharmaceuticals from beta-blockers to antianxiety medications to anticonvulsants in 19 water treatment plants. Environmental impacts are worrisome for sure, but the effects of drugs on us raise far deeper concerns.

Theorizing the World argues that explanations play a central role in our theoretical understanding of the world. Explanations explain in virtue of subsuming what is to be explained under the appropriate projectable regularities. My epistemological account of explanation differs from traditional views in understanding subsumption as a far more complex relation. When a projectable regularity explains, it both confirms its corresponding background theories and draws explanatory strength from them at the same time. The failure of the standard models of explanation, I claim, has to do with their inability to consider explanations as a part of a broader enterprise of theory-formation. In this sense, we account for the essentially epistemic nature of explanation by noting the intimate connection between explanations and theoretical reasoning. ;The dissertation proceeds in four chapters. In the first chapter, I argue that the object of an explanation always contains a reference to the epistemic conditions of the inquirer. The need for an explanation arises out of a detachment between what the inquirer believes and some observation at hand. To explain is to eliminate the detachment in the appropriate manner. The second chapter examines a host of standard models of explanation. I show that the failure of these models is largely due to their inability to explicate the explanation relation in sufficiently strong metaphysical notions. In the third chapter, I propose that in explaining, we connect the epistemic corpus of the inquirer to the observation via an appropriate projectable regularity. Finally, in chapter four, I examine issues of unification, the role of explanation in science and explanations in ethics as further evidence for my view