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Philosophy and Medicine NEWSLETTER | The American Philosophical Association Philosophy and Medicine FALL 2013 VOLUME 13 | NUMBER 1 Amanda Favia FROM THE EDITORS Social Determinants of Health and the Mary Rorty and Mark Sheldon Skeptical Challenge to Universal Health Care FROM THE CHAIR Nir Eyal Felicia Nimue Ackerman A Narrow Fellow in the Glass ARTICLES Marcus Arvan Paul T. Menzel Nonideal Justice and a Decent Health Can Cost-Effectiveness Analysis Care Minimum Accommodate the Equal Value of Life? Len Fleck TRIBUTE to BERNARD GERT Parsimonious Care: Does Ockham’s Laser Heather Gert Belong in Medicine’s Black Bag? An Introduction to Bernard Gert’s Thoughts on Human Nature Lily E. Frank Health, Health Care, and the BOOK REVIEW Contraception Requirement Ben Goldacre: Bad Pharma: How Drug Companies Mislead Doctors and Harm Govind Persad Patients The Right to Health: From Maximization Reviewed by Deborah Barnbaum to Adequacy VOLUME 13 | NUMBER 1 FALL 2013 © 2013 BY THE AMERICAN PHILOSOPHICAL ASSOCIatION ISSN 2155-9708 APA NEWSLETTER ON Philosophy and Medicine MARY RORTY AND MARK SHELDON, EDITORS VOLUME 13 | NUMBER 1 | FALL 2013 I have learned a great deal from working with Professor FROM THE EDITORS Rhodes and the committee on planning this year’s sessions. The committee-sponsored session for the upcoming APA Mary Rorty Eastern Division meeting, titled “Epistemology of Medicine,” STANFORD UNIVERSITY was put together by Miriam Solomon (Temple University), who will also chair it. This panel will address questions at the Mark Sheldon intersection of epistemology and medicine. Epistemological NORTHWESTERN UNIVERSITY inquiry can help evaluate central trends in contemporary medicine. Cases in point include the shift from reliance on Welcome to the latest edition of the newsletter: plus ça clinical judgment to evidence-based medicine, the extensive change, plus c’est la même chose. No—wait! It’s not the same use of meta-analyses, new attention to the potential biasing thing after all! A new format (thanks, Erin), and a new chair of effects of conflicts of interest, and the shift from basic our committee on philosophy and medicine—welcome, Nir. science to more translational medicine. Doctors rarely heed insights in epistemology (and in cognitive psychology) The Eastern Division session on just health care occupies that bear on methodology in medicine—but these insights the majority of this issue, with contributions from Marcus remain pertinent. This panel will seek to learn from such Arvan, Len Fleck, Lily Frank, Amanda Favia, and a superbly insights on the merits of recent trends in medicine. In “How footnoted piece by Govin Persad, plus a contribution from to Think about Mechanisms in Medicine,” Robyn Bluhm Paul Menzel on cost-effective analysis. In a continuation of (Old Dominion College) will explore the role of mechanistic the spring issue’s tribute to our fallen heroes, Heather Gert reasoning in the evidence-based paradigm that typically has allowed us to reprint her musings on an underexplored eschews discussion of mechanisms. In “Studying Studies, aspect of her father’s philosophy, his thoughts on human Induction of Inductions, and Hearing Hearsay: The Continuing nature (plus a picture of him receiving an honorary degree Challenge of Computational Meta-Analysis,” Kenneth from his alma mater, the University of Cincinnati). And—not Goodman (University of Miami) will explore epistemological only a poem, but a book review! (Why don’t you write one, controversies about meta-analysis. Finally, Jason Scott too? You’re reading the book anyway—you might as well put Robert (Arizona State) will look at the translation “from bench it to use!) to bedside” that is needed in clinical research. For the APA Central Division meeting, former committee FROM THE CHAIR member Leonard Kahn (United States Air Force Academy) is organizing and chairing a panel on “Ethics Philosophy and Medicine: An Agenda in Reproductive Technology.” A year ago, the American Society for Reproductive Medicine declared the freezing and Nir Eyal the thawing of women’s eggs to be a safe, normal procedure, HARVARD UNIVERSITY and the field is currently expanding and undergoing rapid structural changes. This past spring, Robert Edwards, who It is an honor to take over as the new chair of the APA had co-developed in vitro fertilization, passed away. In the committee on philosophy and medicine, a position that over panel, Leslie Francis (University of Utah) will discuss the the years was held by some of the central contributors to relevance of ongoing injustice (e.g., disability discrimination, bioethics. and injustices with respect to access to health care) to the use of advanced reproductive technologies. Matthew Liao (New The committee’s activities consist largely of putting together York University) will argue against the position that infertile the newsletter and committee-sponsored sessions at couples should adopt instead of using publicly financed the divisional meetings. I would like for us to continue assisted reproduction to create new children. Rebecca Kukla both activities and make some additions. Let me describe (Georgetown) will discuss ethical and conceptual problems briefly the plans for the upcoming committee-sponsored with using “fertility” and “infertility” as scientific or medical sessions—a collaboration between the new committee and categories, featuring the example of prophylactic “fertility- last year’s committee, which was led by immediate past preserving” technologies for patients about to undergo chair, Rosamond Rhodes. Then I shall say a word on where cancer treatment. Glenn Cohen (Harvard University) will the committee might head in the coming three years. assess the conditions under which the law may legitimately regulate reproductive behavior and which theories might grant it such legitimacy. APA NEWSLETTER | PHILOSOPHY AND MEDICINE The APA Pacific Division will include a committee-sponsored private workplace organization in the interests of employee panel on the definition of death and the so-called “dead and customer health? Do patients who were given sports donor rule.” That “death panel” will debate when you are facilities but failed to use them and consequently developed dead and whether we need to wait for you to die in order disease have a lesser claim for medical assistance? Do we to whisk away your organs. The panel was orchestrated by owe citizens freedom from pollution, equal freedom from Michael Nair-Collins (Florida State University), who will also pollution, or maximin freedom from pollution? chair. Walter Sinnott-Armstrong (Duke University) will discuss what makes death bad and how this evaluation affects how Rather than focusing exclusively on clinical bioethics in we should define death in transplantation practices and laws. affluent societies, it would be exciting if panels also paid Joan McGregor (Arizona State) will discuss philosophical close attention to ethical questions surrounding the health problems in the 2009 President’s Council on Bioethics report, of the global poor and population health. All of us on the which argued that the concept of brain death lacks adequate committee look forward to hearing your further ideas on new scientific and pathophysiologic evidence and concluded that directions for the study of philosophy and medicine. a new philosophical rationale was needed for brain death. George Khushf (University of South Carolina) will defend the dead donor rule and a so-called “whole brain criterion” for ARTICLES determining death. Don Marquis (University of Kansas) will attack the dead donor rule and the whole brain criterion, as Nonideal Justice and a Decent Health well as the (present) cardiac death criterion for determining death in transplant settings. Care Minimum The philosophy and medicine committee has done a heroic Marcus Arvan job under Rosamond Rhodes, coordinating numerous panels UNIVERSITY OF TAMPA and newsletters. We should continue to coordinate both. In addition, Professor Rhodes proposed that we try to organize I am going to suggest that any robustly substantive account an essay contest, and we have started discussing details of what constitutes a decent health care minimum is unjustly with her, as well as ways around logistical bottlenecks. paternalistic, and that the people whose lives and health Former committee member Leonard Kahn has volunteered are at issue in determining a decent health care minimum to maintain and edit our new website, www.apaonline.org/ should be understood as having a collective right—founded group/medicine. in the rights of individuals to justice—to determine what constitutes such a minimum in their social-political context, I also hope to add a new emphasis to the committee’s work. through their expressed preferences as a group, provided Bioethics was created with a focus on clinical medicine, as their preferences are broadly constrained by the following performed in highly developed countries. It was considered background conditions: (1) adequate understanding of most prestigious to ask whether upon the patient’s request relevant facts about human health and modern medicine, (2) we should pull the plug of an enormously expensive life- instrumental rationality, and (3) the general ideal of the equal sustaining machine, and what to make of recent technologies treatment of individuals. that border on science fiction. But the majority of living people do not have access to anything like the medical PROBLEMS WITH EXISTING THEORIES services or health personnel that we in the developed world
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