The Harm of Bioethics: A Critique of Singer and Callahan on Obesity

Debate concerning the social impact of obesity has been ongoing since at least the 1980s. Bioethicists, however, have been relatively silent. If obesity is addressed it tends to be in the context of resource allocation or clinical procedures such as bariatric surgery. However, prominent bioethicists Peter Singer and Dan Callahan have recently entered the obesity debate to argue that obesity is not simply a clinical or personal issue but an ethical issue with social and political consequences. This article critically examines two problematic aspects of Singer and Callahan's respective approaches. First, there is an uncritical assumption that individuals are autonomous agents responsible for health‐related effects associated with food choices. In their view, individuals are obese because they choose certain foods or refrain from physical activity. However, this view alone does not justify intervention. Both Singer and Callahan recognize that individuals are free to make foolish choices so long as they do not harm others. It is at this point that the second problematic aspect arises. To interfere legitimately in the liberty of individuals, they invoke the harm principle. I contend, however, that in making this move both Singer and Callahan rely on superficial readings of public health research to amplify the harm caused by obese individuals and ignore pertinent epidemiological research on the social determinants of obesity. I argue that the mobilization of the harm principle and corresponding focus on individual behaviours without careful consideration of the empirical research is itself a form of harm that needs to be taken seriously.     

Stabilizing cumulative incidence estimation of pregnancy outcome with delayed entries

A pregnancy may end up with (at least) three possible events: live birth, spontaneous abortion, or elective termination, yielding a competing risks issue when studying an association between a risk factor and a pregnancy outcome. Cumulative incidences (probabilities to end up with the different outcomes depending on gestational age) can be estimated via the Aalen–Johansen estimate. Another issue is that women are usually not entering such an observational study from the first day of pregnancy, resulting in delayed entries. As in traditional survival analysis, this can be solved by considering “at risk” at a given gestational age only for those women who entered the study before that age. However, the number of women at risk at an early gestational age might be extremely low, such that the estimates of cumulative incidence may increase exaggeratedly at that age because of a single event. One solution to reduce the problem has been recently proposed in the literature, which is to ignore simply those early events, creating a small mean bias but enhancing stability of estimates. In the present paper, we propose an alternative computationally simple approach to tackle this problem that consists to postpone to later gestational ages (rather than to ignore) those early events. The two approaches are compared with respect to bias, stability, and sensitivity on the smoothing parameter via simulations reproducing realistic pregnancy scenarios, and are illustrated with data from a study on the effects of statins on pregnancy outcomes. We also outline that all three approaches are asymptotically equivalent.     

Fish assemblages as indicators of estuary ecosystem health

Understanding and managing increasing threat from diverse anthropogenic pressures on estuaries requires impact assessment and monitoring indices that provide accurate quantification of change and are readily communicable. Although indices based on nekton assemblage structure have obvious appeal to managers, the imperative to produce the most accurate measures possible has seen a move away from simple composite measures (such as diversity indices) towards complex multivariate approaches. However, complex methods often provide a poor basis for reporting because they can be difficult to report in terms that are meaningful to the end user. Effective indices should be simple to construct and communicate, relate directly to definable biological attributes, fall within predictable ranges for unimpacted systems and show demonstrable responses to known impacts. We use published nekton data for 30 natural and two artificial estuaries to develop a set of nekton assemblage-based summary measures that fit these criteria. We evaluated a suite of simple parallel measures based on both catch per unit effort (CPUE) and probability of encounter (PoE). Parallel measures provide complementary information thus a more robust assessments of change. Three measures fell within consistent bounds as long as comparisons were confined to the same time of year to remove the influence of seasonal variability, and were efficient at differentiating degraded from unimpacted estuaries. Because the successful approaches rely on PoE rather than CPUE they have considerable tactical advantages in that they are less destructive, allow for the collection of many more samples per unit time, and treat schooling and non-schooling species equivalently.     

Biomedical Big Data: New Models of Control Over Access,Use and Governance

Empirical evidence suggests that while people hold the capacity to control their data in high regard, they increasingly experience a loss of control over their data in the online world. The capacity to exert control over the generation and flow of personal information is a fundamental premise to important values such as autonomy, privacy, and trust. In healthcare and clinical research this capacity is generally achieved indirectly, by agreeing to specific conditions of informational exposure. Such conditions can be openly stated in informed consent documents or be implicit in the norms of confidentiality that govern the relationships of patients and healthcare professionals. However, with medicine becoming a data-intense enterprise, informed consent and medical confidentiality, as mechanisms of control, are put under pressure. In this paper we explore emerging models of informational control in data-intense healthcare and clinical research, which can compensate for the limitations of currently available instruments. More specifically, we discuss three approaches that hold promise in increasing individual control: the emergence of data portability rights as means to control data access, new mechanisms of informed consent as tools to control data use, and finally, new participatory governance schemes that allow individuals to control their data through direct involvement in data governance. We conclude by suggesting that, despite the impression that biomedical big data diminish individual control, the synergistic effect of new data management models can in fact improve it.     

Assessment of breast aesthetics

A good aesthetic outcome is an important endpoint of breast cancer treatment. Subjective ratings, direct physical measurements, measurements on photographs, and assessment by three-dimensional imaging are reviewed and future directions in aesthetic outcome measurements are discussed. Qualitative, subjective scales have frequently been used to assess aesthetic outcomes following breast cancer treatment. However, none of these scales has achieved widespread use because they are typically vague and have low intraobserver and interobserver agreement. Anthropometry is not routinely performed because conducting the large studies needed to validate anthropometric measures (i.e., studies in which several observers measure the same subjects multiple times) is impractical. Quantitative measures based on digital/digitized photographs have yielded acceptable results but have some limitations. Three-dimensional imaging has the potential to enable consistent, objective assessment of breast appearance, including properties (e.g., volume) that are not available from two-dimensional images. However, further work is needed to define three-dimensional measures of aesthetic properties and how they should be interpreted.     

Marginalizing Experience: A Critical Analysis of Public Discourse Surrounding Stem Cell Research in Australia (2005�C6)

Over the past decade, stem cell science has generated considerable public and political debate. These debates tend to focus on issues concerning the protection of nascent human life and the need to generate medical and therapeutic treatments for the sick and vulnerable. The framing of the public debate around these issues not only dichotomises and oversimplifies the issues at stake, but tends to marginalise certain types of voices, such as the women who donate their eggs and/or embryos to stem cell research and the patients who might benefit from its potential clinical outcomes. This paper draws on empirical research conducted on a recent stem cell policy episode in Australia. From the qualitative examination of 109 newspaper opinion editorials and twenty-three in-depth interviews, it is argued that these voices are marginalised because they are based on discourses that have less epistemological status in public debate. Our results suggest that the personal experiences of women and patients are marginalised by the alliances that form between more powerful discourse communities that use science as a source of authority and legitimation. It is argued that members of these communities establish legitimacy and assert authority in public debate by discursively deploying science in claims that marginalise other epistemologies. Implications are discussed along with suggestions for a more enriched and inclusive public debate.     

Conscientious Objection in Healthcare Provision: A New Dimension

The right to conscientious objection in the provision of healthcare is the subject of a lengthy, heated and controversial debate. Recently, a new dimension was added to this debate by the US Supreme Court's decision in Burwell vs. Hobby Lobby et al. which effectively granted rights to freedom of conscience to private, for‐profit corporations. In light of this paradigm shift, we examine one of the most contentious points within this debate, the impact of granting conscience exemptions to healthcare providers on the ability of women to enjoy their rights to reproductive autonomy. We argue that the exemptions demanded by objecting healthcare providers cannot be justified on the liberal, pluralist grounds on which they are based, and impose unjustifiable costs on both individual persons, and society as a whole. In doing so, we draw attention to a worrying trend in healthcare policy in Europe and the United States to undermine women's rights to reproductive autonomy by prioritizing the rights of ideologically motivated service providers to an unjustifiably broad form of freedom of conscience.     

Genres of waiting: patronage,healthcare, and dyadic sovereignty in Northeast Brazil

This article offers an ethnographic comparison of two genres of waiting for healthcare in Northeast Brazil in order to explain the persistence of patron-client practices at a time when people otherwise reject patronage. The explanation turns on a recasting of patronage as a form of sovereignty whereby politicians and afflicted persons may choose to suspend the emerging rights-based care regime in favour of older patronage-based approaches to care. Motivating such decisions is the afflicted person's experience of the wait for rights-based healthcare as a form of ‘bare life’, an experience they hope to escape.     

Food-related bray calls in wild bottlenose dolphins (Tursiops truncatus)

Because cetaceans are difficult to study in the wild, little is known about how they use their sounds in their natural environment. Only the recent development of passive acoustic localization systems has enabled observations of the communication behaviour of individuals for correlation with their surface behaviour. Using such a system, I show that bottlenose dolphins in the Moray Firth, Scotland, produce low-frequency bray calls which are clearly correlated with feeding on salmonids. The production of these calls is followed by fast approaches by conspecifics in the area. In animals which use sound as a foraging tool, it is difficult to distinguish between food calls which have evolved because of their role in attracting conspecifics, and food manipulation or searching calls which may attract conspecifics as a by-product. However, the low-frequency structure of the bottlenose dolphin bray suggests that it evolved because of a role in manipulating prey rather than in attracting conspecifics. This conclusion suggests that dolphins exploit the perceptual systems of their prey to facilitate capture.     

Do plant defenses enhance or diminish prey suppression by omnivorous Heteroptera?

Omnivorous plant-feeding predators have been predicted to both increase and decrease prey consumption on resistant host-plants because of behavioral shifts in food preferences and direct ingestion of phytotoxins, respectively. To help resolve this debate, we reviewed the published literature on plant defense-heteropteran interactions using both vote-counting and meta-analytical approaches. The Heteroptera are ideal for this analysis because as a group they are broadly omnivorous, critical in the biocontrol of crop pests, and frequently come in contact with plants varying in quality. We identified 37 studies that matched our search criteria, involving at least 16 species of Heteroptera. Overall, plant resistance lowered the abundance of heteropterans in the field, but had virtually no impact on their performance when reared in the lab (aside from a significant, albeit minor, increase in development time). Prey consumption was strongly affected by plant resistance; however, the outcome was extremely variable with near equal evidence for increasing (22 cases) vs. decreasing (21 cases) predation on resistant host-plants. Thus, prey consumption is far more variable across plant-types differing in quality when compared with either abundance or performance. Heteropteran family and developmental stage (adult vs. nymph) were poor predictors of the outcome for prey suppression. Our results indicate that the feeding ecology of omnivorous heteropterans is highly contingent on plant defense expression, more so than other ecologically-relevant traits, but the factors mediating behavioral shifts in prey consumption remain elusive.     

Adopt a Daughter-in-Law, Marry a Sister: A Chinese Solution to the Problem of the Incest Taboo

In stressing the social advantages of the familial incest taboo, most explanations of the taboo ignore the fact that it makes marriage the enemy of the family. The stranger intruded by marriage often poses a threat to existing domestic relationships. The Chinese solution to this problem is to circumvent the taboo by adopting female children who are raised as wives for their foster parents' sons. The family choosing this form of marriage sacrifices prestige and dependable affinal ties, but by socializing their own daughters-in-law they preserve domestic harmony. The fact that many Chinese arrange marriages within the family as a means of preserving the family suggests that widely accepted explanations of the incest taboo exaggerate the dangers of incest and ignore the dangers of the taboo.     

Why genetic selection to reduce the prevalence of infectious diseases is way more promising than currently believed

Genetic selection for improved disease resistance is an important part of strategies to combat infectious diseases in agriculture. Quantitative genetic analyses of binary disease status, however, indicate low heritability for most diseases, which restricts the rate of genetic reduction in disease prevalence. Moreover, the common liability threshold model suggests that eradication of an infectious disease via genetic selection is impossible because the observed-scale heritability goes to zero when the prevalence approaches zero. From infectious disease epidemiology, however, we know that eradication of infectious diseases is possible, both in theory and practice, because of positive feedback mechanisms leading to the phenomenon known as herd immunity. The common quantitative genetic models, however, ignore these feedback mechanisms. Here, we integrate quantitative genetic analysis of binary disease status with epidemiological models of transmission, aiming to identify the potential response to selection for reducing the prevalence of endemic infectious diseases. The results show that typical heritability values of binary disease status correspond to a very substantial genetic variation in disease susceptibility among individuals. Moreover, our results show that eradication of infectious diseases by genetic selection is possible in principle. These findings strongly disagree with predictions based on common quantitative genetic models, which ignore the positive feedback effects that occur when reducing the transmission of infectious diseases. Those feedback effects are a specific kind of Indirect Genetic Effects; they contribute substantially to the response to selection and the development of herd immunity (i.e., an effective reproduction ratio less than one).     

Genes, language, cognition, and culture: towards productive inquiry

The Queen Mary conference on “Integrating Genetic and Cultural Evolutionary Approaches to Language,” and the papers in this special issue, clearly illustrate the excitement and potential of trans-disciplinary approaches to language as an evolved biological capacity (phylogeny) and an evolving cultural entity (glossogeny). Excepting the present author, the presenters/authors are mostly young rising stars in their respective fields, and include scientists with backgrounds in linguistics, animal communication, neuroscience, evolutionary biology, anthropology, and computer science. On display was a clear willingness to engage with different approaches and terminology and a commitment to shared standards of scientific rigor, empirically driven theory, and logical argument. Because the papers assembled here, together with the introduction, speak for themselves, I will focus in this “extro-duction” on some of the terminological and conceptual difficulties which threaten to block this exciting wave of scientific progress in understanding language evolution, in both senses of that term. In particular I will first argue against the regrettably widespread practice of opposing cultural and genetic explanations of human cognition as if they were dichotomous. Second, I will unpack the debate concerning “general-purpose” and “domain-specific” mechanisms, which masquerades as a debate about nativism but is nothing of the sort. I believe that framing discussions of language in these terms has generated more heat than light, and that a modern molecular understanding of genes, development, behavior, and evolution renders many of the assumptions underlying this debate invalid.     

Adjusting confounders in ranking biomarkers: a model-based ROC approach

High-throughput studies have been extensively conducted in the research of complex human diseases. As a representative example, consider gene-expression studies where thousands of genes are profiled at the same time. An important objective of such studies is to rank the diagnostic accuracy of biomarkers (e.g. gene expressions) for predicting outcome variables while properly adjusting for confounding effects from low-dimensional clinical risk factors and environmental exposures. Existing approaches are often fully based on parametric or semi-parametric models and target evaluating estimation significance as opposed to diagnostic accuracy. Receiver operating characteristic (ROC) approaches can be employed to tackle this problem. However, existing ROC ranking methods focus on biomarkers only and ignore effects of confounders. In this article, we propose a model-based approach which ranks the diagnostic accuracy of biomarkers using ROC measures with a proper adjustment of confounding effects. To this end, three different methods for constructing the underlying regression models are investigated. Simulation study shows that the proposed methods can accurately identify biomarkers with additional diagnostic power beyond confounders. Analysis of two cancer gene-expression studies demonstrates that adjusting for confounders can lead to substantially different rankings of genes.     

Tracheal bioengineering: the next steps. Proceeds of an International Society of Cell Therapy Pulmonary Cellular Therapy Signature Series Workshop,Paris, France,April 22, 2014

There has been significant and exciting recent progress in the development of bioengineering approaches for generating tracheal tissue that can be used for congenital and acquired tracheal diseases. This includes a growing clinical experience in both pediatric and adult patients with life-threatening tracheal diseases. However, not all of these attempts have been successful, and there is ongoing discussion and debate about the optimal approaches to be used. These include considerations of optimal materials, particularly use of synthetic versus biologic scaffolds, appropriate cellularization of the scaffolds, optimal surgical approaches and optimal measure of both clinical and biologic outcomes. To address these issues, the International Society of Cell Therapy convened a first-ever meeting of the leading clinicians and tracheal biologists, along with experts in regulatory and ethical affairs, to discuss and debate the issues. A series of recommendations are presented for how to best move the field ahead.     

Chlorine in the Netherlands, Part II: Risk Management in Uncertainty for Chlorine

The debate over chlorine in industrialized economies has become extremely polarized in the last decade. Environmental pressure groups are striving for a virtual phaseout of chlorine and chlorinated hydrocarbons (CHCs), because they are convinced that the risks cannot be managed. Industry argues this is not necessary because environmental risks can be controlled, nor is it feasible, because at least 60% of all firms use CHCs, produds made with CHCs, or elemental chlorine. In an attempt to give this discussion a more factual basis, the Dutch minister of environment launched a strategic study on chlorine (see Kleijn et al. I997;Tukker et al. 1995). Using all available knowledge about emissions and contemporary evaluation methods, the study found only a limited number of environmental issues outstanding related to the chlorine chain: however, it also found important uncertainties. This article describes the outstanding uncertainties in more detail. It defines which uncertainties have to be regarded as chlorine-specific and the extent to which additional research can resolve them. For the remaining uncertainties the potential benefts of uncertainty reduction strategies are evaluted, relying mainly on the precautionary principle     

Pesticides,Sexual Development,Reproduction, and Fertility: Current Perspective and Future Direction

Improvements in chemical analytical technology and non-invasive sampling protocols have made it easier to detect pesticides and their metabolites at very low concentrations in human tissues. Monitoring has revealed that pesticides penetrate both maternal and paternal reproductive tissues and organs, thus providing a pathway for initiating harm to their offspring starting before fertilization throughout gestation and lactation. This article explores the literature that addresses the parental pathway of exposure to pesticides. We use DDT/DDE as a model for chemicals that oftentimes upon exposure have no apparent, immediate health impacts, or cause no obvious birth defects, and are seldom linked with cancer. Their health effects are overlooked because they are invisible and not life threatening—but might have significant health, social, and economic impacts at the individual and population levels. The purpose of this article is to demonstrate the necessity to develop new approaches for determining the safety of pesticides and the need for innovative regulatory policy to protect human and environmental health.     

Adjusting the focus: A public health ethics approach to data research

This paper contends that a research ethics approach to the regulation of health data research is unhelpful in the era of population‐level research and big data because it results in a primary focus on consent (meta‐, broad, dynamic and/or specific consent). Two recent guidelines – the 2016 WMA Declaration of Taipei on ethical considerations regarding health databases and biobanks and the revised CIOMS International ethical guidelines for health‐related research involving humans – both focus on the growing reliance on health data for research. But as research ethics documents, they remain (to varying degrees) focused on consent and individual control of data use. Many current and future uses of health data make individual consent impractical, if not impossible. Many of the risks of secondary data use apply to communities and stakeholders rather than individual data subjects. Shifting from a research ethics perspective to a public health lens brings a different set of issues into view: how are the benefits and burdens of data use distributed, how can data research empower communities, who has legitimate decision‐making capacity? I propose that a public health ethics framework – based on public benefit, proportionality, equity, trust and accountability – provides more appropriate tools for assessing the ethical uses of health data. The main advantage of a public health approach for data research is that it is more likely to foster debate about power, justice and equity and to highlight the complexity of deciding when data use is in the public interest.     

Paradigm shift in natural product research: traditional medicine inspired approaches

The development of traditional medicine with the perspectives of safety, efficacy and quality would help not only to preserve the traditional heritage but also to rationalize the use of herbal medicine in the human healthcare. Nature is considered as a compendium for templates of new chemical entities. The medicinal plants mentioned in the different ancient texts worldwide may be explored with the modern scientific approaches for better leads in the healthcare. Drugs from medicinal plants are unique for their chemical and biological features, and are gaining global acceptance because they offer natural ways to treat diseases and promote healthcare. Natural products are the best sources of chemical diversity for finding new drugs and leads. Globalization of traditional medicine is necessary for health care with assessment of its safety, efficacy, therapeutic and clinical evidence. Evidence based validation of the ethnopharmacological claims on traditional medicine is necessary for its promotion and development. Applications of techniques such as marker analysis, DNA bar coding, plant metabolomics, network pharmacology etc. are being taken into account for the validation and documentation of medicinal plants. This can be achieved by the scientific exploitation of the established facts from ancient systems through proper validation of the claims based on pharmacological and phytochemical assessments.     

Genetic enhancement, social justice, and welfare-oriented patterns of distribution

The debate over the host of moral issues that genetic enhancement technology (GET) raises has been significant. One argument that has been advanced to impugn its moral legitimacy is the 'unfair advantage argument' (UAA), which states: allowing access to GET to be determined by socio-economic status would lead to unjust outcomes, namely, create a genetic caste system, and with it the exacerbation and perpetuation of existing socio-economic inequalities. Fritz Allhoff has recently objected to the argument, the kernel of which is that it conflates the use of the technology with its distribution. GET, he argues, would generate unjust outcomes only if it is distributed according to principles of an unjust pattern of distribution; for if we can determine what constitutes a 'just' distributive scheme, then the technology can be allocated according to the principles of that scheme. In this paper I argue the following cluster of related claims: (1) both UAA and Allhoff's proposed distributive schemes ignore the importance of non-genetic factors in the development of an individual's characteristics and capacities; (2) if we accept the view that it is good to prevent unjust outcomes that arise because some have exclusive access to GET, then we have to accept wide-ranging distributive schemes; (3) by tracking genetic and non-genetic factors wide-ranging schemes do violate in some sense the widely shared value of neutrality in liberal democracies.