Index Research in Philosophy Theory of Knowledge Theory of Reality Ethics   Game Theory Symbolic Logic Philosophy of Law

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The page contains more than 15 reports of classic torts law cases (in their entirety), and more.

Research in Philosophy:
	Directions for getting journal articles on-line Many philosophy journals at Lawrence are available on-line, and some are now available in no other form. Here are instructions for getting articles via "JSTORS" using a computer at Lawrence—or from off-campus for students, faculty, and staff. When you find an article, you may read it, you may print it out, or you may download to your hard-drive an Acrobat PDF file of the article to read later on your computer. The PDF files are often quite large (e.g., 4.5 MB). Further resources on-line: EBESCO for some journals available on-line. Brief instructions for connecting to EBESCO and searching for an article. Lexis-Nexis for law journal articles and court decisions from the Lawrence campus. Brief instructions for connecting to "Lexis-Nexis Universe" and searching for an article. Stanford Encyclopedia of Philosophy Hippias: a Philosophy search engine Episteme links Expanded Academic ASAP: Periodical index with many full-text titles. From IAC SearchBank LINK to Directory of On-Line Philosophy papers: their authors include Dretske, Dennett, Bloch, Unger, Boghossian, McGinn, Harman, and many others: Lau's Directory of On-Line Philosophy Papers LINK to a variety of texts from early modern philosophy prepared by Jonathan Bennett How to find government documents in the Lawrence Library Philosophy Resources
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Theory of Knowledge (a.k.a. "Epistemology"):
	Carnap, "On Explication" Rudolf Carnap's classic discussion of explication is an excerpt from his Logical Foundations of Probability (1950); it is interesting to compare it to Rawls' "Outline of a Procedure for Ethics," 60 Philosophical Review (1951), and to Rawls' "Some Remarks about Moral Theory," on pp. 46-53 of his A Theory of Justice (Harvard: 1971). Boardman's Notes: The Criteria of Adequacy of An Explication, illustrated by a discussion of Ayer's Language, Truth and Logic. Hempel, "Problems and Changes in the Empiricist Criterion of Meaning" Carl Hempel's discussion of flaws in the various versions of the Verifiability Criterion was published in 11 Revue Internationale de Philosophie 41 (1950), pp. 41-63. An Appraisal of Ayer's Language, Truth and Logic Bertrand Russell's, "On Denoting," Mind, 1905. This is provided by a link; links to other Russell works can be found at the same address by deleting the "denoting/" at the end. Moore's Envelope Argument A sketch of an argument which appears discontinuously in Moore's Some Main Problems of Philosophy (Macmillan: 1953); its clarity makes it possible, I think, to see what is wrong with it. For trenchant criticism of this sort of argument see J. L. Austin, Sense and Sensibilia (Oxford: 1962) Some Comments on Moore's Envelope Argument Some Comments on the foregoing   Austin and the Inferential Account of Perception Some arguments supporting Austin's rejection of the inferential account of perception (held by Ayer, among others) Some articles concerning the relativity of knowledge and skepticism   Queer modal arguments Some instances of the argument, "if it is possible for me to be mistaken about something, then I cannot know it to be true;" Descartes seems to use this sort of argument against the possibility of gaining knowledge through the senses. Nomic dependencies & Contrary- to-fact Conditionals Further discussion of Dretske's "measles example" from p. 74 of his Knowledge and the Flow of Information (MIT: 1981; now in Cambridge paperback). Forms in Plato's Republic A former Freshman Studies lecture. The footnotes have been revised to follow the pagination of the 1987 revised second edition of Lee's translation in Penguin; an afterword has been added. Notes on Teaching Plato's Republic An aid to reading the Republic Descartes' Meditations A former Freshman Studies Lecture. To sleep, perchance to make mistakes? An example outlining a play, a nightmare, and some critical questions about Descartes' Dream Problem. “Dreams, Dramas, and Scepticism,” 29 Philosophical Quarterly 220 (1979) An attempt to explode Descartes’ dream problem: it was criticized in a later issue of the journal. Berkeley's God in the Quad Limerick offering a précis of Berkeley; attributed to Monsignor Ronald Knox. Link on Philosophy of Law Page to a discussion of some of the problems of eye-witness testimony.
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Theory of Reality (a.k.a. "Metaphysics"):
	“OF LIBERTY AND NECESSITY,” by David Hume. Chapter VIII, “OF LIBERTY AND NECESSITY,” from Hume’s An Enquiry Concerning Human Understanding, (1748). The Compatibilist's Counterfactual test of Responsibility A somewhat rambling discussion of the use of the Compatibilist's Counterfactual Test of Responsibility in sorting examples; I have added to it a discussion of the problem of understanding the notion of responsibility under the (typical) Compatibilist's assumption of a Humean view of desires. Discussion of van Inwagen's argument A brief, critical discussion of van Inwagen, "The Incompatibility of Free Will and Determinism" Notes on Davidson's "Mental Events" Random Notes on Donald Davidson's "Mental Events" Especially promising directions for further reading: Dennis Stampe and Martha Gibson, "Of One's Own Free Will," 52 Philosophy and Phenomenological Research 529-556 (Sept., 1992): an excellent discussion; Fred Dretske, "The Metaphysics of Freedom," 22 Canadian Journal of Philosophy 1-13 (March, 1992); together with his Explaining Behavior (MIT: 1988). Excerpt from Plato's Phaedo, trans. Benjamin Jowett Socrates distinguishes between mental causes and physical conditions of bodily behavior. Excerpt from Shakespeare's Othello Iago expresses his belief in free will Responsibility at my Philosophy of Law page Find there, for example, material on the use of "objective" standards of liability in the criminal law, and brief explanations of mens rea and the McNaughten rules for insanity. On-Line Philosophy Articles. At the link, find papers by Dretske, Bloch, Dennett, Boghossian, and others.
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Ethics: skip down to Ethics continued: Game Theory
	Notes on a Utilitarian justification of RIGHTS: the strategy of PRE-COMMITMENT Discussion of a utilitarian justification of Rights which construes them as an instance of "Pre-commitment," sketching an analysis suggested by L.W. Sumner, The Moral Foundation of Rights (Oxford: 1987) Some background for Bernard Harrison’s “Moral Judgment, Action and Emotion,” Philosophy, 1984 How can we simultaneously account for the objectivity of moral standards and explain the motivation of a rational person's following them? Compassion, Incompetence, and the Presumption to Favor Life: Sketch of a reply to Sanford H. Kadish's "Letting Patients Die: Legal and Moral Reflections;" Kadish's article was published in 80 California Law Review 857 (1992). Butler on Self-Interest (from his Sermons). Boardman's (somewhat turgid) account of the classic argument of Bishop Joseph Butler [1692-1752] against Hobbes' and Mandeville's psychological egoism. Ethics Updates Home Page Ethics Resources page edited by Lawrence M. Hinman ENVIRONMENTAL ETHICS LINK to a WWW server focusing on environmental ethics and environmental philosophy; hosted by the Center for Environmental Philosophy at the University of North Texas. Ben Schneider's The Stoic Legacy to the Renaissance Professor Schneider provides E-Text translations of Cicero's De Officiis, and Seneca's Moral Essays and Moral Epistles, with further texts forthcoming. His interest in these texts comes from his scholarship on Shakespeare's plays (see following link). LINK TO Ben Ross Schneider, Jr., "King Lear in Its Own Time: The Difference that Death Makes," from Early Modern Literary Studies , Volume 1, Number 1 (April 1995) Professor Schneider discusses how the ethics of Stocism figures in the background of Shakespeare's King Lear. Elsewhere he draws our attention particularly to Cicero's De Officiis ("Of Duty") as the English gentleman's handbook of the Renaissance. McMaster University, Page for History of Economic Thought Internet Library of works by Bentham, Hale, Maine, Maitland, J.S. Mill, and many others.   The Founders' Constitution Originally published by the University of Chicago Press in five volumes edited by Philip Kurland and Ralph Lerner, and consisting of "extracts from the leading works of political theory, history, law, and constitutional argument on which the Framers and their contemporaries drew and which they themselves produced." Provided by the University of Chicago Press in cooperation with the Liberty Fund. LINK to Wisconsin Department of Health Services: Advance Directives (Last Revised: May 22, 2008) On this page, you can download the official Wisconsin Advance Directives forms in PDF: Living Will, Power of Attorney Forms, Authorization for Final Disposition some older Biomedical Ethics links; including some acronyms and specialized terms "Health Care Rationing: What it Means," by Henry J. Aaron, December 2005; Brookings Institution: Hamilton Project.
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SKIP DOWN TO Ethics continued: Game Theory omitting Ethics-related news clippings
	Ethics in the News Partial Birth Abortion Ban Act Ruled Constitutional “ The Supreme Court today [April 18, 2007] narrowly upheld a nationwide ban on a controversial late-term abortion procedure, voting for the first time to restrict abortion rights and handing a major victory to President Bush and his social conservative allies. “ In a 5-4 vote, the court ruled that the Partial Birth Abortion Ban Act, which Bush signed into law in 2003, does not violate a woman's right to have an abortion, which has been the law of the land since the landmark 1973 ruling in Roe v. Wade. “ The dramatic decision delivered to abortion opponents the promise of a more conservative court reconstituted by Bush. “ The ruling marked the first time that the court has banned a specific abortion procedure. It also marked a departure from the Supreme Court's past practice of requiring a 'health exception' in laws governing abortion to allow the procedure when a woman's health would otherwise be at risk. “ Writing for the majority, Justice Anthony M. Kennedy said opponents of the ban 'have not demonstrated that the Act would be unconstitutional in a large fraction of relevant cases.' Nor, he wrote, have they shown that it is 'void for vagueness, or that it imposes an undue burden on a woman's right to abortion based on its overbreadth or lack of a health exception.' … “ 'Today's decision is alarming,' Ginsburg wrote for the minority. 'It tolerates, indeed applauds, federal intervention to ban nationwide a procedure found necessary and proper in certain cases by the American College of Obstetricians and Gynecologists. . . . And, for the first time since Roe, the Court blesses a prohibition with no exception safeguarding a woman's health.' [But according to Justice Kennedy's opinion, the statute contains an exception for the life of the woman: “No as-applied challenge need be brought if the Act's prohibition threatens a woman's life, because the Act already contains a life exception. 18 U. S. C. § 1531(a). Pp. 37-39.”] “ She added: 'Retreating from prior rulings that abortion restrictions cannot be imposed absent an exception safeguarding a woman's health, the Court upholds an Act that surely would not survive under the close scrutiny that previously attended state-decreed limitations on a woman's reproductive choices.' … “ Today's ruling came on two combined cases, Gonzales v. Carhart and Gonzales v. Planned Parenthood Federation of America. ” —From 4-18-07 Washington Post,"Court Backs Ban on Late-Term Abortion Procedure," By William Branigin and Robert Barnes, Washington Post Staff Writers. GONZALES, ATTORNEY GENERAL v. CARHART et al. Justice Ginsburg, with whom Justice Stevens, Justice Souter, and Justice Breyer join, dissenting. excerpts: “ … Women, it is now acknowledged, have the talent, capacity, and right 'to participate equally in the economic and social life of the Nation.' [Planned Parenthood of Southeastern Pa. v. Casey, 505 U. S., at 856]. Their ability to realize their full potential, the Court recognized, is intimately connected to 'their ability to control their reproductive lives.' Ibid. Thus, legal challenges to undue restrictions on abortion procedures do not seek to vindicate some generalized notion of privacy; rather, they center on a woman's autonomy to determine her life's course, and thus to enjoy equal citizenship stature. See, e.g., Siegel, Reasoning from the Body: A Historical Perspective on Abortion Regulation and Questions of Equal Protection, 44 Stan. L. Rev. 261 (1992); Law, Rethinking Sex and the Constitution, 132 U. Pa. L. Rev. 955, 1002-1028 (1984). “ In keeping with this comprehension of the right to reproductive choice, the Court has consistently required that laws regulating abortion, at any stage of pregnancy and in all cases, safeguard a woman's health. See, e.g., Ayotte, 546 U. S., at 327-328 ('[O]ur precedents hold … that a State may not restrict access to abortions that are necessary, in appropriate medical judgment, for preservation of the life or health of the [woman].' (quoting Casey, 505 U. S., at 879 (plurality opinion))); Stenberg, 530 U. S., at 930 ('Since the law requires a health exception in order to validate even a postviability abortion regulation, it at a minimum requires the same in respect to previability regulation.'). See also Thornburgh v. American College of Obstetricians and Gynecologists, 476 U. S. 747, 768-769 (1986) (invalidating a post-viability abortion regulation for 'fail[ure] to require that [a pregnant woman's] health be the physician's paramount consideration'). … “ In 2003, a few years after our ruling in Stenberg, Congress passed the Partial-Birth Abortion Ban Act--without an exception for women's health. See 18 U. S. C. §1531(a) (2000 ed., Supp. IV).[fn. omitted] The congressional findings on which the Partial-Birth Abortion Ban Act rests do not withstand inspection, as the lower courts have determined and this Court is obliged to concede. Ante, at 35-36. … “ Many of the Act's recitations are incorrect. See ante, at 35-36. For example, Congress determined that no medical schools provide instruction on intact D&E. §2(14)(B), 117 Stat. 1204, notes following 18 U. S. C. §1531 (2000 ed., Supp. IV), p. 769, ¶(14)(B) (Congressional Findings). But in fact, numerous leading medical schools teach the procedure. … “ More important, Congress claimed there was a medical consensus that the banned procedure is never necessary. Congressional Findings (1), in notes following 18 U. S. C. §1531 (2000 ed., Supp. IV), p. 767. But the evidence 'very clearly demonstrate[d] the opposite.' Planned Parenthood, 320 F. Supp. 2d, at 1025. … “ In contrast to Congress, the District Courts made findings after full trials at which all parties had the opportunity to present their best evidence. The courts had the benefit of 'much more extensive medical and scientific evidence . . . concerning the safety and necessity of intact D&Es.' Planned Parenthood, 320 F. Supp. 2d, at 1014; cf. National Abortion Federation, 330 F. Supp. 2d, at 482 (District Court 'heard more evidence during its trial than Congress heard over the span of eight years.'). … “ During the District Court trials, 'numerous' 'extraordinarily accomplished' and 'very experienced' medical experts explained that, in certain circumstances and for certain women, intact D&E is safer than alternative procedures and necessary to protect women's health. Carhart, 331 F. Supp. 2d, at 1024-1027; see Planned Parenthood, 320 F. Supp. 2d, at 1001 ('[A]ll of the doctors who actually perform intact D&Es concluded that in their opinion and clinical judgment, intact D&Es remain the safest option for certain individual women under certain individual health circumstances, and are significantly safer for these women than other abortion techniques, and are thus medically necessary.'); cf. ante, at 31 ('Respondents presented evidence that intact D&E may be the safest method of abortion, for reasons similar to those adduced in Stenberg.'). … “ Based on thoroughgoing review of the trial evidence and the congressional record, each of the District Courts to consider the issue rejected Congress' findings as unreasonable and not supported by the evidence. See Carhart, 331 F. Supp. 2d, at 1008-1027; National Abortion Federation, 330 F. Supp. 2d, at 482, 488-491; Planned Parenthood, 320 F. Supp. 2d, at 1032. The trial courts concluded, in contrast to Congress' findings, that 'significant medical authority supports the proposition that in some circumstances, [intact D&E] is the safest procedure.' Id., at 1033 (quoting Stenberg, 530 U. S., at 932); accord Carhart, 331 F. Supp. 2d, at 1008-1009, 1017-1018; National Abortion Federation, 330 F. Supp. 2d, at 480-482;[fn. omitted] cf. Stenberg, 530 U. S., at 932 ('[T]he record shows that significant medical authority supports the proposition that in some circumstances, [intact D&E] would be the safest procedure.'). The District Courts' findings merit this Court's respect. See, e.g., Fed. Rule Civ. Proc. 52(a); Salve Regina College v. Russell, 499 U. S. 225, 233 (1991). Today's opinion supplies no reason to reject those findings. Nevertheless, despite the District Courts' appraisal of the weight of the evidence, and in undisguised conflict with Stenberg, the Court asserts that the Partial-Birth Abortion Ban Act can survive 'when … medical uncertainty persists.' Ante, at 33. This assertion is bewildering. Not only does it defy the Court's longstanding precedent affirming the necessity of a health exception, with no carve-out for circumstances of medical uncertainty, see supra, at 4-5; it gives short shrift to the records before us, carefully canvassed by the District Courts. Those records indicate that 'the majority of highly-qualified experts on the subject believe intact D&E to be the safest, most appropriate procedure under certain circumstances.' Planned Parenthood, 320 F. Supp. 2d, at 1034. See supra, at 9-10. … “ Ultimately, the Court admits that 'moral concerns' are at work, concerns that could yield prohibitions on any abortion. See ante, at 28 ('Congress could … conclude that the type of abortion proscribed by the Act requires specific regulation because it implicates additional ethical and moral concerns that justify a special prohibition.'). Notably, the concerns expressed are untethered to any ground genuinely serving the Government's interest in preserving life. By allowing such concerns to carry the day and case, overriding fundamental rights, the Court dishonors our precedent. … “ Without attempting to distinguish Stenberg and earlier decisions, the majority asserts that the Act survives review because respondents have not shown that the ban on intact D&E would be unconstitutional 'in a large fraction of relevant cases.' Ante, at 38 (citing Casey, 505 U. S., at 895). But Casey makes clear that, in determining whether any restriction poses an undue burden on a 'large fraction' of women, the relevant class is not 'all women,' nor 'all pregnant women,' nor even all women 'seeking abortions.' 505 U. S., at 895. Rather, a provision restricting access to abortion, 'must be judged by reference to those [women] for whom it is an actual rather than an irrelevant restriction,' ibid. Thus the absence of a health exception burdens all women for whom it is relevant--women who, in the judgment of their doctors, require an intact D&E because other procedures would place their health at risk. [fn.: There is, in short, no fraction because the numerator and denominator are the same: The health exception reaches only those cases where a woman's health is at risk. Perhaps for this reason, in mandating safeguards for women's health, we have never before invoked the 'large fraction' test.] … It makes no sense to conclude that this facial challenge fails because respondents have not shown that a health exception is necessary for a large fraction of second-trimester abortions, including those for which a health exception is unnecessary: The very purpose of a health exception is to protect women in exceptional cases. … “ The Court's allowance only of an 'as-applied challenge in a discrete case,' ante, at 38--jeopardizes women's health and places doctors in an untenable position. Even if courts were able to carve-out exceptions through piecemeal litigation for 'discrete and well-defined instances,' ante, at 37, women whose circumstances have not been anticipated by prior litigation could well be left unprotected. In treating those women, physicians would risk criminal prosecution, conviction, and imprisonment if they exercise their best judgment as to the safest medical procedure for their patients. The Court is thus gravely mistaken to conclude that narrow as-applied challenges are 'the proper manner to protect the health of the woman.' Cf. ibid. … “ For the reasons stated, I dissent from the Court's disposition and would affirm the judgments before us for review. ”
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SKIP DOWN TO Ethics continued: Game Theory omitting Ethics-related news clippings
	more Ethics in the News “ … Just a quick review: In the 1950s and 1960s, the U.S. dominated the world in K-12 education. We also dominated economically. In the 1970s and 1980s, we still had a lead, albeit smaller, in educating our population through secondary school, and America continued to lead the world economically, albeit with other big economies, like China, closing in. Today, we have fallen behind in both per capita high school graduates and their quality. Consequences to follow. “ For instance, in the 2006 Program for International Student Assessment that measured the applied learning and problem-solving skills of 15-year-olds in 30 industrialized countries, the U.S. ranked 25th out of the 30 in math and 24th in science. That put our average youth on par with those from Portugal and the Slovak Republic, 'rather than with students in countries that are more relevant competitors for service-sector and high-value jobs, like Canada, the Netherlands, Korea, and Australia,' McKinsey noted. “ Actually, our fourth-graders compare well on such global tests with, say, Singapore. But our high school kids really lag, which means that 'the longer American children are in school, the worse they perform compared to their international peers,' said [a new study by the consulting firm McKinsey, entitled 'The Economic Impact of the Achievement Gap in America's Schools.' … It is not that we are failing across the board. There are huge numbers of exciting education innovations in America today — from new modes of teacher compensation to charter schools to school districts scattered around the country that are showing real improvements based on better methods, better principals and higher standards. The problem is that they are too scattered — leaving all kinds of achievement gaps between whites, African-Americans, Latinos and different income levels. … ” —From 4-21-09 New York Times, "Op-Ed Columnist: Swimming Without a Suit," By THOMAS L. FRIEDMAN. “ When a huge explosion occurred last August at a West Virginia chemical plant, managers refused for several hours to tell emergency responders the nature of the blast or the toxic chemical it released, and they later misused a law intended to keep information from terrorists to try to stop federal investigators from learning what had happened, members of a House subcommittee said Tuesday. “ The explosion, at Bayer CropScience, in Institute, W. Va., killed two employees and sickened six volunteer firefighters. It was felt 10 miles away, and a tank weighing several thousand pounds 'rocketed 50 feet through the plant,' committee investigators found. “ Fortunately, it did not go in the direction of a tank holding the same chemical that killed thousands in a 1984 chemical plant explosion in Bhopal, India. Devices meant to detect releases of the chemical, methyl isocyanate, or MIC, had been disabled, and video cameras had been disconnected, steps that 'raise concerns about an orchestrated effort by Bayer, a subsidiary of Bayer AG, to shroud the explosion in secrecy,' said the subcommittee chairman, Representative Bart Stupak, Democrat of Michigan. “ After the Bhopal catastrophe, Congress created an independent agency, the Chemical Safety and Hazard Investigation Board, to investigate chemical accidents in this country. But Bayer's chief executive, William Buckner, said in his prepared testimony that company officials believed they could 'refuse to provide information' to the board. … “ The plant was previously owned by Union Carbide, which also owned the plant in Bhopal that had released tons of MIC in December 1984. Representative Henry A. Waxman, Democrat of California and chairman of the Energy and Commerce Committee, noted that the same month in 1984, he had held a hearing at the West Virginia plant, near Charleston, to inquire about safe use of the chemical. “ 'I think it's finally time to ask whether it makes sense to allow Bayer to continue producing and storing such massive amounts of this highly toxic chemical,' Mr. Waxman said Tuesday. … ” —From 4-21-09 New York Times, "Lawmakers Say Chemical Company Withheld Information About Explosion," By MATTHEW L. WALD. “ … But while hospitals and drug companies often have more negotiating leverage than insurers, it is also true that insurers don't go out of their way to compete on the basis of price. The market in most regions is dominated by two or three big players that have learned they are better off raising prices in tandem than getting into price wars from which only the customers emerge as winners. Rather than compete on price, insurers compete to attract the healthiest patients. “ That's why advocates of a public option believe a government insurance plan is needed to bring more robust price competition to the market, using its size to extract lower prices from providers and passing those savings on to consumers. Medicare already effectively dictates the prices it is willing to pay to doctors and hospitals, and there are very few providers who choose to opt out of the system. A public insurance plan for the non-elderly could simply piggyback on those lower Medicare prices. “ The problem with this arrangement is that Medicare is so powerful that it can get away with paying only 80 to 85 percent of actual costs, forcing doctors and hospitals to overcharge private insurers to make up the difference. Private insurers fear that if they were forced to compete against a public plan with that kind of cost disadvantage, they would be driven out of the market. And doctors and hospitals warn that, without private insurers to overcharge, they'll wind up out of business, as well. “ Uwe Reinhardt, a Princeton University economist, has a simple fix for this screwy pricing system. Reinhardt suggests that, once a year, each hospital or physicians group come up with a list of prices for individual procedures, or bundles of services, that it is willing to offer to any and all insurers, regardless of size. After reviewing the offers, Medicare and private insurers can then announce what price they are willing to pay and give providers one last chance to adjust their offers accordingly. After that, everyone would be free to do business with whomever they choose on the basis of the posted bids. “ There is, of course, a name for such an arrangement. It's called a free market -- in this case a market open to multiple buyers and sellers with regular bidding and transparent pricing. More to the point, it is a market that would work whether there was a public insurance option or not. … ” —From 3-10-09 Washington Post, "A 'Public' Fix for Health Care Need Not Abandon the Market," By Steven Pearlstein. “ Here we have [in today's colleges] a generation of young adults away from home for the first time, free to enjoy the most experimental period of their lives, yet they're choosing books like 13-year-old girls -- or their parents. The only specter haunting the groves of American academe seems to be suburban contentment. “ Professor Eric Williamson -- a card-carrying liberal in full tweed glory -- argues that 'the entire culture has become narcotized.' An English teacher at the University of Texas-Pan American, he places the blame for students' dim reading squarely on the unfettered expansion of capitalism. 'I have stood before classes,' he tells me, 'and seen the students snicker when I said that Melville died poor because he couldn't sell books. 'Then why are we reading him if he wasn't popular?' ' Today's graduate students were born when Ronald Reagan was elected, and their literary values, he claims, reflect our market economy. 'There is nary a student in the classroom -- and this goes for English majors, too -- who wouldn't pronounce Stephen King a better author than Donald Barthelme or William Vollmann. The students do not have any shame about reading inferior texts.' “ Roger Kimball, editor and publisher of the New Criterion, marches in the other direction -- he has no complaints about the market economy -- but he arrives at the same dismal appraisal of the academic culture. Universities and colleges 'enforce an intellectually stultifying, politically correct atmosphere that pretends to diversity,' he complains. 'One of the results of this is a notable uptick in superficiality and a notable uptick in the anesthetizing of that native curiosity that was once a prominent feature of the adolescent mind.' … “ But maybe young people's reading choices reflect our desire to keep them young. David Farber, editor of 'The Sixties: From Memory to History,' says that the way Americans think about the age of maturity has shifted considerably. 'There's much more an emphasis now on kids thinking of themselves as kids, even into their early to mid-20s,' he says. 'But in the '60s, they thought of themselves as agents of historical change. The sit-ins, the civil rights movement, the possibility of being drafted focused the mind. The contagion of protest made everyone think of themselves as possible demonstrators.' … ” —From 3-8-09 Washington Post, "On Campus, Vampires Are Besting the Beats," By Ron Charles. Read in the Friday, January 30, 2009 Washington Post, "Why Easy Grading Is Good for Your Career," By Jay Mathews. “ Medical and surgical residents in hospitals should work no more than 16 hours without taking a mandatory five-hour sleep break, and they should get one full day off a week and at least two back-to-back days off a month, a panel of experts at the Institute of Medicine recommended yesterday. … “ 'Our overarching conclusion is that the science clearly shows that fatigue increases the chances of errors, and residents often work long hours without rest and regular time off,' said Michael M.E. Johns, a physician and the chancellor of Emory University who led the 17-member panel. “ The 324-page document is the latest in a series of reports on ways to improve the quality and safety of American medicine. The Institute of Medicine, part of the National Academy of Sciences, provides expert advice to Congress. “ The Accreditation Council for Graduate Medical Education, which oversees residency programs, currently sets the maximum workweek at 80 hours, with shifts to last no more than 30 hours. It also requires that residents get at least four days off per month, although there does not have to be one in each week. “ A survey of about 4,000 interns found that in the first year those rules were in effect, 84 percent reported working shifts that violated them at least one month of the year. Forty-three percent reported working more than 80 hours weekly. … “ A study in 1996 found that pediatric residents, who slept on average less than three hours a night when they were on call, were twice as likely to be in car accidents as faculty members, who did not report sleep-deprived nights. “ The panel, which included sleep researchers and quality-assurance experts, as well as physicians, acknowledged that there is a chance the new recommendations could make things worse. That is principally because an enforced sleep break after 16 hours will require more patient 'handoffs' than occur now. … ” —From 12-3-08 Washington Post, "Medical Residents Must Sleep After 16 Hours, Experts Urge," By David Brown, Washington Post Staff Writer. Link to 12-3-08 New York Times, "The Evidence Gap: British Balance Benefit vs. Cost of Latest Drugs," By GARDINER HARRIS. An interesting article about a British government agency, the National Institute for Health and Clinical Excellence, which decides cost/benefit questions regarding drugs and medical procedures for the National Health Service. Successfully driving down the cost of drugs and medical procedures, the institute is being copied by other countries. “ When a Congressional investigation revealed in June that Dr. Joseph Biederman, a world-renowned child psychiatrist, had earned far more money from drug makers than he had reported to his university, he said that his interests were 'solely in the advancement of medical treatment through rigorous and objective study.' “ But e-mail messages and internal documents from Johnson & Johnson made public in a court filing reveal that Dr. Biederman pushed the company to finance a research center at Massachusetts General Hospital, in Boston, with a goal to 'move forward the commercial goals of J.& J.' The documents also show that the company prepared a draft summary of a study that Dr. Biederman, of Harvard, was said to have written. “ Dr. Biederman's work helped to fuel a fortyfold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder and a rapid rise in the use of powerful, risky and expensive antipsychotic medicines in children. … “ Johnson & Johnson makes a popular antipsychotic medicine called Risperdal, or risperidone. More than a quarter of its use is in children and adolescents. “ Last week, a panel of federal drug experts said that medicines like Risperdal were being used too cavalierly in children and that regulators must do more to warn doctors of their substantial risks. Other popular antipsychotic medicines, also referred to as neuroleptics, are Zyprexa, made by Eli Lilly; Seroquel, made by AstraZeneca; Geodon, made by Pfizer; and Abilify, made by Bristol-Myers Squibb. … “ A February 2002 e-mail message from Georges Gharabawi, a Johnson & Johnson executive, said Dr. Biederman approached the company 'multiple times to propose the creation' of the center. 'The rationale of this center,' the message stated, 'is to generate and disseminate data supporting the use of risperidone in' children and adolescents. “ Documents show that Johnson & Johnson gave the center $700,000 in 2002 alone. Massachusetts General said in its statement on Monday that grant agreements indicated the center 'was for scientific and educational purposes only and not for purposes of promoting, directly or indirectly, the products of Johnson & Johnson and its affiliates.' “ A statement Monday from Janssen Pharmaceutica, a unit of Johnson & Johnson, said it helped finance the research center in 2002 'with an objective to conduct rigorous clinical trials to clarify appropriate use and dosing of Risperdal in children.' … “ Drug makers have long hired professional writers to compose scientific papers and then recruited well-known doctors to list themselves as the author. The practice, known as ghostwriting, has come under intense criticism recently, and medical societies, schools and journals have condemned it. … ” —From 11-25-08 New York Times, "Research Center Tied to Drug Company," By GARDINER HARRIS. “ A state-by-state analysis by The New York Times found that in the 40 states reporting on their compliance so far this year, on average, 4 in 10 schools fell short of the law's testing targets, up from about 3 in 10 last year. Few schools missed targets in states with easy exams, like Wisconsin and Mississippi [!], but states with tough tests had a harder time. In Hawaii, Massachusetts and New Mexico, which have stringent exams, 60 to 70 percent of schools missed testing goals. And in South Carolina, which has what may be the nation's most rigorous tests, 83 percent of schools missed targets. ” —From 10-13-08 New York Times, "Under ‘No Child' Law, Even Solid Schools Falter," By SAM DILLON. “ Surveys show that cheating in school — plagiarism, forbidden collaboration on assignments, copying homework and cheating on exams — has soared since researchers first measured the phenomenon on a broad scale at 99 colleges in the mid-1960s. “ The percentage of students who copied from another student during tests grew from 26 percent in 1963 to 52 percent in 1993, and the use of crib notes during exams went from 6 percent to 27 percent, according to a study conducted by Dr. Donald McCabe of Rutgers. By the mid-1990s, only a small minority said they had never cheated, meaning that cheating had become part of the acceptable status quo. “ Dr. McCabe's later national survey of 25,000 high school students from 2001 to 2008 yielded equally depressing results: more than 90 percent said they had cheated in one way or another. “ Dr. Jason Stephens of the University of Connecticut has now embarked on a three-year pilot program to reduce cheating. His premise is that honesty and integrity are not only values but habits — habits that can be encouraged in school settings, with positive benefits later in life. “ The program seeks to enlist students and teachers in six high schools in promoting a culture of honesty. Schools will be asked to consider honor codes, and, since peer pressure is vitally important, students will be invited to help shape policies and strategies to discourage cheating. Two schools are suburban and wealthy, two are middle class, two are urban and poor. One school from each pair will work to end the cheating epidemic, and the other will serve as the control group. “ The challenge is daunting. Students of both genders and every demographic group cheat even though they know it is wrong, a mind-set Dr. Stephens describes as 'a corrosive force' — especially when it is acquired in the early years of moral development. “ The fact that so many students cheat doesn't make them intrinsically bad, he says: 'It's not a case of the bad seed. It's more like bad soil.' … ” —From 10-13-08 New York Times, "Editorial Observer: Digging Out Roots of Cheating in High School," By MAURA J. CASEY. “ At the heart of the [economic] troubles, both short term and long term, is debt. Debt helped create the housing bubble and has now left almost one of every six homeowners with a mortgage larger than the value of their home. Debt built up, and then laid low, modern Wall Street, where firms borrowed $30 for every $1 they owned. And in the coming years, debt will constrain the United States government, as it copes with the combined deficits created by the Bush administration's policies, the ever-more expensive financial rescue and the biggest item of all, Medicare for the baby boomers. “ In essence, households, banks and the government have already spent some of their future earnings. The current crisis marks the point at which the bills begin to get paid. Whereas Britain [at the turn of the 20th century] lumbered under the weight of imperial overreach, as the historian Niall Ferguson has written, the United States will be shackled primarily by its financial overreach. … “ It is possible, then, that the main legacy of the crisis will be some form of corrective to the country's recent excesses. The economy looks to be heading into a period of more regulated, but still American-style, capitalism, more along the lines of how it operated in the 1950s, 1960s and 1990s. Those three decades happen to have produced the biggest and most widely shared economic gains since World War II. “ But if that outcome is possible, it's not inevitable, and many economists say it isn't even likely. The debts run up in recent years are particularly unfortunate, because they stole resources from the future without laying the groundwork for future growth. 'If you told me we were spending like crazy to build schools and send everyone to college, that would have infinitely different implications than borrowing like crazy to finance current consumption,' said Christina Romer, an economist at the University of California at Berkeley. ” —From 10-12-08 New York Times, "A Power That May Not Stay So Super," By DAVID LEONHARDT. “ … This is … a hard time for D.C. teachers. They are fine people who have chosen a tough profession and put their hearts into their work. Many fear being judged by principals who, unlike [Sarah] Hayes, [principal of the KIPP DC:KEY Academy,] were not skillful teachers themselves and have little clue as to what helps kids learn and what doesn't. But I don't see any way the city's children are going to get the instruction they deserve -- the imaginative, fun-loving, firm teaching found at schools like KEY -- unless principals are given the power to hire and fire teachers based on demonstrated skill and improved learning in class. “ [D.C. Schools Chancellor Michelle A.] Rhee is likely to pick a few principals who fail, much as Hayes erred in hiring the two teachers. But the great virtue of the approach used at KEY and similar charter schools, the approach Rhee wants to adopt, is that achievement results -- not friendships, not union rules, not inertia -- would determine which principals and which teachers keep their jobs. If Hayes and other KIPP principals don't show learning gains, they are out. Rhee says her principals will also be gone if they don't show good results. … “ For instance, nationally, KIPP middle schools have been shown to raise average reading achievement from the 32nd to the 60th percentile and math achievement from the 40th to the 82nd percentile for children who stay from grades five through eight. These children, neglected in regular public schools, thrive when they transfer to KIPP. That seems to be because the principals and teachers in their new schools want to be judged by their results and don't need a promise of higher salaries to take the risk that they might fail. ” —From 9-29-08 Washington Post, "For Kids' Sake, Power to Fire Teachers Crucial," By Jay Mathews; he writes a regular column, "Class Struggle." “ Even as Washington and Wall Street debate the best way to avert an economic disaster, increasing numbers of Americans are struggling with another financial crisis: the growing burden of unpaid medical bills. “ Two studies released Wednesday provide further evidence of the toll that health care is increasingly placing on working families, even for those with health insurance. And as employees are paying more medical expenses out of their own pockets, they are having a harder time coming up with the money. “ The studies, by the Kaiser Family Foundation and the Center for Studying Health System Change, were completed earlier this year before the financial markets reached their current state of crisis. But policy analysts say the findings underscore the mounting additional strain that medical care is placing on working Americans. … “ Although inflation in insurance premiums has moderated in recent years, the Kaiser survey found that employees were continuing to spend more in medical costs, including their share of yearly insurance premiums. Employees are paying an average of $3,354 in premiums for family coverage, more than double the amount they paid in 1999. The total cost for family coverage now averages $12,680 a year, up 5 percent from 2007. “ And as people are paying more, they are finding the higher expense less affordable. In the study by the nonpartisan Center for Studying Health System Change, based on its national survey of households, nearly one of every five families had problems paying medical bills last year. More than half of these families said they borrowed money to pay these expenses, and nearly 20 percent of those having difficulty said they contemplated declaring personal bankruptcy as a result of their medical bills. “ The study estimates that 57 million Americans live in families struggling with medical bills, and 43 million of those have insurance coverage. 'It's hitting both the insured and the uninsured, and it's hitting middle-class families,' said Karen Davis, the president of the Commonwealth Fund, a nonprofit research organization that financed the study. “ Because they are already in debt over their medical care, some families start forgoing treatments, even for serious or chronic conditions, Ms. Davis said. By deciding not to fill a prescription for high blood pressure medication or failing to go to the doctor for diabetes, they are at risk of incurring more serious and costly problems that can land them in the emergency room. … “ While large employers remain a strong and generous source of coverage, the Kaiser study pointed to the widening divide between employees working for big companies and those at companies with fewer than 200 employees. “ Virtually all large employers offered coverage, but only 62 percent of small companies did. People working for big companies were also paying less — about $3,000 a year for family coverage — compared with $4,100 for those in small companies. “ Faced with the choice of dropping coverage altogether, many small companies have opted for health plans that ask employees to pay much more in the form of deductibles and out-of-pocket expenses. One in three workers in small businesses has annual deductibles of $1,000 or more, in contrast to one in five in the previous year's survey. … ” —From 9-25-08 New York Times, "Health Care Costs Increase Strain, Studies Find," By REED ABELSON. “ … “ In a country where insurance is out of reach for many, it is not uncommon for couples to marry, or even to divorce, at least partly so one spouse can obtain or maintain health coverage. “ There is no way to know how often it happens, but lawyers and patient advocacy groups say they see cases regularly. “ In a poll conducted this spring by the Kaiser Family Foundation, a health policy research group, 7 percent of adults said someone in their household had married in the past year to gain access to insurance. The foundation cautions that the number should not be taken literally, but rather as an intriguing indicator that some Americans 'are making major life decisions on the basis of health care concerns.' … “ In some instances, the need for insurance may prolong unhappy marriages. … “ Other couples, like Michelle and Marion Moulton, are forced to consider divorce so that an ailing spouse can qualify for affordable insurance. “ Ms. Moulton, 46, a homemaker who lives near Seattle with her husband and two children, learned three years ago that she had serious liver damage, a side effect, she believes, of drugs she was once prescribed. She is trying to get on a transplant list, but the clock is ticking; her once slender body has ballooned, and her doctors say her liver could give out at any time. “ Two years ago, Ms. Moulton looked into buying more comprehensive coverage through the Washington State Health Insurance Pool, a state-financed program for high-risk patients. She found the premiums unaffordable, but noticed that the state offered subsidies to those with low incomes. As their debts and desperation multiplied, it occurred to Ms. Moulton that divorcing her husband of 17 years would make her eligible for the subsidized coverage. “ 'I felt like I had done this to us,' she said. 'We had worked hard our entire lives, and if this was all the insurance we had, we could become homeless. I just said, ‘You know, we really need to sit down and talk about divorce.' ' … “ 'Nobody should have to make a choice like that,' Ms. Moulton said. 'What happened to our country? I don't remember growing up like this.' ” —From 8-13-08 New York Times, "Health Benefits Inspire Rush to Marry, or Divorce," By KEVIN SACK. “ Last week, [after many complaints by physicians] Zimmer announced it was suspending sales of the [hip socket replacement implants] device, known as the Durom cup, until it trained doctors how best to implant it. The company said a 'low' percentage of the 13,000 patients who got the socket would need replacements, but some doctors fear the number could reach into the hundreds. “ If those patients lived in other countries where artificial joints were tracked by national databases — including Australia, Britain, Norway and Sweden — many might have been spared that risk. And Zimmer might have suspended sales of the cup months ago. “ But the United States lacks such a national database, called a joint registry, that tracks how patients with artificial hips and knees fare. The risk in the United States that a patient will need a replacement procedure because of a flawed product or technique can be double the risk of countries with databases, according to Dr. Henrik Malchau of Massachusetts General Hospital. “ Experts say that the United States wastes billions of dollars annually on medical treatments which may not work. But the financial and human consequences are also large when evidence exists but is not collected. “ The toll of early device replacement is magnified here because of the sheer number of procedures that take place in the United States. Nearly one million hips and knees were used last year, about half of the world's total. “ 'We are No. 1 both as a provider and user of implants,' said Dr. John J. Callaghan, a professor of orthopedics at the University of Iowa. 'We should be the leader in the follow-up of them.' “ The Food and Drug Administration is charged with monitoring devices like artificial joints. But that system is often overwhelmed by the vast number of products it monitors and because doctors often do not report problems. “ Medicare, which pays for about half the hip and knee implants in this country, rebuffed a proposal two years ago from a medical group to support a joint database. It said it was not the agency's job to gather such data — despite the considerable savings in taxpayer dollars that might come from reducing the number of do-over surgeries. “ The use of joint registries has proven beneficial abroad. In Australia, regulators use such data to force manufacturers to justify why poorly performing hips or knees should remain available, and products have been withdrawn as a result. In Sweden several years ago, surgeons alerted by their national registry stopped using a badly flawed hip long before their American counterparts did. A few medical organizations here, like Kaiser Permanente, operate their own registries to good effect and the Hospital for Special Surgery in New York has recently set up a registry. “ But for more than a decade, efforts to set up an open national registry in this country have failed. One witness to those events has been Dr. Malchau, who worked for a decade at the Swedish registry. He and other registry advocates have heard all the reasons a registry cannot work here — busy doctors hate paperwork, plaintiffs' lawyers would mine a database to find cases, general hospitals would be unfairly compared with specialty ones, to name a few. “ A registry for artificial joints is much like any system that can compare performance of competing cars or appliances, but in this case it involves appliances going into the human body. “ A patient — identified by a number — is entered into a database along with information about the device he or she received, the surgical technique used and the name of the doctor who performed the procedure. If a patient returns for a replacement, the information is recorded again, creating a rolling surveillance system. “ Such databases can be examined at any time for information and groups that operate national registries issue annual reports comparing performance of devices, differing surgical techniques and hospitals. “ Registries do not catch all problems and some registries have not been effective because not enough doctors participate. But the success of the Swedish program inspired Australian orthopedists to start their registry in the late 1990s through a professional association, said Dr. Stephen Graves, the program's director. Since then Australia's rate of early replacement procedures, or revisions, has declined. “ Confronted with registry data indicating problems, a 'significant percentage of companies will take the devices off the market,' Dr. Graves said. “ They may keep selling those devices elsewhere, including the United States. … “ For several years, Dr. William Jiranek, an orthopedic surgeon in Richmond, has waged a lonely campaign for a registry in Virginia, one that has offered him a crash course in government, law and medical ethics. “ One of Dr. Jiranek's patients got the ball rolling in 2003 with a $50,000 donation. Then, the doctor, after learning that Virginia law needed to be changed to protect registry data, used some of that money to hire lobbyists who convinced lawmakers to do so. Soon, Dr. Malchau, the Swedish researcher now in Boston, helped provide software for doctors to enter data after a procedure. “ But now Dr. Jiranek is about to hit the hard part. Thus far, only six of the estimated 200 doctors doing joint replacements in Virginia are participating. 'Most of them are supportive,' Dr. Jiranek said. 'Few of them are willing to do a lot of work.' “ Dr. Jiranek's effort is the latest in a long series of attempts to create a registry in the United States. Even advocates acknowledge that the barriers to such a database are substantial. “ The American health care system is sprawling and fragmented, compared with the highly centralized systems in countries that do have the databases. Also, the number of orthopedic devices used here and the number of doctors implanting them is huge. … “ Some registry advocates suspect there may be another reason why a registry has not gained urgency here — the financial relationships between many orthopedists and device producers. Last year, several major manufacturers, including Zimmer and Smith & Nephew, agreed to pay $310 million to settle civil charges and resolve a Department of Justice investigation into whether the firms paid illegal inducements to get some doctors to use their products. ” —From 7-29-08 New York Times, "The Evidence Gap: A Call for a Warning System on Artificial Joints," By BARRY MEIER. “ With the Supreme Court becoming more conservative, many people who support women's right to choose an abortion fear that Roe v. Wade, the 1973 decision that gave them that right, is in danger of being swept aside. “ When such fears arise, we often hear about the pre-Roe 'bad old days.' Yet there are few physicians today who can relate to them from personal experience. I can. “ I am a retired gynecologist, in my mid-80s. My early formal training in my specialty was spent in New York City, from 1948 to 1953, in two of the city's large municipal hospitals. “ There I saw and treated almost every complication of illegal abortion that one could conjure, done either by the patient herself or by an abortionist — often unknowing, unskilled and probably uncaring. Yet the patient never told us who did the work, or where and under what conditions it was performed. She was in dire need of our help to complete the process or, as frequently was the case, to correct what damage might have been done. … “ … Yet this much was clear: The woman had put herself at total risk, and literally did not know whether she would live or die. “ This, too, was clear: Her desperate need to terminate a pregnancy was the driving force behind the selection of any method available. “ The familiar symbol of illegal abortion is the infamous 'coat hanger' — which may be the symbol, but is in no way a myth. In my years in New York, several women arrived with a hanger still in place. Whoever put it in — perhaps the patient herself — found it trapped in the cervix and could not remove it. … “ Almost any implement you can imagine had been and was used to start an abortion — darning needles, crochet hooks, cut-glass salt shakers, soda bottles, sometimes intact, sometimes with the top broken off. … “ It is important to remember that Roe v. Wade did not mean that abortions could be performed. They have always been done, dating from ancient Greek days. “ What Roe said was that ending a pregnancy could be carried out by medical personnel, in a medically accepted setting, thus conferring on women, finally, the full rights of first-class citizens — and freeing their doctors to treat them as such. ” —From 6-3-08 New York Times, "Essay: Repairing the Damage, Before Roe," By WALDO L. FIELDING, M.D.; Waldo L. Fielding was an obstetrician and gynecologist in Boston for 38 years. He is the author of 'Pregnancy: The Best State of the Union' (Thomas Y. Crowell, 1971). The U.S. Supreme Court decision of June 12, 2008: Detainee Treatment Act of 2005 fails to offer the fundamental procedural protections of habeas corpus links to the text: BOUMEDIENE et al. v. BUSH, PRESIDENT OF THE UNITED STATES, et al. (via FindLaw.com) or, alternatively, BOUMEDIENE v. BUSH (Nos. 06-1195 and 06-1196) (via Legal Information Institute -- Cornell Law School) Excerpts from New York Times and Washington Post stories “ In February, the day after his infamous encounter at Washington's Mayflower Hotel, Eliot Spitzer, then the governor of New York, published a remarkable opinion piece in The Washington Post. “ He wrote that several years earlier, state attorneys general noticed a spike in predatory lending that the federal government was doing nothing about. When the states tried to rein in abusive mortgage lenders, the Bush administration finally did something. The Office of the Comptroller of the Currency issued rules nullifying state predatory lending laws over the objection of all 50 state banking superintendents. “ The clampdown, which paved the way for the subprime mortgage crisis, was done by 'pre-emption,' a little-understood doctrine that allows the federal government to wipe away state laws. The Constitution's supremacy clause says federal law can trump state law. But the federal rule should be a floor, not a ceiling. It should set a minimum level of rights, not stop states from doing more to protect their citizens. … “ The Associated Press recently reported that the administration has quietly rewritten more than 50 proposed or adopted federal regulations to make it more difficult for consumers to sue makers of unsafe food, drugs and other dangerous products. The federal standard for head restraints in automobiles had language expressly saying it did not pre-empt state-court lawsuits — but it was taken out. Manufacturers are more likely to make unsafe products if they know a customer who is injured or killed cannot sue. … “ Most Americans may not know about the supremacy clause, but they do seem to understand that they are increasingly vulnerable. Weeks before the 2006 elections shifted control of Congress from the Republicans to the Democrats, 79 percent of respondents in an Opinion Research poll said big business had too much influence over the Bush administration. As Democrats and Republicans contemplate what kind of 'change' voters are looking for now, they can start with the idea that both the federal and state government need to do a better job of protecting their citizens. ” —From 5-23-08 New York Times, "Editorial Observer: What Ever Happened to (the Good Kind of) States' Rights?" By ADAM COHEN. “ Factory farming takes a big, hidden toll on human health and the environment, is undermining rural America's economic stability and fails to provide the humane treatment of livestock increasingly demanded by American consumers, concludes an independent, 2 1/2 -year analysis that calls for major changes in the way corporate agriculture produces meat, milk and eggs. “ The report released yesterday, sponsored by the Pew Charitable Trusts and Johns Hopkins Bloomberg School of Public Health, finds that the 'economies of scale' used to justify factory farming practices are largely an illusion, perpetuated by a failure to account for associated costs. “ Among those costs are human illnesses caused by drug-resistant bacteria associated with the rampant use of antibiotics on feedlots and the degradation of land, water and air quality caused by animal waste too intensely concentrated to be neutralized by natural processes. … “ The report, "Putting Meat on the Table: Industrial Farm Production in America," comes at a time when food, agriculture and animal welfare issues are prominent in the American psyche. “ Food prices are rising faster than they have for decades. Concerns about global climate change have brought new attention to the fact that modern agriculture is responsible for about 20 percent of the nation's greenhouse-gas production. And recent meat recalls, punctuated by the release of undercover footage of cows being abused at a California slaughterhouse, have struck a chord with consumers. … “ [Despite the benefit of cheaper meat] the system has brought unintended consequences. With thousands of animals kept in close quarters, diseases spread quickly. To prevent some of those outbreaks -- and to spur faster growth -- factory farms routinely treat animals with antibiotics, speeding the development of drug-resistant bacteria and in some cases rendering important medications less effective in people. “ It appears that the vast majority of U.S. antibiotic use is for animals, the commission noted, adding that because of the lack of oversight by the Food and Drug Administration and other agencies, even regulators can only estimate how many drugs are being given to animals. “ The commission urges stronger reporting requirements for companies and a phaseout and then ban on antibiotics in farm animals except as treatments for disease, a policy already initiated in some European countries. “ 'That's a good recommendation. A strong recommendation,' said Margaret Mellon of the Union of Concerned Scientists, which released its own report last week documenting billions of dollars in farm subsidies to factory farming operations and annual federal expenditures of $100 million to clean up their ongoing environmental damage. “ The Pew report also calls for tighter regulation of factory farm waste, finding that toxic gases and dust from animal waste are making CAFO workers and neighbors ill. … “ Activists said it will be up to Congress and agency officials, under public pressure, to implement some of the commission's recommendations. Congress is now considering a bill, the Preservation of Antibiotics for Medical Treatment Act, that would accomplish some of the Pew recommendations. ” —From 5-30-08 Washington Post, "Report Targets Costs Of Factory Farming," By Rick Weiss, Washington Post Staff Writer. “ The drug maker Merck drafted dozens of research studies for a best-selling drug, then lined up prestigious doctors to put their names on the reports before publication, according to an article to be published Wednesday in a leading medical journal. “ The article, based on documents unearthed in lawsuits over the pain drug Vioxx, provides a rare, detailed look in the industry practice of ghostwriting medical research studies that are then published in academic journals. … “ The lead author of Wednesday's article, Dr. Joseph S. Ross of the Mount Sinai School of Medicine in New York, said a close look at the Merck documents raised broad questions about the validity of much of the drug industry's published research, because the ghostwriting practice appears to be widespread. “ 'It almost calls into question all legitimate research that's been conducted by the pharmaceutical industry with the academic physician,' said Dr. Ross, whose article, written with colleagues, was published Wednesday in JAMA, The Journal of the American Medical Association. and posted Tuesday on the journal's Web site. … “ The final work is the product of the doctor and 'accurately reflects his or her opinion,' said a Merck lawyer, James C. Fitzpatrick. “ And at least one of the doctors whose published research was questioned in Wednesday's article, Dr. Steven H. Ferris, a New York University psychiatry professor, said the notion that the article bearing his name was ghostwritten was 'simply false.' He said it was 'egregious' that Dr. Ross and his colleagues had done no research besides mining the Merck documents and reading the published journal articles. “ In an editorial, JAMA said the analysis showed that Merck had apparently manipulated dozens of publications to promote Vioxx. “ 'It is clear that at least some of the authors played little direct roles in the study or review, yet still allowed themselves to be named as authors,' the editorial said …. “ 'The fact that the draft was written by a Merck employee for later discussion by all the authors does not in and of itself constitute ghostwriting,' Dr. Kirby's e-mail message said. … ” —From 4-16-08 New York Times, "Merck Wrote Drug Studies for Doctors," By STEPHANIE SAUL. “ Only a tiny minority of drug trials on children have an independent safety monitoring committee to pick up potentially dangerous side-effects, a study has revealed. “ Researchers from Nottingham University found that under 2% of the 739 international drug trials published between 1996 and 2002 had such committees of independent experts who would scrutinise data and warn, if necessary, that it was not safe to carry on. “ Among the 2%, six trials had to be stopped early because of toxic effects on the child patients. “ 'We were very surprised by the low level of trials that had independent safety monitoring committees and are urging pharmaceutical companies to include these in all future trials involving children,' said Dr Helen Sammons, associate professor of child health at Nottingham and lead author of the paper, published in the child health journal Acta Paediatrica. … “ The team found that children experienced adverse effects caused by the drugs in a third of the trials - nearly 37%. In 11%, side-effects were moderate or severe and even sometimes life-threatening. Sammons stressed that the point of a trial was to find out whether the benefits of the drug outweighed any side-effects before the drug was used in the population at large. … ” —From 3-18-08 The Guardian, "Study finds 98% of child drug trials lack independent safety checks," Sarah Boseley, health editor. "FEMA Knew Of Toxic Gas In Trailers: Hurricane Victims Reported Illnesses," By Spencer S. Hsu, Washington Post Staff Writer; from 7-20-07 Washington Post: “ The Federal Emergency Management Agency since early 2006 has suppressed warnings from its own field workers about health problems experienced by hurricane victims living in government-provided trailers with levels of a toxic chemical 75 times the recommended maximum for U.S. workers, congressional lawmakers said yesterday. “ A trail of e-mails obtained by investigators shows that the agency's lawyers rejected a proposal for systematic testing of the levels of potentially cancer-causing formaldehyde gas in the trailers, out of concern that the agency would be legally liable for any hazards or health problems. As many as 120,000 families displaced by hurricanes Katrina and Rita lived in the suspect trailers, and hundreds have complained of ill effects. “ On June 16, 2006, three months after reports of the hazards surfaced and a month after a trailer resident sued the agency, a FEMA logistics expert wrote that the agency's Office of General Counsel 'has advised that we do not do testing, which would imply FEMA's ownership of this issue.' A FEMA lawyer, Patrick Preston, wrote on June 15: 'Do not initiate any testing until we give the OK. . . . Once you get results and should they indicate some problem, the clock is running on our duty to respond to them.' … “ On the eve of yesterday's hearing by the House Oversight and Government Reform Committee, FEMA reversed course on the issue and said it has asked federal health officials to help conduct a new assessment of conditions in trailers under prolonged use. But revelation of the agency's earlier posture -- in documents withheld by FEMA until they were subpoenaed by Congress -- attracted harsh bipartisan criticism. … ” “ Some of the nation's most prominent spine surgeons hailed it as a medical breakthrough. “ In a study of nearly 240 patients with lower back pain, the doctors said that the Prodisc, an artificial spinal disk, had worked much better than conventional surgery in which patients' vertebrae were fused. “ 'As a surgeon, it is gratifying to see patients recover function more quickly than after fusion and return to their normal activities more easily,' Dr. Jack E. Zigler, a well-known spine specialist and one of the study's lead researchers, said in a 2006 news release announcing the latest results of the Prodisc clinical trial. “ As it turns out, Dr. Zigler had more than a medical interest in the outcome. So did doctors at about half of the 17 research centers involved in the study. They stood to profit financially if the Prodisc succeeded, according to confidential information from a patient's lawsuit settled last year. “ The companies behind the disks and the surgeons who were willing to comment say the researchers' financial interests had no impact on findings of the research, which they say have been published in various peer-reviewed medical journals. … “ In the study results submitted to the F.D.A., moreover, an unusually large number of patients were not included, and some of those patients have said they fared poorly. As a result, some patients and doctors critical of the research say the study may have cast the Prodisc in an overly flattering light. “ The way the Prodisc was tested and approved provides a stark example of conflicts of interest among clinical researchers — conflicts that are seldom evident to doctors and patients trying to weigh the value of a new device or drug. Instead of serving as objective gatekeepers who can screen out potentially harmful or ineffective new devices or drugs, some medical experts say, clinical researchers with conflicts may have incentives to overstate the value of a new product for patients. “ For better or worse, doctors in this country frequently have financial ties to the companies whose devices or drugs they recommend to patients. But in the case of the Prodisc clinical trial, as with any clinical research, the doctors were supposed to be acting not as advocates for the product but as objective scientists studying whether the disk was safe and effective enough to be widely sold and used in the United States. … “ Dr. Charles Rosen, a spine surgeon at the University of California, Irvine, was not involved in the Prodisc trial. But he provided his expert opinion to Patricia Kennedy's lawyers and has reviewed the medical records of some of the other patients who are dissatisfied with their treatment. He is among a growing number of specialists who say the relationships between some prominent spine surgeons and the device industry have become too cozy. “ 'Industry's goal is to make a profit for its shareholders, not to advance medicine,' said Dr. Rosen, who in 2006 saw a need to start a group called the Association for Ethics in Spine Surgery. It now includes 85 specialists who say one of their aims is to warn the public about industry influence on medical practice. … “ Few would argue that doctors should never be allowed to invest in promising new technologies. But when doctors are acting as researchers, they should not have money riding on the outcome, in the view of outside experts like Dr. Kevin A. Schulman, a professor of medicine and business at Duke University Medical Center who helps oversee clinical research there. … “ The F.D.A.'s rules allow clinical investigators to have financial ties with the maker of the device or drug they are studying — on the condition that such relationships are fully disclosed. Lawyers who have worked with the F.D.A. say that when it becomes aware of potential conflict, it tends to subject research to a higher level of scrutiny. “ The F.D.A. now says it is checking to see whether there was adequate financial disclosure information about the Prodisc researchers during the clinical trial and at the time that the subsequent application for approval was submitted. … “ Close relationships between surgeons and device companies can affect more than the potential quality of an individual clinical trial, said Dr. Drummond Rennie, a professor of medicine at the University of California, San Francisco who has studied conflicts of interest among physicians. Because the entanglements are so common, Dr. Rennie said, it is unlikely another surgeon will speak out about any potential misgivings they have about any device. “ 'The absolute ideal from a drug or device company is everyone is covered,' he said. 'And what they have it covered with is money.' ” —From 1-30-08 New York Times, "Financial Ties Are Cited as Issue in Spine Study," By REED ABELSON. “ Not long ago, I asked a respected cancer researcher if he could send me raw data from a trial he had recently published. He refused. Sharing data would make the study team members 'uncomfortable,' he said, as I might use this to 'cast doubt' on their results. “ I'd heard this before: as a statistician who designs and analyzes cancer studies, I regularly ask other researchers to provide additional information or raw data. Sometimes I want to use the data to test out a new idea or method of statistical analysis. And knowing exactly what happened in past studies can help me design better research for the future. Occasionally, however, there are statistical analyses I could run that might make an immediate and important impact on the lives of cancer patients. “ A few years back, a study was published showing that a certain drug could prevent one type of cancer. The problem was that the drug didn't work very well and had some side effects, so almost no one used it. At the same time, a colleague showed that a protein found in the blood could predict which patients were at high risk for cancer. We put two and two together and realized that we could use the protein test to work out which patients would benefit from the drug. “ To make things even easier for us, it turned out that the researchers who had conducted the trial had actually measured this protein in all their patients. So we wrote to them and asked whether they would share their data. They refused on the grounds that they might consider a similar analysis at some point in the future. But years have passed, no such analyses have been forthcoming and few patients are benefiting from what could be a very effective drug. … “ Dr John Kirwan, a rheumatologist from the University of Bristol in England, has studied researchers' attitudes on sharing data from clinical trials. He found that three-quarters of researchers he surveyed, as well as a major industry group, opposed making original trial data available. It is worth restating this finding: most scientists doing research on how best to help those in pain, or at risk of death, want to keep their data a secret. “ Dr. Kirwan went on to ask his subjects why. Their reasons were entirely trivial: one cited the difficult of putting together a data set (wouldn't this have to be done anyway in order to publish a paper?); another was concerned that the data might be analyzed using invalid methods (surely a judgment for the scientific community as a whole). This is something of a clue that the real issue here has more to do with status and career than with any loftier considerations. Scientists don't want to be scooped by their own data, or have someone else challenge their conclusions with a new analysis. “ Yet this is exactly what cancer patients need. They want new results to be published as quickly as possible and to encourage a robust debate on the merits of key research findings. … ” —From 1-22-08 New York Times, "Essay: Cancer Data? Sorry, Can't Have It," By ANDREW VICKERS; Andrew Vickers is a biostatistician at Memorial Sloan-Kettering Cancer Center in New York.
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SKIP DOWN TO Ethics continued: Game Theory omitting Ethics-related news clippings
	more Ethics in the News Kaiser Foundation study of employer-provided health insurance: 6.1 % increase outpaces wage growth “ The cost of employer-provided health insurance rose 6.1 percent this year, the smallest jump since 1999 but still well above the increase in wages and consumer prices, according to an annual survey released yesterday by the Henry J. Kaiser Family Foundation. … “ The $12,106 average cost of family coverage this year is roughly equivalent to a year's salary for a full-time worker earning the minimum wage, which is $12,168. … “ 'We are witnessing a slow but certain long-term erosion of our employer-based system,' said Jon R. Gabel, an author of the Kaiser study and a Washington-based senior fellow at the nonprofit National Opinion Research Center. “ The number of Americans without health insurance rose to a record high of 47 million in 2006, an uptick that Census Bureau officials attributed largely to continuing declines in employer-sponsored coverage. … “ The slowdown is scant consolation for workers. The 6.1 percent rise in health insurance costs in 2007 is higher than growth in wages (3.7 percent) and more than double the inflation rate (2.6 percent), the Kaiser survey found. … ” —From 9-12-07 Washington Post, "Rise in Cost of Employer-Paid Health Insurance Slows: Study Says 6.1 % Increase This Year Still Outpaces Wage Growth, as Percentage of People Covered Shrinks," By Christopher Lee, Washington Post Staff Writer. "Economic Scene: No. 1 Book, and It Offers Solutions," By DAVID LEONHARDT “ In 1967, Jack Wennberg, a young medical researcher at Johns Hopkins, moved his family to a farmhouse in northern Vermont. “ Dr. Wennberg had been chosen to run a new center based at the University of Vermont that would examine medical care in the state. With a colleague, he traveled around Vermont, visiting its 16 hospitals and collecting data on how often they did various procedures. “ The results turned out to be quite odd. Vermont has one of the most homogenous populations in the country — overwhelmingly white (especially in 1967), with relatively similar levels of poverty and education statewide. Yet medical practice across the state varied enormously, for all kinds of care. In Middlebury, for instance, only 7 percent of children had their tonsils removed. In Morrisville, 70 percent did. “ Dr. Wennberg and some colleagues then did a survey, interviewing 4,000 people around the state, to see whether different patterns of illness could explain the variations in medical care. They couldn't. The children of Morrisville weren't suffering from an epidemic of tonsillitis. Instead, they happened to live in a place where a small group of doctors — just five of them — had decided to be aggressive about removing tonsils. “ But here was the stunner: Vermonters who lived in towns with more aggressive care weren't healthier. They were just getting more health care. “ Dr. Wennberg would eventually move to Dartmouth and, over the last 30 years, has done versions of his Vermont study for the entire country. Again and again, he has come up with the same broad result. And that result holds the key to health care reform — how to spend less on health care while not making the population any less healthy. “ Dr. Wennberg's story forms the backbone of 'Overtreated,' by Shannon Brownlee, which is my choice for the economics book of the year. … “ As you've doubtless heard, this country spends far more money per person on medical care than other countries and still seems to get worse results. We devote 16 percent of our gross domestic product to health care, while Canada and France, where people live longer, spend about 10 percent. “ Some of this difference is unavoidable. The United States does more than its share of medical research and bears much of those costs. It also has a diverse, economically unequal population, which, in turn, leads to a diverse and complicated set of health problems. … 'We spend between one fifth and one third of our health care dollars,' writes Ms. Brownlee, a senior fellow at the New America Foundation and former writer for U.S. News & World Report, 'on care that does nothing to improve our health.' “ Worst of all, overtreatment often causes harm, because even the safest procedures bring some risk. One study found that a group of Medicare patients admitted to high-spending hospitals were 2 to 6 percent more likely to die than a group admitted to more conservative hospitals. “ Why is this happening, then? “ Above all, it's the natural outgrowth of our fee-for-service health care system. It turns doctors into pieceworkers, as Ms. Brownlee puts it, 'paid for how much they do, not how well they care for their patients.' Doctors and hospitals typically depend on the volume of work for their income, and they are the gatekeepers who decide when work needs to be done. They also worry about being sued if they do too little. So they err on the side of overtreatment. “ Patients play a role, too. We're entranced by the wonders of modern medicine and fooled by our byzantine health insurance system into thinking that we're not really paying for all those unnecessary spinal fusions. … “ [Brownlee's book] includes some steps that should be widely popular, like giving doctors incentives to explain the risks and benefits of procedures more clearly than they do now. Research has shown that patients frequently decide against marginal care when they know the true risks and benefits. Malpractice laws would also need to be changed so doctors were not sued by patients who later changed their minds. “ Other solutions would be more difficult — because medical evidence is often murky, because hospitals and insurers would fight to keep their revenues and because most Americans think itÕs the other guy whoÕs getting unnecessary treatment. These are the reasons that presidential candidates donÕt focus on wasteful treatment. “ But models for reform are out there. Hospitals that don't use the fee-for-service model, like those run by the Veterans Health Administration, are already getting better results for less money. They closely track their performance — that is, the health of their patients — and motivate employees to improve it. … ” —From 12-19-07 New York Times, "Economic Scene: No. 1 Book, and It Offers Solutions," By DAVID LEONHARDT. “Economix: Health Care as if Costs Didn't Matter,” By DAVID LEONHARDT “ But if we are really at the start of a once-in-a-generation push to fix health care, we need to be clear about the true problem. The main reason so many people lack health insurance is because of its cost. And a big reason for that cost is the explosion of expensive, medically questionable care, be it knee replacement, preventive angioplasty or lumbar fusion. The route to an affordable health insurance solution runs straight through this thicket. “ Along these lines, the three leading Democratic candidates have quietly come up with nearly identical ideas. Deep inside their health care plans, Mrs. Clinton, Mr. Edwards and Mr. Obama have each called for the creation of a national institute to figure out which kinds of medical care actually work. This institute would sort through the scientific research on, say, spinal fusion and help people understand when it may make sense and when it's likely to be just another big medical expense that doesn't solve anything. “ Medicare and private insurers could then use the research findings to determine when a procedure or a drug would be covered. There would be room for exceptions, based on a doctor's judgment. In general, though, a doctor and a patient could proceed with dubious treatment only if they didn't stick the rest of us with the bill. … “ But campaign advisers acknowledge that any institute will ultimately help set insurance payments, and they are not the only ones pushing the idea. Peter Orszag, the head of the Congressional Budget Office, has mentioned it when talking about the fiscal disaster that awaits if Medicare spending isn't slowed. A number of Republican health care experts also favor some sort of cost-effectiveness institute. It's another way to cut wasteful government spending. “ Still, we shouldn't be naïve: a lot of people would lose if medical care came to be based more on what actually worked. Right now, drug companies and medical device makers can go to the Food and Drug Administration and get approval for an expensive new product so long as they show that it's as effective as its predecessor. They can then turn around and suggest to doctors that the new product is more effective than its predecessor. The doctors often profit, too. And many patients demand the latest, most expensive procedure, regardless of the evidence. “ So reforming the system will require a fight — not just over the meaning of the word 'universal' but also over finding tough, sensible ways to save money. … “ The simple truth is that medical spending can't continue to rise at its current rate. Somehow, we need to make choices. ” —From 6-6-07 New York Times, "Economix Health Care as if Costs Didn't Matter," By DAVID LEONHARDT. Put Physicians on Salary “ Doctors in the United States earn two to three times as much as they do in other industrialized countries. Surveys by medical-practice management groups show that American doctors make an average of $200,000 to $300,000 a year. Primary care doctors and pediatricians make less, between $125,000 and $200,000, but in specialties like radiology, physicians can take home $400,000 or more. “ In Europe, however, doctors made $60,000 to $120,000 in 2002, according to a survey sponsored by the British government in 2004. “ Given the years of training that doctors require and the stress and importance of their jobs, few would disagree that they should be well paid. In addition, with a year of medical school now about $30,000, many doctors leave school deeply in debt. And many doctors would argue that cutting salaries would only persuade talented, college graduates to pursue better-paying professions. “ Still, the lower salaries are a significant part of the reason that European countries spend less on health care than the United States does — a fact liberals avoid mentioning when they preach the advantages of a European-style single-payer system. … “ The way that doctors are paid may be an even more significant factor driving up costs and may lead to unnecessary care, said Dr. Peter B. Bach, a pulmonary physician at Memorial Sloan-Kettering Cancer Center and a former senior adviser to Medicare and Medicaid. “ In the United States, nearly all doctors are paid piecemeal, for each test or procedure they perform, rather than a flat salary. As a result, physicians have financial incentives to perform procedures that further drive up overall health care spending. “ Doctors are paid little for routine examinations and very little for 'cognitive services,' such as researching different treatment options or offering advice to help patients get better without treatment. … “ Primary care doctors and pediatricians, who rarely perform complex procedures, make less than specialists. They are attracting a declining percentage of medical students, and some states are facing a shortage of primary care doctors. “ Doctors are also paid whether the procedures they perform go well or badly, Dr. Bach said, and whether they are crucial to a patient's health or not. “ 'Almost all expenditures pass through the pen of a doctor,' he said. So a doctor may decide to perform a test that costs a total of $4,000 in order to make $800 for himself — when a cheaper test might work equally well. 'This is a highly inefficient way to pay doctors,' Dr. Bach said. “ Medicare, especially, does not like to second-guess doctors' clinical decisions, said Dr. Stephen Zuckerman, a health economist at the Urban Institute. 'There's not a lot of utilization review or prior authorization in Medicare,' he said. 'If you're doing the work, you can expect to get paid.' “ As a result, doctors have steadily increased the number of procedures they perform on Medicare beneficiaries — and thus have increased their income from Medicare, Dr. Zuckerman said. But the extra procedures have not helped patients' health much, he said. 'I don't think there's any real strong evidence of improvements in health status.' … “ BUT [the commonly proposed cost-saving] measures are a minor fix, said Dr. Alan Garber, a practicing internist and the director of the Center for Health Policy at Stanford University. Instead, he argues, the United States should move toward paying doctors fixed salaries, plus bonuses based on the health of the patients they care for. ” —From 7-29-07 New York Times, "Sending Back the Doctor's Bill," By ALEX BERENSON. From 7-29-07 New York Times, "Cancer Patients, Lost in a Maze of Uneven Care," By DENISE GRADY: “ … Cancer, more than almost any other disease, can be overwhelmingly complicated to treat. Patients are often stunned to learn that they will need not just one doctor, but at least three: a surgeon and specialists in radiation and chemotherapy. Diagnosis and treatment require a seemingly endless stream of appointments. Doctors do not always agree, and patients may find that at the worst time in their lives, when they are ill, frightened and most vulnerable, they also have to seek second opinions on biopsies and therapy, fight with insurers and sort out complex treatment options. “ The decisions can be agonizing, in part because the quality of cancer care varies among doctors and hospitals, and it is difficult for even the most educated patients to be sure they are receiving the best treatment. 'Let the buyer beware' is harsh advice to give a cancer patient, but it often applies. Excellent care is out there, but people are often on their own to find it. Patients are told they must be their own advocates, but few know where to begin. “ 'Here it is, a country with such a great health system, with so many different breakthroughs in treatment, but even though we know things that work, not everybody who could benefit gets them,' said Dr. Nina A. Bickell, an associate professor of health policy and medicine at the Mount Sinai medical school in Manhattan. … Private vs. Single Payer Health Insurance “ When asked to identify the two most important items from their list of 10 public policy commandments, most antigovernment crusaders pick (1) public spending shall be kept to an absolute minimum and (2) the state shall not transfer income from rich to poor. “ No government heeds these admonitions in any literal sense. Yet they have had a profound impact on public policy decisions, especially in the United States. Often, however, their impact has been the opposite of what antigovernment crusaders intended. “ The problem is that many compellingly advantageous public policies cannot be enacted without violating the two commandments. Every significant policy change benefits some people and harms others. If the gains to winners substantially outweigh the costs to losers, solutions can always be found that allow everyone to come out ahead. But those solutions often involve higher taxes and income transfers to the poor. . . . “ This example is part of a much broader pattern. In health care, for example, the private insurance system employed in the United States delivers worse outcomes at substantially higher cost than the single-payer system employed in virtually every other industrial country. But switching to the single-payer system would require higher taxes and increased benefits for low-income citizens, steps that would violate the two commandments. So for now, we remain saddled with a system that everyone agrees is dysfunctional. . . . “ Is it better to solve a problem by spending two extra dollars in the private sector than by spending one additional dollar in the public sector? The two commandments insist, preposterously, that it is. “ Economic efficiency is a worthy goal because when the economic pie grows larger, everyone can have a larger slice than before. Antigovernment crusaders deserve credit for emphasizing the importance of this goal. But as events of recent years have repeatedly demonstrated, they are often the biggest obstacles to its achievement. ” —From 3-15-07 New York Times, "When to Violate the Top Two Commandments of Antigovernment Crusaders," By ROBERT H. FRANK; Robert H. Frank, an economist at the Johnson School of Management at Cornell University, is the author of The Economic Naturalist, which will be published this spring. Contact: www.robert-h-frank.com.         But: In short, altruism has its limits, as does the public's appetite for trade-offs in their own lives for the sake of the uninsured, said Bill McInturff, a Republican pollster who worked for the insurance industry in 1993 and 1994. "Never, in my years of work, have I found someone who said, 'I will reduce the quality of the health care I get so that all Americans can get something,' " he said. "Every time the debate reaches that point, it collapses." —From 9-16-07 New York Times, "Elective Surgery: Unveiling Health Care 2.0, Again By ROBIN TONE. “To Lower Costs, Hospitals Try Free Basic Care for Uninsured ” “ Unable to afford health insurance, Dee Dee Dodd had for years been mixing occasional doctor visits with clumsy efforts to self-manage her insulin-dependent diabetes, getting sicker all the while. “ In one 18-month period, Ms. Dodd, 38, was rushed almost monthly to the emergency room, spent weeks in the intensive care unit and accumulated more than $191,000 in unpaid bills. “ That is when nurses at the Seton Family of Hospitals tagged her as a 'frequent flier,' a repeat visitor whose ailments — and expenses — might be curbed with more regular care. The hospital began offering her free primary care through its charity program. “ With the number of uninsured people in the United States reaching a record 46.6 million last year, up by 7 million from 2000, Seton is one of a small number of hospital systems around the country to have done the math and acted on it. Officials decided that for many patients with chronic diseases, it would be cheaper to provide free preventive care than to absorb the high cost of repeated emergencies. “ With patients like Ms. Dodd, 'they can have better care and we can reduce the costs for the hospital,' said Dr. Melissa Smith, medical director of three community health centers run by Seton, a Roman Catholic hospital network that uses its profits and donations to provide nearly free care to 5,000 of the working poor. Over the last 18 months, Ms. Dodd's health has improved, and her medical bills have been cut nearly in half. . . . “ 'For most preventive efforts there is an upfront expense,' said Alan D. Aviles, president of the corporation. 'But over the long term it saves money.' “ Denver's public system, Denver Health, has 41,000 uninsured patients enrolled in its clinics. Officials there calculate that for every dollar they spend on prenatal care for uninsured women, they save more than $7 in newborn and child care. . . . “ Still, only a fraction of the uninsured, in Central Texas and in most other states, are benefiting. “ 'All these local efforts are commendable, but they are like sticking fingers in the dikes,' Ms. Davis of the Commonwealth Fund [a foundation in New York that concentrates on health care] said, noting that the larger trend was hospitals' seeking to avoid the uninsured. . . . “ 'All the hospitals here provide some uncompensated care, and they are eating it and passing the costs along to the payers,' said Patricia A. Young Brown, president of the Travis County Healthcare District, which was set up last year to oversee care of the indigent through public clinics, drawing on property taxes to pay. “ 'So insurance rates go up, and then more businesses drop insurance,' Ms. Young Brown continued, describing a trend unfolding nationwide. 'It's hard to see where it will end. We hear a cry for national and state leadership.' . . . “ Natavidad Martinez, 51, who used to work as a bookbinder for $7 an hour and never had insurance, has found herself in a bureaucratic nightmare. “ In March 2005, Ms. Martinez, a Seton patient, was found to have liver cancer. She was put on Medicaid, applied for federal disability and was put in line for a liver transplant, without which, doctors said, she had six months to two years to live. Through the summer of 2005, she made the hour-and-a-half drive from her home to San Antonio for preparatory tests. “ That August, she was awarded disability payments of $561 a month. But because her income surpassed the $535 limit for Medicaid in her circumstances, she said, she was told by the state that her coverage had ended, and the hospital said it could not proceed with a transplant. “ 'I asked Social Security if they couldn't just reduce my payments by $30 a month,' she said, 'but they said it doesn't work that way.' “ In another twist, by federal rules, she will qualify for Medicare two years after the initial finding of disability. She awaits the start of Medicare coverage next March, when she can rejoin the transplant line. . . . ” —From 10-25-06 New York Times, "To Lower Costs, Hospitals Try Free Basic Care for Uninsured," By ERIK ECKHOLM. “After Years of Growth, What About Workers' Share?” “ JOB growth is starting to slow, and wages are barely keeping up with inflation. Five years into a relatively robust economic expansion, it's understandable that many American workers feel that they are not getting their fair share of the pie. “ In fact, the share of the economy devoted to workers' wages and benefits has eroded in the United States over the last five years. But if it's any consolation, the trend for workers in other rich industrial nations isn't much better. “ The portion of the economy going to the workers in wages and benefits is perhaps the broadest measure of the workers' share of economic growth. The numbers are based on how many workers are employed and how much they are paid for their toil. “ In the United States, this economic slice, including wages, health insurance and pension benefits, declined 2.5 percentage points from 2000 to 2005, to 56.5 percent of gross domestic product, according to the United States Bureau of Economic Analysis. “ Workers in some countries have lost even more. According to data from the Organization for Economic Cooperation and Development, the forum of industrialized countries, the workers' share of gross domestic product in Germany fell 3.1 percentage points over the last half-decade. In Japan, the decline was 3 points. . . . “ In the United States, where labor unions have lost much of their bargaining power and few workplace regulations limit employers' decisions, companies have had an easier time reducing real wages. In the last year, wages have risen only enough to keep pace with inflation. In real terms, the wages of nonmanagement employees in the United States are now 10 percent below their level in the early 1970's, according to Labor Department statistics. “ In Western Europe, collective bargaining has been more successful in keeping wages up. These differences affect the distribution of the workers' share. America's low-wage labor market is virtually nonexistent in the European Union. There is no Western European equivalent of the American earning $5.15 an hour, the federal minimum wage, on the overnight shift as a convenience store cashier. A $7-an-hour baby-sitter is nearly impossible to find in London. Over all, the wage distribution in Europe is much less polarized than it is in the United States. . . . ” —From 10-15-06 New York Times, "Economic View: After Years of Growth, What About Workers' Share?," By EDUARDO PORTER. “The Choice: A Longer Life or More Stuff” “ There is no question that the American medical system does suffer from a lot of waste, be it insurance industry bureaucracy or expensive procedures that haven't been proven effective. But the No. 1 cause of the cost increases is still the one you can see at the hospital and in your medicine cabinet — defibrillators, chemotherapy, cholesterol drugs, neonatal care and other treatments that are both expensive and effective. “ Not even most forms of preventive care, like keeping diabetes under control, usually save money, despite what many people think. The care itself has some costs, and, more important, patients then live longer than they otherwise would have and rack up medical bills. 'When I make this point, people accuse me of wanting people to die earlier. But it's exactly the opposite,' Dr. Jay Bhattacharya, a researcher at Stanford Medical School, told me. 'If these expenditures are keeping people alive, it's money well spent.' “ As Dr. Mark R. Chassin of the Mount Sinai School of Medicine in New York says, 'You almost always spend money to gain health.' Of course, the opposite is also true: the best way to reduce health care spending is to reduce health care itself. “ Which is exactly what we're starting to do. The growing number of families without health insurance are, in effect, families who have been kicked off the country's health care rolls. Many will go without available treatment, will get sicker than they need to get — and will thereby save the rest of us money. They are what now passes for a solution to the health care mess. . . . “ It's easy to be against high costs, and it will no doubt be hard to come up with a broad health care solution. But the way to start is by acknowledging that an affluent society should devote an ever-growing share of its resources to the health of its citizens. 'We have enough of the basics in life,' Mr. Cutler, the economist and author, points out. 'What we really want are the time and the quality of life to enjoy them.' ” —From 9-27-06 Washington Post, "Economix: The Choice: A Longer Life or More Stuff," By DAVID LEONHARDT.
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SKIP DOWN TO Ethics continued: Game Theory omitting Ethics-related news clippings
	more Ethics in the News Mental Activity Seen in a Woman Diagnosed as Being in a Vegetative State “ A severely brain-damaged woman in an unresponsive, vegetative state showed clear signs on brain imaging tests that she was aware of herself and her surroundings, researchers are reporting today, in a finding that could have far-reaching consequences for how unconscious patients are cared for and how their conditions are diagnosed. “ In response to commands, the patient's brain flared with activity, lighting the same language and movement-planning regions that are active when healthy people hear the commands. Previous studies had found similar activity in partly conscious patients, who occasionally respond to commands, but never before in someone who was totally unresponsive. “ Neurologists cautioned that the new report characterized only a single, perhaps unique case and that it did not mean that unresponsive brain-damaged people were more likely to recover or that treatment was possible. The woman in the study could not communicate with the researchers, and there was no way to know whether her subjective experience was anything like what healthy people call consciousness. The woman was injured in a traffic accident in England last year. “ Yet the study so drastically contradicted the woman's diagnosed condition that it exposed the limitations of standard methods of bedside diagnosis. And its findings are bound to raise hopes for tens of thousands of families caring for unresponsive, brain-damaged patients around the world — whether those hopes are justified or not, experts said. . . . “ Dr. Bernat [a professor of neurology at the Dartmouth Medical School, who was not involved in the study] added that brain imaging promised to improve the diagnosis of unconscious states in certain patients, but that the prospect of imaging could also raise false hopes in cases like that of Terri Schiavo, the Florida woman who was removed from life support and died last year after a bitter national debate over patients' rights. “ Ms. Schiavo suffered far more profound brain damage than the woman in the study and was unresponsive for some 15 years, according to neurologists who examined her. . . . “ The journal that published the new paper, Science, promoted the finding in a news release, but added a 'special note' citing the Schiavo case and warning that the finding 'should not be used to generalize about all other patients in a vegetative state, particularly since each case may involve a different type of injury.' . . . “ In a more recent exam, more than 11 months after her injury, the patient exhibited a sign of responsiveness: she tracked with her eyes a small mirror, as it was moved slowly to her right, and could fixate on objects for more than five seconds, said Dr. Steven Laureys, a neurologist at the University of Liege and an author of the study. This means by definition that the young woman has transitioned from an unresponsive, vegetative state to a sometimes responsive condition known as a minimally conscious state, Dr. Laureys said in an interview. An estimated 100,000 Americans exist in this state of partial consciousness, and some of them eventually regain full awareness. . . . “ The chances that an unresponsive, brain-damaged patient will eventually emerge depend on the type of injury suffered, and on the length of time he or she has been unresponsive. Traumatic injuries to the head, often from car accidents, tend to sever brain cell connections and leave many neurons intact. About 50 percent of people with such injuries recover some awareness in the first year after the injury, studies find; very few do so afterward. By contrast, brains starved of oxygen — like that of Ms. Schiavo, whose heart stopped temporarily — often suffer a massive loss of neurons, leaving virtually nothing unharmed. Only 15 percent of people who suffer brain damage from oxygen deprivation recover some awareness within the first three months. Very few do after that, and a 1994 review of more than 700 vegetative patients found that none had done so after two years. “ The imaging techniques used in the new study could help identify which patients are most likely to emerge — once the tests are studied in larger numbers of unconscious people, said Dr. Joseph Fins, chief of the medical ethics division of New York Presbyterian Hospital-Weill Cornell Medical Center. . . . ” —From 9-8-06 New York Times, "SCIENCE: Mental Activity Seen in a Brain Gravely Injured," By BENEDICT CAREY. Stem Cell Research and the Right to Life of Embryos “ The issue of stem cell research -- which is back before the Senate -- is often described as a moral dilemma, but it simply is not. Or at least it is not the moral dilemma often used in media shorthand: the rights of the unborn vs. the needs of people suffering from diseases that embryonic stem cells might cure. . . . “ Against this, you have the fact that embryonic stem cells are extracted from human embryos, killing the latter in the process. If you believe that embryos a few days after conception have the same human rights as you or me, killing innocent embryos is obviously intolerable. But do opponents of stem cell research really believe that? Stem cell research tests that belief, and sharpens the basic right-to-life question, in a way abortion never has. “ Here's why. Stem cells used in medical research generally come from fertility clinics, which produce more embryos than they can use. This isn't an accident -- it is essential to their mission of helping people have babies. Often these are 'test tube babies': the product of an egg fertilized in the lab and then implanted in a womb to develop until birth. Controversy about test-tube babies has all but disappeared. Vague science-fiction alarms have been crushed by the practical evidence, and potential political backlash, of grateful, happy parents. “ In any particular case, fertility clinics try to produce more embryos than they intend to implant. Then -- like the Yale admissions office (only more accurately) -- they pick and choose among the candidates, looking for qualities that make for a better human being. If you don't get into Yale, you have the choice of attending a different college. If the fertility clinic rejects you, you get flushed away -- or maybe frozen until the day you can be discarded without controversy. . . . “ In short, if embryos are human beings with full human rights, fertility clinics are death camps -- with a side order of cold-blooded eugenics. No one who truly believes in the humanity of embryos could possibly think otherwise. . . . “ Proponents of stem cell research like to emphasize that it doesn't cost the life of a single embryo. The embryos killed to extract their stem cells were doomed already. But this argument gives too much ground, and misses the point. If embryos are human beings, it's not okay to kill them for their stem cells just because you were going to kill them, or knowingly let them die, anyway. The better point -- the killer point, if you'll pardon the expression -- is that if embryos are human beings, the routine practices of fertility clinics are far worse -- both in numbers and in criminal intent -- than stem cell research. And yet, no one objects, or objects very loudly. President Bush actually praised the work of fertility clinics in his first speech announcing restrictions on stem cells. “ Even strong believers in abortion rights (I'm one) ought to acknowledge and respect the moral sincerity of many right-to-lifers. I cannot share, or even fathom, their conviction that a microscopic dot -- as oblivious as a rock, more primitive than a worm -- has the same human rights as anyone reading this article. . . . ” —From 7-7-06 Washington Post, "False Dilemma On Stem Cells," By Michael Kinsley, Op-Ed Columnist. Proposal to Use Prison Inmates in Drug Trials “ An influential federal panel of medical advisers has recommended that the government loosen regulations that severely limit the testing of pharmaceuticals on prison inmates, a practice that was all but stopped three decades ago after revelations of abuse. “ The proposed change includes provisions intended to prevent problems that plagued earlier programs. Nevertheless, it has dredged up a painful history of medical mistreatment and incited debate among prison rights advocates and researchers about whether prisoners can truly make uncoerced decisions, given the environment they live in. . . . “ Until the early 1970's, about 90 percent of all pharmaceutical products were tested on prison inmates, federal officials say. But such research diminished sharply in 1974 after revelations of abuse at prisons like Holmesburg here, where inmates were paid hundreds of dollars a month to test items as varied as dandruff treatments and dioxin, and where they were exposed to radioactive, hallucinogenic and carcinogenic chemicals. “ In addition to addressing the abuses at Holmesburg, the regulations were a reaction to revelations in 1972 surrounding what the government called the Tuskegee Study of Untreated Syphilis in the Negro Male, which was begun in the 1930's and lasted 40 years. In it, several hundred mostly illiterate men with syphilis in rural Alabama were left untreated, even after a cure was discovered, so that researchers could study the disease. . . . “ Critics also doubt the merits of pharmaceutical testing on prisoners who often lack basic health care. . . . “ Under current regulations, passed in 1978, prisoners can participate in federally financed biomedical research if the experiment poses no more than 'minimal' risks to the subjects. But a report formally presented to federal officials on Aug. 1 by the Institute of Medicine of the National Academy of Sciences advised that experiments with greater risks be permitted if they had the potential to benefit prisoners. As an added precaution, the report suggested that all studies be subject to an independent review. . . . “ The discussion [of changes to the regulations] comes as the biomedical industry is facing a shortage of testing subjects. In the last two years, several pain medications, including Vioxx and Bextra, have been pulled off the market because early testing did not include large enough numbers of patients to catch dangerous problems. . . . “ Dr. A. Bernard Ackerman, a New York dermatologist who worked at Holmesburg during the 1960's trials as a second-year resident from the University of Pennsylvania, said he remained skeptical. 'I saw it firsthand,' Dr. Ackerman said. 'What started as scientific research became pure business, and no amount of regulations can prevent that from happening again.' . . . “ 'It strikes me as pretty ridiculous to start talking about prisoners getting access to cutting-edge research and medications when they can't even get penicillin and high-blood-pressure pills,' said Paul Wright, editor of Prison Legal News, an independent monthly review. 'I have to imagine there are larger financial motivations here.' “ The demand for human test subjects has grown so much that the so-called contract research industry has emerged in the past decade to recruit volunteers for pharmaceutical trials. The Tufts Center for the Study of Drug Development, a Boston policy and economic research group at Tufts University, estimated that contract research revenue grew to $7 billion in 2005, up from $1 billion in 1995. “ But researchers at the Institute of Medicine said their sole focus was to see if prisoners could benefit by changing the regulations. “ The pharmaceutical industry says it was not involved. Jeff Trewitt, a spokesman for the Pharmaceutical Research and Manufacturers of America, a drug industry trade group, said that his organization had no role in prompting the study and that it had not had a chance to review the findings. [!] “ Dr. Albert M. Kligman, who directed the experiments at Holmesburg and is now an emeritus professor of dermatology at the University of Pennsylvania Medical School, said the regulations should never have been written in the first place. “ 'My view is that shutting the prison experiments down was a big mistake,' Dr. Kligman said. “ While confirming that he used radioactive materials, hallucinogenic drugs and carcinogenic materials on prisoners, Dr. Kligman said that they were always administered in extremely low doses and that the benefits to the public were overwhelming. . . . “ During the Holmesburg experiments, inmates could earn up to $1,500 a month by participating. The only other jobs were at the commissary or in the shoe and shirt factory, where wages were usually about 15 cents to 25 cents a day, Professor Hornblum of Temple said. “ On the issue of compensation for inmates, the report raised concern about 'undue inducements to participate in research in order to gain access to medical care or other benefits they would not normally have.' It called for 'adequate protections' to avoid 'attempts to coerce or manipulate participation.' . . . ” —From 8-13-06 New York Times, "Panel Suggests Using Inmates in Drug Trials," By IAN URBINA; Barclay Walsh contributed research for this article.
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Ethics continued: Game Theory
	Game Theory: Notes on David K. Lewis's book, Convention: A Philosophical Study, on the mechanics of game theory and conventions Notes on the relevance to ethics of David K. Lewis's book, Convention: A Philosophical Study, and Cristina Bicchieri's article, "Norms of Cooperation." Strategies dealing with the free rider problem in David Schmidtz, The Limits of Government: An Essay on the Public Goods Argument (Westview Press: 1991) "Coordination and the Moral Obligation to Obey the Law," William S. Boardman, 97 Ethics 543-557 (April 1987); possibly available via Ebesco or Lexis-Nexis. Roger McCain's notes on game theory, “Strategy and Conflict: An Introductory Sketch of Game Theory” (c) A helpful introduction to game theory by Dr. Roger A. McCain, Professor of Economics, Drexel University; see also Stanford Encyclopedia of Philosophy, under the headings of "game theory" and "prisoner's dilemma." New York Times: "Mindless Creatures Acting 'Mindfully'" From this NYT story (March 23, 1999) by GEORGE JOHNSON: "Exotic as it seems, this behavior [ants' turning their bodies into a bridge and 'other miracles of cooperation'] is just a stark example of one of the most familiar phenomena in the living world: the way individuals, whether cells in a body, plants and animals in an ecosystem, or members of a corporation or society, congregate into complex wholes that take on autonomous existences of their own. There is no need for a central controller orchestrating their movement. . . . To better understand how independent entities can operate in unison, reseachers use computer models in which mindless agents, called cellular automata, act according to simple instructions. Each member simply by exchanging information with its nearest neighbor, unwittingly contributes to the commonweal. From simple, shortsighted, generally selfish actions, a transcendent global behavior emerges." From 5-28-07 Washington Post,"If It Feels Good to Be Good, It Might Be Only Natural," By Shankar Vedantam, Washington Post Staff Writer. “ … Moll and Jordan Grafman, neuroscientists at the National Institutes of Health, had been scanning the brains of volunteers as they were asked to think about a scenario involving either donating a sum of money to charity or keeping it for themselves. … “ The results were showing that when the volunteers placed the interests of others before their own, the generosity activated a primitive part of the brain that usually lights up in response to food or sex. Altruism, the experiment suggested, was not a superior moral faculty that suppresses basic selfish urges but rather was basic to the brain, hard-wired and pleasurable. … “ Grafman and others are using brain imaging and psychological experiments to study whether the brain has a built-in moral compass. The results -- many of them published just in recent months -- are showing, unexpectedly, that many aspects of morality appear to be hard-wired in the brain, most likely the result of evolutionary processes that began in other species. … “ What the new research is showing is that morality has biological roots -- such as the reward center in the brain that lit up in Grafman's experiment -- that have been around for a very long time. “ The more researchers learn, the more it appears that the foundation of morality is empathy. Being able to recognize -- even experience vicariously -- what another creature is going through was an important leap in the evolution of social behavior. And it is only a short step from this awareness to many human notions of right and wrong, says Jean Decety, a neuroscientist at the University of Chicago. … “ Moral decisions can often feel like abstract intellectual challenges, but a number of experiments such as the one by Grafman have shown that emotions are central to moral thinking. In another experiment published in March, University of Southern California neuroscientist Antonio R. Damasio and his colleagues showed that patients with damage to an area of the brain known as the ventromedial prefrontal cortex lack the ability to feel their way to moral answers. “ When confronted with moral dilemmas, the brain-damaged patients coldly came up with 'end-justifies-the-means' answers. Damasio said the point was not that they reached immoral conclusions, but that when confronted by a difficult issue -- such as whether to shoot down a passenger plane hijacked by terrorists before it hits a major city -- these patients appear to reach decisions without the anguish that afflicts those with normally functioning brains. “ Such experiments have two important implications. One is that morality is not merely about the decisions people reach but also about the process by which they get there. Another implication, said Adrian Raine, a clinical neuroscientist at the University of Southern California, is that society may have to rethink how it judges immoral people. “ Psychopaths often feel no empathy or remorse. Without that awareness, people relying exclusively on reasoning seem to find it harder to sort their way through moral thickets. Does that mean they should be held to different standards of accountability? … “ Marc Hauser, another Harvard researcher, has used cleverly designed psychological experiments to study morality. He said his research has found that people all over the world process moral questions in the same way, suggesting that moral thinking is intrinsic to the human brain, rather than a product of culture. It may be useful to think about morality much like language, in that its basic features are hard-wired, Hauser said. Different cultures and religions build on that framework in much the way children in different cultures learn different languages using the same neural machinery. “ Hauser said that if his theory is right, there should be aspects of morality that are automatic and unconscious -- just like language. People would reach moral conclusions in the same way they construct a sentence without having been trained in linguistics. Hauser said the idea could shed light on contradictions in common moral stances. “ U.S. law, for example, distinguishes between a physician who removes a feeding tube from a terminally ill patient and a physician who administers a drug to kill the patient. “ Hauser said the only difference is that the second scenario is more emotionally charged -- and therefore feels like a different moral problem, when it really is not: 'In the end, the doctor's intent is to reduce suffering, and that is as true in active as in passive euthanasia, and either way the patient is dead.' ” Moral Minds (HarperCollins 2006), by Marc D. Hauser, a Harvard biologist. Discussion about it from 10-31-06 New York Times, "Books on Science: An Evolutionary Theory of Right and Wrong," By NICHOLAS WADE: “ Who doesn't know the difference between right and wrong? Yet that essential knowledge, generally assumed to come from parental teaching or religious or legal instruction, could turn out to have a quite different origin. “ Primatologists like Frans de Waal have long argued that the roots of human morality are evident in social animals like apes and monkeys. The animals' feelings of empathy and expectations of reciprocity are essential behaviors for mammalian group living and can be regarded as a counterpart of human morality. “ Marc D. Hauser, a Harvard biologist, has built on this idea to propose that people are born with a moral grammar wired into their neural circuits by evolution. In a new book, 'Moral Minds' (HarperCollins 2006), he argues that the grammar generates instant moral judgments which, in part because of the quick decisions that must be made in life-or-death situations, are inaccessible to the conscious mind. “ People are generally unaware of this process because the mind is adept at coming up with plausible rationalizations for why it arrived at a decision generated subconsciously. “ Dr. Hauser presents his argument as a hypothesis to be proved, not as an established fact. But it is an idea that he roots in solid ground, including his own and others' work with primates and in empirical results derived by moral philosophers. “ The proposal, if true, would have far-reaching consequences. It implies that parents and teachers are not teaching children the rules of correct behavior from scratch but are, at best, giving shape to an innate behavior. And it suggests that religions are not the source of moral codes but, rather, social enforcers of instinctive moral behavior. . . . “ The moral grammar too, in Dr. Hauser's view, is a system for generating moral behavior and not a list of specific rules. It constrains human behavior so tightly that many rules are in fact the same or very similar in every society — do as you would be done by; care for children and the weak; don't kill; avoid adultery and incest; don't cheat, steal or lie. “ But it also allows for variations, since cultures can assign different weights to the elements of the grammar's calculations. Thus one society may ban abortion, another may see infanticide as a moral duty in certain circumstances. Or as Kipling observed, 'The wildest dreams of Kew are the facts of Katmandu, and the crimes of Clapham chaste in Martaban.' “ Matters of right and wrong have long been the province of moral philosophers and ethicists. Dr. Hauser's proposal is an attempt to claim the subject for science, in particular for evolutionary biology. The moral grammar evolved, he believes, because restraints on behavior are required for social living and have been favored by natural selection because of their survival value. “ Much of the present evidence for the moral grammar is indirect. Some of it comes from psychological tests of children, showing that they have an innate sense of fairness that starts to unfold at age 4. Some comes from ingenious dilemmas devised to show a subconscious moral judgment generator at work. These are known by the moral philosophers [e.g., Philippa Foot, "Abortion and the Doctrine of the Double Effect," (1967) and Judith Jarvis Thomson, Rights, Restitution, & Risk (1986)] who developed them as 'trolley problems.' “ Suppose you are standing by a railroad track. Ahead, in a deep cutting from which no escape is possible, five people are walking on the track. You hear a train approaching. Beside you is a lever with which you can switch the train to a sidetrack. One person is walking on the sidetrack. Is it O.K. to pull the lever and save the five people, though one will die? “ Most people say it is. “ Assume now you are on a bridge overlooking the track. Ahead, five people on the track are at risk. You can save them by throwing down a heavy object into the path of the approaching train. One is available beside you, in the form of a fat man. Is it O.K. to push him to save the five? “ Most people say no, although lives saved and lost are the same as in the first problem. “ Why does the moral grammar generate such different judgments in apparently similar situations? It makes a distinction, Dr. Hauser writes, between a foreseen harm (the train killing the person on the track) and an intended harm (throwing the person in front of the train), despite the fact that the consequences are the same in either case. It also rates killing an animal as more acceptable than killing a person. “ Many people cannot articulate the foreseen/intended distinction, Dr. Hauser says, a sign that it is being made at inaccessible levels of the mind. This inability challenges the general belief that moral behavior is learned. For if people cannot articulate the foreseen/intended distinction, how can they teach it? . . . “ Dr. Hauser believes that the moral grammar may have evolved through the evolutionary mechanism known as group selection. A group bound by altruism toward its members and rigorous discouragement of cheaters would be more likely to prevail over a less cohesive society, so genes for moral grammar would become more common. “ Many evolutionary biologists frown on the idea of group selection, noting that genes cannot become more frequent unless they benefit the individual who carries them, and a person who contributes altruistically to people not related to him will reduce his own fitness and leave fewer offspring. “ But though group selection has not been proved to occur in animals, Dr. Hauser believes that it may have operated in people because of their greater social conformity and willingness to punish or ostracize those who disobey moral codes. … ” game of life Evolving Cellular Automata (EvCA) Welcome to Zooland
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The SYMBOLIC LOGIC PAGE contains links to Boardman's Supplement for Symbolic Logic (c); links to a recent syllabus in Phil 12 B; help on some problems in predicate logic; and several practice exams with some answers provided.

Miscellanies:
	LINK to "The Philosophy Major" A statement prepared under the auspices of the Board of Officers of the American Philosophical Association. George Orwell, “Politics and the English Language,” 1946. Orwell's classic advice about simplicity in writing. Paul A. Boghossian New York University, "What the Sokal Hoax Ought To Teach Us" A Philosopher discusses "postmodernist" relativism; Commentary from Times Literary Supplement, December 13, 1996. LINK to Sokal's original article LINK to Sokal's home page; he has links to commentary by others. The Postmodernism Generator; you get a different "essay" each time you connect or refresh. The generator is provided by Andrew Bulhak using "the Dada Engine" (what else?) “Why AP and IB Schools Soar,” By Jay Mathews, 5-22-07 Washington Post: “ … [R]esearchers at ACT Inc. [have] just issued a report, 'Rigor at Risk,' that reveals what most college professors have long known -- high school courses, even those labeled 'honors' or 'college prep,' often demand little critical thinking or analysis, and yield good grades on the high school transcript for very little work. AP, IB and Cambridge courses, on the other hand, are not just college prep, but college courses. Students can earn college credit if they score high enough on the exams. And since the exams are written and graded by outside experts to match college standards, there is no way to dumb down the teaching of the course without being caught, as long as every student takes the exam. ” [The article suggests that offering rigor in high school courses raises the aptitude for low-income students who, normally, could not compete academically with advantaged middle class students.] Report of National Reading Panel on "Teaching Children to Read": LATimes: "The Reading Wars," by Kenneth Anderson; an essay on the issues. LINK to the Report; in HTML, and also as downloadable PDF document. LINK to article from Aug 25 issue of New Republic LIFE IMITATES SATIRE: "Defining Disability Down" by Ruth Shalit, Aug 25, 1997, New Republic   According to Linda Chavez's Commentary, "Lower Learning," in 8-20-97 (Appleton) Post-Crescent, U.S. District Judge Patti B. Saris ruled for the plaintiffs last week in a case challenging Boston University "graduation requirements for certain math and language courses on the grounds that such requirements placed an unfair burden on students with learning disabilities," and charging "that it was unlawful for the university to require students to produce a recent diagnosis of learning disability from a physician or psychologist in order to qualify for special accommodations from the university, such as tutoring and extra time to complete tests and assignments." "In ruling for the plaintiffs, Saris said that such requirements were 'high hurdles' that placed emotional and financial burdens on disabled students. She ordered the university henceforth to accept diagnoses of learning disability from any 'professional' with a master's degree in education." Chavez concudes her discussion: "Maybe some enterprising judge should just ban schools from giving tests or handing out grades altogether. If we forbid recognizing ability in the first place, there would be no claim to special privileges on the basis of disability." LINK to "The Philosophical Lexicon," Daniel Dennett, Editor VIA Blackwell Publishers; Copyright © 1987 by Daniel Dennett. A Portrait of the artist as an old man From The Läwrentiän , vol CXV, No. 13; April 1, 1998. Perseus Project A digital library of resources for studying the ancient world, including ancient texts and translations, philological tools, maps, extensively illustrated art catalogs, and secondary essays on topics like vase painting.
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Computer Aids (chiefly Macintosh):
	LINK to Lawrence Committee on Instructional Technology Committee's home page. Answers to Frequently Asked Questions Instructions from Lawrence Computer Services on: exchanging information between Macs and IBM-clones; sharing files between different versions or different brands of word-processor; and more. LINK to EFF's (Extended) Guide to the Internet The successor to Big Dummy's Guide to the Internet, provided by Electronic Frontier Foundation.  It is a  comprehensive, and reasonably clear, guide to the internet, including Telnet and FTP. LINK to Big Dummy's Guide to the Internet: A round trip through Global Networks, Life in Cyberspace, and Everything..., The HTML version (Texinfo Edition 2.2, February 1994) of this earlier work; its index makes it very easy to navigate. LINK to Zen and the Art of the Internet: A Beginner's Guide to the Internet, First Edition, January 1992, by Brendan P. Kehoe. LINK to site of FREE Macintosh spelling checker, "Excalibur." Rick Zaccone and his team produced this nice spelling checker; if you don't have a spelling checker, get this one and use it. It seems to work with lots of different word processing programs. LINK for obtaining the Macintosh program, GraphicConverter Site for downloading this very useful shareware (@$35-) program; it is updated frequently; it is a poor-man's Photoshop. On-line sources of instructions for using GraphicConverter: St Paul's School: How To Prepare Graphic Files for the Web Using GraphicConverter Editing Graphics with GraphicConverter Using GraphicConverter--How to Do a Few Basic Things Tutorial on Using GraphicConverter Photoshop Techniques, a publication of Swanson Tech Support Mac OS Internet freeware/shareware via LondonNet On-line source of instructions for using scanners and PhotoShop: Index of on-line Tutorials from MacAssistant Tips and Tutorial Newsletter Helpful tutorials on a variety of subjects, including scanning techniques, PhotoShop, and AppleScript. LINK to MacWorld's Software Collection from which you can download "HTML Table Tool" Bertil Holmberg's "HTML TableTool" is a freeware HyperCard stack for Macintosh that turns tab-delimited text files (information from spreadsheets or databases, or tables created in a word processing program which have been converted to text with tabs) into HTML-tagged text that you can plug into your Web pages to create simple tables. (If you find that you are unable to change settings, in the menu GO, choose home, and then click on backwards arrow to HyperCard program's preferences and switch from Browsing to Browsing & Typing .) This will not work on OS X. Page with Links to various Macintosh HTML Editors; it also has links to Windows HTML Editors, and to those for other "platforms." If a link appears to be out of date, type the name of the creator in a search engine, and you can probably find the HTML Editor that way. InfoMac archive MIT's mirror site of the Stanford InfoMac collection of Macintosh software: freeware, shareware, demos, and posted upgrades. LINK to MacWorld's Software Collection Shareware and freeware with brief descriptions and suggestions about usefulness. The Munich Macintosh Archive Collection of Freeware and Shareware Software; non-Macintosh users can also start from here to find software compatible with their platforms. Tex-Edit Home Page Tex-Edit Plus is a small, general purpose word-processing program with multiple "undo"s; its main drawbacks are that it cannot create footnotes or tables. With the Apple scripts which various users have provided for the application, it does a nice job converting text into HTML format, including tables formatted from tabbed lines. It's $15- shareware and is frequently updated. LogicTran Home Page The successor to Chris Hector's "rtf to html": an older version, 2.7.5, was freeware, and you might find that pre-OS X version posted at http://www-ftp.lip6.fr/ftp/pub/www/tools/translators/rtftoweb/; though it would not do tables automatically, it had a freeware license. The newest version, now from LogicTran, is $70. It is available for various "platforms".
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Syllabi for some of Boardman's Courses:
	previous Phil 10    [Applied Ethics: The Morality of Abortion last taught in Spring of 1999] Phil 10    [Applied Ethics: Introduction to Bio-Medical Ethics last taught in 2000] Phil 11B  [Introduction to Philosophy: Problems last taught in 2001] Phil 12B  [Symbolic Logic   last taught in Spring, 2002] Phil 20    [Philosophy of Law last taught in 2001] Phil 26    [Theory of Knowledge last taught in 2000] Phil 28    [Theory of Reality last taught in 1998] Phil 29    [Ethics: Obligations, Rights, and Social Conventions last taught in 2001] Phil 37    [Political Philosophy: Hobbes and Rational Choice last taught in 1999] Phil 82    [Studies in Philosophy: “The Philosophy of Ludwig Wittgenstein” last taught in 2001] BIET 65  [Advanced Seminar in Bioethics (taught with Dr. David Hathaway) last taught in 2001]                                                             Schedule of Philosophy Courses
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Comments: William.S.Boardman@lawrence.edu William S. Boardman Main Hall (Emeritus office) Lawrence University Appleton, Wisconsin 54912-0599