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Nancy Cartwright on the Limits of RCTs

Nancy Cartwright on the Limits of RCTs

Guest Post by Bill Gardner @Bill_Gardner

Many researchers and physicians assert that randomized clinical trials (RCTs) are the “gold standard” for evidence about what works in medicine. But many others have pointed to both strengths and limitations in RCTs (see, for example, Austin Frakt’s comments on Angus Deaton here). Nancy Cartwright is a major philosopher of science. In this Lancet paper she provides insights into why RCTs are so highly valued and also why they are by themselves insufficient to answer the most important questions in medicine.

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Shouldering the burden of risk

By Dominic Wilkinson @NeonatalEthics

 

The UK supreme court last week awarded a woman £5 million in compensation after her obstetrician failed to warn her of a risk that she would have difficulty delivering her baby. Over on the JME Blog Kirsty Keywood discusses some interesting and important legal elements of this judgment for the practice of informed consent and how this will be evaluated in negligence claims.

However, the case raises one important ethical issue. Several expert witnesses in the Montgomery case testified that informing women of even very low risks of complications of vaginal birth would likely lead to a significant increase in the number of women choosing elective caesarean section.

If that is true, would it be justified for doctors to deliberately not discuss such risks?Read More »Shouldering the burden of risk

Global surveillance is not about privacy

putin-merkel-obama-caricatureIt has now been almost two years since Snowden. It’s time for us to admit this has little to do with privacy. Global surveillance is not global only because it targets people all over the world. Global surveillance is done for and against global interests. Privacy, by contrast, is an individual right. It’s simply the wrong description level. This is not about your internet history or private phone calls, even if the media and Snowden wish it were.

Privacy is rarely seen as a fundamental right. Privacy is relevant insofar as it enables control, harming freedom, or insofar as it causes the violation of a fundamental right. But the capabilities of intelligence agencies to carry out surveillance over their own citizens are far lower than their capability to monitor foreigners. Any control this monitoring might entail will never be at the individual level; governments can’t exert direct control over individual citizens of foreign countries.

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Framing this as an issue of individual privacy is a strategic move done against the interests of individuals. Read More »Global surveillance is not about privacy

Should remorseful offenders be punished less harshly?

New Book: ‘Remorse, Penal Theory and Sentencing’ (Oxford: Hart Publishing)

If an offender is genuinely remorseful about the crime she committed, should she receive some small-but-non-trivial mitigation of her sentence? – i.e. should she be punished a little bit less than she would have been had she not been remorseful? In many jurisdictions, including England and Wales, this practice is written into the sentencing guidelines that judges have to follow. However, it is difficult to see how this practice can be justified, and intuitions about the relevance of remorse to criminal sentencing seem to vary wildly.

One first obvious concern is that it can be difficult to know whether an offender’s remorse is genuine: is she just pretending in the hope that her sentence will consequently be somewhat lighter than it would otherwise have been? Whilst the possibility of simulation indeed presents a practical challenge, the prior question is whether an offender’s genuine remorse should matter at all. Should judges try to determine whether an offender is remorseful and, if so, with what consequences?Read More »Should remorseful offenders be punished less harshly?

Announcement: Winners of the Inaugural Oxford Uehiro Prize in Practical Ethics.

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It is with great pleasure that we can announce the winners of the Oxford Uehiro Prize in Practical Ethics 2015. The winner of the Undergraduate Category is Xavier Cohen with his essay: How Should Vegans Live? The winner of the Graduate Category is Jessica Laimann with her essay:  Is prohibition of breast implants a good way… Read More »Announcement: Winners of the Inaugural Oxford Uehiro Prize in Practical Ethics.

Death and the Self

On Tuesday the 10th of March, Shaun Nichols delivered the 2015 Wellcome & Loebel Lecture in Neuroethics. You can listen to the lecture here.

Nichols presented a range of intriguing empirical data on how our view of the self affects our attitudes. The common view about the self is that it is something that persists through our lives. The self is an essential part of us that remains the same from childhood to adulthood.  However some views in philosophy and religion see the self as something much less permanent.Read More »Death and the Self

Self-control and Public Policy.

I have just finished a series of lectures at the University of Oxford on the topic of self-control, the culmination of my first stint in Oxford as a Leverhulme visiting professor (for which I am very grateful to the Leverhulme Trust). My theme has been self-control as a problem of self-management; taking ‘management’ seriously. The idea is that we need to think strategically about ourselves: rather than deciding how to act as temptations arise, we ought to plan for those occasions, or avoid them. That, I’ve argued, is how people who are successful at avoiding temptations when they conflict with their longer-term goals actually do it.Read More »Self-control and Public Policy.

Smart pills vs. motivation pills – is one morally worse than the other?

Imagine a huge pile of unwashed dishes reminds you that you should clean your kitchen. Would you rather take a pill that increases your ability to clean very elaborately or one that helps you get off the couch and actually bring yourself to start cleaning? No hard decision for me…

Certain substances like methylphenidate can not only enhance cognition, but also motivation or, to be more precise, self-regulation. This is not too surprising as treating conditions associated with decreased self-regulation like ADHD often is a main purpose of such medication.Read More »Smart pills vs. motivation pills – is one morally worse than the other?

Should We Reward Psychopaths?

Psychopaths frequently make the news and rarely for good reasons. Take, for instance, the recent case of Becky Watts, a 16-year old girl who was abducted and murdered in Bristol; her body parts were discovered by the police at a house in Barton Court, Bristol. While her murder remains unsolved, it is hard not to suspect that there is a person with psychopathic tendencies behind it. And this is not unreasonable. Between 25 to 30 percent of crimes are committed by psychopaths, despite them representing only 1 percent of the population. The percentages are especially high for extremely violent crimes such as rape and homicide. Given the detrimental effect psychopaths have on society, is there a way to cure them or at least to reduce their negative impact on society?

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Countering Islamic Extremism

By Professor Peter Singer

 

PRINCETON – Last month, US President Barack Obama hosted a three-day summit on “Countering Violent Extremism.” That term has already spawned a new abbreviation, “CVE,” used no fewer than 12 times in a Fact Sheet that the Obama administration released on February 18.

The Fact Sheet also uses the term “violent extremism” 31 times.  How many times do, terms like “Islam,” “Islamic,” or “Muslim” appear?   Zero. There is not even a reference to the “Islamic State,” That entity is referred to only by the initials “ISIL.”

This is not an accident; it is part of a strategy to win the support of mainstream Muslims. Riham Osman, speaking on behalf of the Muslim Public Affairs Council, which participated in the summit, said that using terms like “radical Islam” harms the cause of stopping the violence. This may partly reflect the Muslim community’s understandable fears that associating Islam with terrorism and violence would contribute to an increase in attacks on, or discrimination against, all Muslims.Read More »Countering Islamic Extremism