Philosophical Comment

Take sustainability serious in healthcare to avoid harming future patients!

noreply@blogger.com (Christian Munthe) — Thu, 12 Nov 2020 10:38:00 +0000

In a brand new blog post at the BMJ Journal of Medical Ethics blog, me, Davide Fumagalli and Erik Malmqvist write about a severe ethical challenge for healthcare systems that arises due to structural deficiencies in established systems for healthcare resource allocation:

Most countries with publicly funded healthcare systems have ethically informed priority setting schemes to decide how to allocate scarce resources. Established principles in such schemes recognise patients’ need of care, the effects of interventions, and background requirements of equal consideration and cost-effectiveness. However, the typical use of such schemes is alarmingly short-sighted, systematically allowing the future resource base of healthcare to be undermined. In short: our way of helping current patients is systematically exposing future patients to serious harm and risk.

As a remedy, we propose that a sustainability principle is added to estableshed ethical framworks that govern this central aspect of health policy. Read more about the challenge, as well as our proposal over at the JME blog!

So, I'm officially a published fiction writer (in Swedish)

noreply@blogger.com (Christian Munthe) — Sat, 03 Oct 2020 09:21:00 +0000

Not new to publishing books, or chapters in books, in my professional academic role, it nevertheless gives me immense pleasure to announce my official debute as a published fiction writer.

Just as with my activity in music, this is an artistic expression I have been engaging with since my youth, on and off. The last ten years, I have returned to it with more concentration, and found a form I feel works well in the genre of short stories and novellas (or long short stories).

Last year, I submitted one short story entitled "Memoir" (that's "Memoar" in Swedish) to a competition organised by the publishing house Joelsgårdens Förlag, on the vague theme of It wasn't me, and was lucky to be selected among the approxiamately forty entries included in an anthology volume entitled so, but in Swedish: Det var inte jag.

Naturally, the language of my fiction writing is Swedish, and so is that of all stories in this collection. If you happen to read Swedish and is interested in checking out this text, as well as other samples of my fiction writing currently in preparation for a forthcoming collection (as well as my musical activity), you can do so via my Swedish web page for literature and music.

Ethics Briefing for Covid19 Policy: Interesting Experience in Germany and a Plea for the Swedish Context

noreply@blogger.com (Christian Munthe) — Sun, 19 Apr 2020 10:40:00 +0000

As the Covid19 pandemic continues to sweep the world, states are struggling to shape policies according to their epidemiological situation, resources and political possibilities. It is very obvious that all this policy-making has far-reaching ethical implications on many levels. It regards the identification of relevant values, the balancing of these in cases of conflicts, the pragmatics of implementing "ideal" solutions in a non-ideal world, and the normative aspect of deciding how competing institutional "rules" or "guidelines" for balancing values and implementing the outcome may be traded off in cases of tension.

All of this is, of course, a well-known aspect of the area of public health ethics, such as it has evolved over the last two decades. It regards both principal issues of what should be done, and issues about how this should be done to be done in an acceptable way. These issues are especially complicated due to the multi-sectorial and multi-level nature of public health, and the advanced and dynamic uncertainty under which all decisions on pandemic (and much other public health) policy needs to be taken.

One level is, of course, the implications for the healthcare system and, in effect, clinical medical ethics, of a far-reaching public health crisis, such as a pandemic. In this area, I was engaged, together with several colleagues with direct experience of this particular issue, in a working party that speed developed specific guidelines for ICU resource allocation for the Swedish context. However, albeit thorny and highly complex ethical considerations are recognised to be built into both public health and infectious disease policy in the Swedish central policy document in this area, the Swedish public health authorities have no organised way of dealing with the ethical tensions that necessarily appear on a daily basis. This inspired some of my colleagues – themselves not public health ethicists but recognising the need – to publish a plea for an ethics councel function to be linked to the Swedish public health agency, Folkhälsomyndigheten. Such a councel has to involve different comnpetences, of course, besides public health ethics and relevant health science, not least advanced knowledge of (relevant) law, economics and politics.

Interestingly, I have been recently involved in exactly this type of endeavour related to Covid19, not in Sweden, but in Germany. It started when I was contacted, as one of several public health ethics specialists, to be part of an ad hoc ethics briefing to the Bavarian public health authorities with regard to sevaral of the type of basic value and norm.-conflicts briefly sketched above. The work was led from the Ludwig Maximilians University of Munich, where Verina Wild (bioethicist and public health specialist), quickly organised an international expert group to answer a set of questions formulated by the state authorities. This work (with links to the full briefing from the group to the Bavarian authorities) is described here. Additionally, the German federal Ethikrat has issued several statements on the ethical dimensions of the Covid19 policy response, and also there specific public health ethical competence is in place, eg. Alena Buyx.

Lägg till bildtext

In addition, German scholarly organisations in social medicine and public health have organised a Covid19 "competence centre" with specific working groups being coordinated for several areas, one of which is ethics. The coordinators for ethics is, once again, Verina Wild and her Munich colleagues Jan-Christoph Heilinger and Georg Marckmann, and they have invited a broad group of international scholars from the public health ethics field, among these myself. We have just finalised the first policy brief, which attempts to sketch in a few pages the complex landscape of consideration offered from a public health ethical perspective on pandemic policy. The final versionis now public via the competence centre website. A number of more specific briefs are planned, and will appear shortly.

I do believe that many states would do well to follow the German example. Besides the expertise of discovering, describing and analysing ethical and related legal and political dilemmas, relevant scholars are also able to articulate more clearly the logic of reasoning behind made policy decisions, thereby helping governments and agencies to better dodge conspiracy-like speculations of why certain decisions are made due to hazy explanations and arguments. Among these, my own country Sweden, where there already exist a number of internationally recognized public health ethics scholars, besides myself, e.g., Bengt Brülde, Jessica Nihlén Fahlqvist, Kalle Grill and Erik Malmqvist, and additional legal scholarly expertise relating to the health policy area, such as Moa Kindström Dahlin and Ulrika Sandén.

New Swedish Guidelines for ICU Priority Setting in Exceptional Circumstances

noreply@blogger.com (Christian Munthe) — Fri, 27 Mar 2020 10:43:00 +0000

This post was updated March 30, 2020 with criteria for rationing outside ICU!

During the last two weeks, I have, together with a bunch of philosophy and bioethics colleagues specialised on these kinds of questions not only in theory but also in practice, contributed to a speedy development of of new central guidelines on ICU priority setting and resource allocation from the National Board of Health and Welfare (one of the central governing authorities of the Swedish healthcare system). The guidelines address exceptional circumstances, such as an unusual high pressure of cases that exceeds normal capacity, and are, of course, prompted by the Covid19 pandemic. Lars Sandman, head of the national Center for healthcare priority setting, led the work, and it took a little less than two weeks to go from zero to end product. Besides philosophers, the National Council for Medical Ethics, representatives of the Ethics Delegation of the Swedish Society of Medicine, and ICU specialist consultants have contributed.

As the legal language of Swedish public documents is Swedish, this is also the language of the guidelines. This full version can be read and downloaded here. But, as there has been quite a bit of international interest, here is a short English summary by myself (ie. this is not an official translation from NBHW):

BACKGROUND

Health care priority setting is already regulated by special laws, where non-instrumentality, equal treatment and non-discrimination, priority based on patient need only, and ban on unnecessary waste of resources are the key principles decided by the Swedish Parliament since before.

APPLICATION IN THE GUIDELINES

First of all, ICU capacity should be strengthened by rationing less acute or important care, or care than can be postponed without severe consequences (and without disturbing management of the pandemic), so that an exceptional ICU situation is avoided as far as is practically possible. There is a specific appendix in the full guidelines setting out rationing principles to this effect (see below).

In exceptional circumstances, ICU should focus on patients where the treatment can do the most good, thus focusing more on the prognosis of the treatment than the severity of the condition (both dimensions of patient need). This means that indication for ICU may be strengthened to exclude some patients with severe conditions that are given ICU in normal circumstances to give extra time for planning and family contact.

While the legal regulation excludes chronological age as priority basis in its own right, it allows for life expectancy (if given successful care) to be part of the assessment of the patient need for a resource (besides the severity of the condition and the immediate prognosis of the treatment). Factors to assess life expectancy in the clinic are:

Extent and severity of vital organ failure
Extent and severity of pre-existring co-morbidities
High chrononological age in combination with a bad prognosis after intensive care

Priority groups are patients with:

Priority 1

Severe condition or injury with >12 months life prognosis, otherwise meet indication for ICU, and don't suffer severly decreased life expectancy (see above). If there is necessary to make a choice between patients in this group, patients with a general longer life expectancy (higher biological age) should be given priority.

Priority 2
(a) One or several serious systemic diseases with extensive functional impact, and/or (b) expected survival of 6-12 months based on pre-existing underlying disease.

Priority 3

Bad prognosis in ICU, and where ICU is normally undertaken only to provide time for planning, or family contacts.

These priority groups should ground resource allocation both when assessing new patients, and when reassessing patients admitted to ICU care, and may therefore also ground discontinuation of ICU care, to free resources for new patients with a higher priority.

Patients who are denied or taken off ICU should receive best possible palliative and other care to manage their care need given the ICU resource allocation.

There are also some sections on management of staff ethical stress, and of how to involve patients and family in the decisions.

COMMENTS BY MYSELF

In the preparatory stage, it was discussed whether or not the guidelines should include the feature of being crucial for life saving societal functions as a further item to sort among those in priority group 1. There seems to have been agreement that the requirement of equal treatment for all patients with similar need of care could support this idea if the circumstances are extremely prolonged (as loss of critical staff could then undermine the treatment prospects for future patients). However, the general assessment was that the crisis possibly caused by the Covid19 pandemic for Swedish ICU care would probably not be of this nature, especially in view of the time it would take for someone to return to work after a very critical ICU episode. Should the situation change, the guidelines may be amended to this effect.

RATIONING OUTSIDE OF ICU
These are the rationing criteria for healthcare outside ICU, in order to free capacity for ICU in an Covid19 crisis, mirroring the priority setting criteria above, and based on the same legal principles. They apply on the condition that rationing can free resources/capacity for ICU, and that the rationing does not impede communicable disease control work:
RATIONING GROUP 1: Elective procedures that may be postponed without deterioratiuon of the condition;
GROUP 2: Elective procedures that may be postponed without threat to life, abeit with negative effect on QoL:
GROUP 3: Elective or acute procedures that are unlikely to restore health and likely to lead to prolonged care with risk of ICU need;
GROUP 4: Acute procedures where postponement will affect QoL during the delay, but not lead to a worse longterm prognosis;
GROUP 5: Acute procedures where postponement will affect QoL also in the longterm, but not be a threat to survival.

Longstanding Conscientious Refusal Assault to Undermine Swedish Abortion Policy Ended by European Court.

noreply@blogger.com (Christian Munthe) — Fri, 13 Mar 2020 11:38:00 +0000

Ellinor Grimmark, one of the midwifes

For a number of years, two openly pro-life Swedish midwifes have been fronting for radical conservative US activist Christian organization Alliance Defending Freedom (ADF), to run a legal case against Swedish County Councils (that run the publicly funded healthcare system) in order to invalidate the Swedish model for freedom of conscience and conscientious objection in healthcare. In particular, the assault has been focused on the strong pro choice abortion legislation in Sweden, as both cases have been about trying to establish health professionals' (here midwifes) legal right to refuse to perform tasks related to abortion (everything from informing women about their rights and options to assist in the actual performance of a procedure). Since having an abortion at a public hospital is a positive right in Sweden, a midwife or other obstetric professional working in the public healthcare system can always be assigned to such duties, and it would be impossible to run the system is this was not the case. Therefore, a legal right to conscientious refusal in this area could very well be strategically exploited by anti-abortion propaganda ventures to undermine Swedish abortion policy.Read more and learn how this assault has now been stopped, and how other European countries may profit from that.

I blogged about this push, as well as the general issue of conscientious refusal in healthcare, in 2015. That post led to invitations to contribute to two separate special ethics journal issues on the topic, one of which describes the Swedish solution to conscientious refusal and is linked above. The other one, authored with Danish colleague Morten Ebbe Juul Nielsen, presents a general argument against the notion of conscientious refusal as a legal right required by the generally embraced legal human right to freedom of conscience. Simple put, as long as employment and choice of profession is voluntary, the latter freedom does not require a right to refuse particular work tasks.

The midwifes have been fronting the ADF campaign by running legal procedures complaining about religious discrimination, or breach of their freedom of religion, against (potential) employers who have denied them a right to refuse any dealings with abortion care, or refused employment after a declaration of such a right as a condition to accept employment. The case have been run through the Swedish legal system, and then, with one of the midwifes, Ellinor Grimmark, on to the European Court of Human Rights. Since 2014, bankrolling and legal councel has come from ADF, confirmed by its representative Robert Clarke. Two days ago, the court delivered its decision to rule the application for the court to try her case to be inadmissible. In short, this means that the court cannot see any indication of discrimination or restriction the right to religious freedom in Grimmark's (and ADF's) writ. This has also been my impression from day 1 – what ADF and Grimmark have been asking for is not equal rights to others, but for special privilege. But, please, don't let me be the judge, read the decision for yourselves!

The court decision's most important implication is, however, not that the Swedish solution to the phenomenon of conscientious objection has been vidicated, and that its abortion policy has been safeguarded against radical religious conspiracy. It also means that all European countries can safely adopt the Swedish solution to conscientious refusal in healthcare, without fear of legal damage.

The Red Baron: Outline of A Conservatism for the Political Left

noreply@blogger.com (Christian Munthe) — Wed, 04 Mar 2020 12:40:00 +0000

Introduction
"A spectre is haunting Europe—the spectre of" conservatism.

As it does the Americas, and Russia, and Turkey, and India, I may add. Throughout the world, more or less imperfect (semi)democracies find the voter support drifting from the (neo/social) liberal democratic hegemony of past decades, making the mock citation of Marx's and Engels' Communist Manifesto, ring truer today than the original statement regarding communism did in 1847. Most importantly, large segments of the working and middle class now seems to be swayed by conservative messages about King and Country and People and Church and Traditional Values, and so on. In its wake follows familiar elements of autoritarianism chauvinism, bigotry, misogyny, racism, cultural hegemony, submission to arbitrary power, and a whole bunch of other things we all know are bound to harm the very same groups directly or indirectly. But this is also because the political left - all over the world - has been mostly incapable of capitalizing on the underlying sentiments attracting people towards a conservative political preference. There are probably many explanations for this – the broad mistrust against non-liberal leftist politics in the wake of the horrors of "state socialism" in Russia, Eastern Europe and East Asia, the (perhaps linked) "social liberal" and globalist/internationalist style of leftist political rhetoric since the 1970's, and the "antifascist" and "antauthoritarian" lines, making any kind of nation-state centred political program placing duties on citrizens against society rhetorically and ideologically inaccessible within leftist debate and sentiment.

At the same time, successful non-communist political left forces in Europe and other places through many decades in the 1900's, especially following WW2, were dominated by many such elements. This goes, not least, for the social democracy and linked labour union movements that shaped the Scandinavian welfare states. For this reason, it has struck me more than one time that the political left should be able to identify with much of the conservative sentiments currently moving large segments of voters, without thereby deteriorating into some kind of "red fascism" or stalinist/maoist national chauvinism. There is, I have sensed, an important core of sound (from a leftist perspective) conservatism to rediscover in leftist political ideas, and this core I believe to match pretty well the sentiments underlying today's broad attraction of rightwing conservative politics. Therefore, there is, I will claim, room for a "red baron" position in leftist politics, one that combines leftist values with central conservative ideas and sentiments. In this post, I will present an outline of what I believe to be the content of this conservative core available for leftist politics.

A Demarcation of the Political Left
Before embarking on the mission of finding fitting conservative ideas for the political left, I'd better be a bit clearer on what political left I am talking about. A negative start is to make clear that I have no interest in the anti-democratic left that gave us the state-communism of the USSR of the past, and the present day China (not to speak about North Korea). We already know that these political ideals and realizations of them are virtually inseparable from fascism. They are, as will be noted in passing below, supreme examples of certain strands of political conservatism to be found at the farthest rightwing end of the political spectrum. What interests me, however, is a political left that shares a committment to the following features of a good society:

Liberal democracy with regard to state power
Rule of law, legal security and independence of judicial power
Socioeconomic egalitarianism and solidarity with society's worse off
Political economic effectiveness and sustainability

Each of these features constrain each other, meaning that, e.g., capitalism and the market can be regulated for the common good, and wealth redistributed to achieve the socioeconomic aims of society. At the same time, any such policies much abide by rule of law and observe the need for effectiveness (not wasting resources) and a continuation of such policies over time (sustainability). Whatever mix of policies is the upshot can always be changed through a democratic shift of power, or if it is found to be illegal.

This demarcation leaves a large room for variations as regards national, cultural and international contexts, as it does for ideological variations across different political leftist movements. I will leave the explanation of what I mean by "political left" at that, now moving to an analysis of conservatism.

Dimensions of Political Conservatism
While conservatism can be described as the simple idea that society should not change (too much, too fast), conservatism as an actual political ideological camp is - like liberalism and socialism - complex and multidimensional, even more so if we include those who present themselves as conservative. I will here make a division between 6 different core dimensions of conservative ideology, linking to an underlying conservative moral psychology, and a set of basic values and rational arguments based on that. It is perfectly possible to mix aspects of the dimensions. In fact, I would argue that it is necessary to do so in order to have a conservatism that can pass as a bona fide political ideology.

1. Reactionism
This is basically the idea (and sentiment) that society used to be much better in the (far) past, and that drastic steps are needed to restore this lost golden age. The description of what has been lost can vary - from the typical fascist/nazi glorification of a prehistoric "might is right" clan society, over some authoritarian order of social hierarchy and allocation of power (typically of a feudal or predemocratic monarchy sort), to some assumed past state of cultural/moral/social harmony/cohesion (such as the times when everybody bowed to their rightful masters, supposedly ascribed to the same religion, moral code, societal ideal, etc). While conservatives through the ages (in later times, a good example is the recently deceased Roger Scruton) have indeed idealised societal features such as these ones, what is truly non-conservative in reactionism is its radically revolutionary nature. Where a conservative would typically plead caution, small steps – and be careful to intellectually distinguish the sense of something good having been lost from the justification of action to retrieve it – the reactionist wants to throw the present order out the window and disregard all transaction costs involved in realizing its utopian past. This type of (alleged) conservatism, therefore, has much in common with the extreme revolutionary communist left - the only thing distinguishing them is what exact omelette is supposed to be justifying the reckless cracking of innumerable eggs.

2. Communitarianism
Appealing to traditional values and their importance for a good society is a classic conservative theme. The background idea is one that present day political philosophy and theory often refer to as communitarianism (I would place above mentioned Scruton roughly in this camp). This is the notion of having a societal ideal that is not only about power allocation, institutional structure and (in a broad sense) economic outcome – such as the political paradigms based on Hobbes and Locke once set it up. An additional part of a good society is of what a moral philosopher would label a virtue ethical nature – having to do with the relationship between the attitudes and beliefs of citizens, and the just mentioned aspects. Simply put, a good society should be such that it balances the nature of its structure re. economics, institutions and power against a legitimizing attitude to this structure among citizens. There are basically three pathways to achieving such communitarian harmony: (a) recognizing as citizens only those who support the societal structure, (b) educating and otherwise shaping the attitudes of citrizens to support the societal structure, (c) adapting the societal structure so that it is legitimate among citizens.

Most actual states employ some mix of a-c for the purpose of legitimization, but this mix may be very different both regarding how a-c are balanced, and regarding what more exact attitudes among citizens are focused on. The typical "rightwing" conservative would usually press (a) and (b) as a matter of principle, and stress authority-derived values (obey the church, honour your king and country, respect family, nation, etc.) to be shared by citizens. But this is clearly not the only way to satisfy the communitarian notion of a good society. From a leftist standpoint, it would probably make more sense to stress (b) and (c), and to have a more pragmatic approach to what exact values need to be required by citizens in order to secure social cohesion and legitimacy.More about this will be said in points 3 and 4 below.

3. Moral Objectivism
As was once held out by Alastair McIntyre and Charles Taylor, the communitarian political philosophical idea is incapable of grounding a single, particular notion of what values should be shared among citizens, but is rather at heart (culturally) constructivist and relativistic. There is a dimension of conservatism that tries to escape this aspect by attempting to link communitarian ideas to a metaethics that could avoid the relativism. This dimension appears in a variety of ways throughout the political history of conservatism, but they all pertain to establish some variant of a given (objective) moral truth that fixes what values should be promoted and preserved in a good society - what philosophers sometimes refer to as the notion of moral objectivism (which can then come in different subvariants). The age-old way of achieving this once more takes us back to the fascist idealisation of the ancient "might is right" clan societies, by involking a notion of a given moral authority. Originally the patriarch, or otherwise head of the family (warlord of the clan, what Plato and Aristotle meant by oikos), this notion eventually transformed into the abrahamitic idea of a super authority, a capo di tutti capi, that everyone has to obey: God. In Western culture, this notion then was passed on to ideas of the Pope's divine authority, and then to the anointed sovereign, the emperor by God's grace, thus transferring the moral authority from some ambigously written book supposed to reveal the will of God to actual people and political institutions. However, as the realization that different authorities prescribe different things, religious texts can be read in a trillion ways, different religions may claim equal authority, and popes and kings may come and go and do whatever the please while claiming the sanctified authority to prescribe what is right and good, this attempt to establish a moral objectivism lost reputation within conservatism, giving way to attempts to base a moral thruth on human nature, or on the nature of human society (and its history). Out of this attempt has come ideas such as those of Edmund Burke (and, before him, David Hume), where protoscientific notions of human nature and the nature of human societies where used to motivate moderation in the radical political agendas coming out of the enlightenment, and the increasing efforts of liberal democratization of the European monarchies and lingering feudal socioeconomic structures. Modernized and put into contemporary shape, such notions could very well be taken into account by leftist politics, and below I will describe a number of ways in which this can happen. Another, quite different, development is the one proceeding from Kant's failure to convince the world that he had saved the moral authority of traditional christianity, and landing in the lap of Hegel's theories, where moral authority is transferred from God to a supposed logic of rational historical development (Scruton has referred to both Burke and Hegel as inspirations for his own favouring of a communitarian traditional values style conservatism, however was able to make sense of that). As with the latter phenomenological variant of this 'historicist' idea launched by Heidegger, this notion was at the time used to "sanctify" the authority of the supreme leader of the respective states – Prussia and Nazi Germany. This variation of moral objectivism was picked up in Marx's and Engels' theory of historical materialism, preserving the notion of historical development leading to even "higher stages", and has later embarrassed leftist politics by being used to glorify a series of communist tyrants, in a way very simlilar to how Hegel and Heidegger served their respective masters. Most of this philosophical rubbish can be safely dropped by any contemporary leftist politics, of course. But there is one small aspect of the Marxist notion of societal progress that is of value to take note of: it is a reminder that not only conservatism, but also leftist politics needs a set of basic values on the basis of which social progress (or deterioration) can be evaluated. Some central ideas to this effect has been written into the characterisation of the political left given in the foregoing section: socioeconomic effective and sustainable promotion of egalitarian values and societal solidarity with those worse off. These values, I submit, are more attractive as moral foundations for leftist poilitics than lofty theories about higher stages of economic organisation and ends of history.

How to ground or "prove" them remains as much a challenge for leftists as it does for conservatives with the values listed under items 1 and 2 above. But I do believe that what is demonstrated is a shared fundamental preference for substantial moral conviction, rather than intelctually shallow relativism, and unsound teachings of unbounded tolerance built on that. In Samwise Gamgi's words, most of us believe that "there is something good in this world, and its worth fighting for!" – we actually do not buy into the lofty "everyone is right in their own way" junk we might resort to in order to avoid unpleasant confrontations and conflict over a birthday dinner. Conservatives and leftist should agree on the existence of moral truths, albeit they might want to debate what they are.

4. Responsibility
Another theme throughout the history of political conservatism is that of individual responsibility. Most commonly wielded when rightwing conservatives spinn their traditional "law and order" rhetoric, it is also very much present when conservatives oppose structural explanations of social phenomena and linked claims to distributive justice regularly embraced by the left. The basic idea is, roughly, that whatever wrongdoings and misfortunes remain in a rightwing conservative ideal society is the responsibility of individuals. Within the boundaries set by the given moral authorities, and the social communitarian structures of care (e.g., wthin the family, or the informal civil society of a village), whatever remains of unjustified negative situations is either due to the culpable behavior of that individual, or of some other individual (including members of the community or family). This mirror's Marx's observation that even under utopian communism there may be suffering and wrongful behavior, but not because of unjustified socioeconomic arrangements or structural oppression, but due to individual (as opposed to social/class) antagonism. The notion of responsibility as the concept that will account for the imperfections of a utopian political ideal is also embraced by liberals, in the famnous line of reasoning that in a free market (possibly adjusted for unjust basic conditions), a person's fortune or misfortune is entirely up to themself, on the same conditions as everyone else and within the boundaries set by the (possibly socially augmented) nightwatcher state.
One thing that this hints is that, in fact, some idea of individual responsibility must be a part of any political ideology. No matter how much or how little power or wellbeing you want to allocate to the state, to moral authorities or to people, there will always be a boundary where the source of the outcome for a person will be placed at their and not society's feet. This goes also for extremely solidaric and altruistic ideals: once you have provided people with the means to the good and empowered life – in terms of socioeconomic structures as well as personal resources – they will be left free to use or not to use them and thus be the sources of their own fate, with no one else to blame for what might go wrong (unless someone wrongs them). This goes for a political leftist ideal too, but there is more to it than that.

If a society is to be organised on the basis of egalitarian and solidaristic ideals, considerations of efficiency and sustainability require not only a broadly shared communitarian spirit and that there is a room for individual responsibility for individual actions and life trajectories, but also a broad conrtribution across the population in terms of citizen duties that are met. This fact has always been recognised in the wellfare states of postwar Europe: these have all been built up on the format that in political philosophy/theory is known under the name of (classical) republicanism (not to be confused with the variant of liberal theory called neo-republicanism) – the idea of a good society as combining complementary duties for society towards cirtizens and for citizens towards society. For this reason, these societies have also embraced communitarian notions to this effect: the idea of a solidarity with the worse off is accompanied with the idea of a duty of contribution (according to ability) for everyone. In fact, the classic Marxist formula of "from each according to his ability, to each according to his needs" expresses such a (classical) republican idea of social justice and individual moral responsibility (and further demonstrates the need of moral objectivism for a plausible leftist political theory).

5. Sustainability
Both the communitarianism and the responsibility dimensions link to a more generic feature often stressed in political conservative thought: the value of preserving an allegedly valuable societal structure or order or over time, allowing for not only ideal theoretical considerations about what makes for a good society, but also considerations of human and social nature. This is a main theme especially in the British tradition that runs from Hume and Burke (starting in Hobbes). This is why social cohesion and legitimacy is of such importance to conservative political thought: without it, the ideal society threatens to fall apart. Especially Hume's discussion of the essentially communitarian idea of the virtue of justice in book 3 of A Treatise of Human Nature seems almost entirely about this need. People and institutions are – from an ideal theoretical political standpoint – imperfect, and society needs to be organised in light of this insight to prevent decline. This sets political conservatism apart from the various utopian ideas of "a new man", according to which the ideal society will (have to) change human nature so that social decline from the utopian ideal is never a threat. This is why utopian political projects (be they communist/socialist, fascist or liberal) tend to end up as virtual prisons and indoctrination and labor camps for its citizens (since they are unable to adjust for the pragmatics of how people, social institutions and economics tend to function in reality).

As may be observed, economic sustainability is written into the very characterization of the kind of leftist politics that interests me in this blogpost – this follows immediately from the Marxist "materialistic" legacy of leftist politics (although it was never well taken care of in the Marxist-Leninist tradition). There is thus an immediate way in which this conservative dimension can be easily taken up by the political left. It is a recurring tragedy of leftwing projects to fail due to a lack of pragmatic economic sense. But economics is not isolated from other pragmatic aspects of society, such as psychology, culture and the contingencies of how the political world happens to be organised. Especially with a democratic system to allocate political power, any regime will have to adjust to dominant sentiments of the public where persuation does not bite, and state force would be counterproductive. To the extent that these popular sentiments value what is otherwise seen as typical rightwing conservative concerns, such as in the case of strong nationalistic or monarchistic feelings, it may make lots of sense for a leftwing politics to adjust to this for instrumental reasons. Such adjustments were obvious with regard to nationalism in the Nordic welfare states after WW2, with its rhetoric of "folkhemet" (the home of the people), and a tight control on the mobility of capital, labour, etc., that didn't start to change until the 1980's. A similar story can be told about refugee policies. The liberalisation or globalisation that opened borders for money and people could be sustained as long as it was in line with dominant popular sentiments. But when these change, the sustainability of such policies also change, even if one holds the basic leftist idea that nation state borders are arbitrary historical artifacts, and ethnic differences are of no basic moral importance. A similar line of reasoning can be applied to the case of monarchy, and remains a strong reasons for the political left not to make any attempt to dismantly the nowadays powerless monarchs of e.g. Norway or the UK. True, a convinced leftist may find such pills utterly bitter to swallow, and maybe this is what explains why so many initially promising leftist political projects have crumbled. But nevertheless, if your leftist agenda is social equality and anti-fascism, and your globalised economic and migration policies drive people into fascist political camps, it makes sense to adjust them for pragmatic reasons, in order to facilitate what is possible and prevent the worst.

6. Precaution
The dimension of sustainability therefore points to another – if not the most classic and central – dimension of conservatism, that of precaution. This dimension is illustrated by one of the most classic
texts of political conservatism, Hume's defence of the current (in his time) distribution and regulation of private property in book 3, sections II-IV, of A Treatise of Human Nature. Hume argued that enlightment-based calls for radical transformation of economic arrangements perceived to be deeply unjust (eg., due to their roots in feudalism and unjust exploitation) or to rebell against the legal order upholding these arrangements are too risky to be defensible. Here, he combines a communitarian and somewhat constrained moral objectivist ( what would nowadays be characterized as some sort of moral social constructivist) idea of citizen virtues that motivate a responsibility to be careful not to destroy certain basic social arrangements, in order to preserve what everyone would agree to be desirable. Hume's exact argument is a sort of upside-down variant of Hobbes' famous argument in favour of the sovereign state, pointing to the value for all of having some sort of set, organised society rather than anarchy. What Hume points to is the risk of losing this most precious of social values when pursuing radical, hurried or even revolutionary societal transformation for the better. Even if it is actually true that the current economic order is deeply unjustified, this is not sufficient to justifiy action that risks throwing society into chaos, Hume insisted. This brand of argument has been sustained in later conservative political thought, such as that of Stuart Hampshire's "antirationalism", where he questioned some basic tenets of social progress and transformation advocated within the modernist, utilitarian and positivist movements of the 1900's. It can be noted that the conservative sentiment expressed by these ideas is in stark conflict with that of the dimension of reactionism (no. 1 above). Hume's argument could very well be applied to any political situation, as long as it displays the quality of a functioning state. In 1990, my then supervisor and, later, colleague Torbjörn Tännsjö used this observation as a stepping stone for defending a conservative stance to socialist political orders as well as the welfare state against neoliberal onslaught. Today, similar arguments in favour of globalisation and the free market are heard from neoliberals in the face of rising nationalist and antiglobalist tendencies.

But there is another aspect to Hume's argument which is probably of greater significance for leftist politics, and this is its implied call for piecemeal reformism, and open pragmatism to what actual measures best may realise the desired political aims in a sustainable way. In politics, this also, of course, applies to the chance of a political left to hold on to political power, and therefore links especially to the dimnensions of communitarinism and sustainability. This dimension of conservatism then includes the other ones that have been observed above to be available for leftist use: communitarianism, moral objectivism, responsibility and sustainability.

A Conservatism for the Political Left
On the basis of my analysis of the six dimensions of conservative politics and linked sentiments, I find that the prospect for a "red baron" position to be excellent. Except for one, all of the dimensions are readily available to be incorporated in leftist political strategies and and suggestions. The one conservative dimension that does not qualify is that of reactionism. This type of "rebellic", "revolutionary" or "radical" conservatism is, on the other hand, in potential stark conflict with all of the other dimensions. This leaves me with the conclusion that rightwing reactionaries such as fascists and nazis, "alt-rights", "nationalist conservatives", "nativists" or "identitaries" are not much of conservatives, ideologically speaking, or in terms of political sentiment. They are reckless hotheads with wild utopian dreams of recreating a clan society ruled by honour culture and vendettas, or a feudal past where everyone obey their given master, more or less the state of nature described by Hobbes and feared by many conservative thinkers, such as Hume and Burke. Reactionism is basically the utopian idea of returning to a barbaric state of human pre-civilisation or pre-nation state organisation, whatever the cost. It is at the same time the mirror and the closest sibling of the worst examples of utopian revolutionary communism.

So, let's sum up the parts of the conservative ideological core avialble for the shaping of leftist politics:

Recognition of the need for communitarian ingredients in a good society: there needs to be some sort of reasonably shared vision of important values and virtues. Unlike the conservative right, however, the political left can have a more pragmatic stance to what these values and virtues are, and how they may be fostered and enforced. An obvious candidate, however, is the notion of solidarity as communitarian cornerstone virtue of a leftist political vision.
The claim that these values and virtues are actually justified, and not just arbitrary. This calls for a need of linking a leftist vision of the good society to a justifying story for the idea of what values and virtues are needed in this society, and how they are to be actualised and maintained. This story will have to be markedly different than the rightwing conservative story invoking some given supernatural or natural authority, or historicist rationality, marxist, hegelian, heideggerian or something else.
A clear idea of the allocation of responsibilities between individuals, institutions and the state in the leftist good society. This allocation needs to be linked to the communitarian vision, and to its moral justification.
A recognition, internally and publicly, of the limitations for political reform set by the need for sustainability, and the unavoidable pragmatic dimensions following from this with regard to adaption to dominant political sentiments and opinions.
Organised scepticism against all calls for rapid and radical social change, no matter its source and direction, to facilitate a precautionary political stance that may facilitate desired change in a responsible way.

This, then is the building blocks of a "red baron" political position. It needs to be filled with concrete political content, of course, linking to the basic leftist vision sketched earlier. Also, it may – just as for rightwing conservatives – necessitate balancing conflicts between the dimensions, eg. between a developed solidaristic virtue and sustainability reasons to maintain (for instrumental reasons) some ingredients of national partiality.

An Improved Model Definition of Antisemitism

noreply@blogger.com (Christian Munthe) — Sat, 23 Nov 2019 12:47:00 +0000

1. The need for a clear definition of "antisemitism"
A few years back, I blogged about the savvy tactic of the Netanyahu government to accuse virtually all criticism of the Israel occupation policy as antisemitic. Since then, more complex disputes have evolved at higher levels, not least the debate and controversy around antisemitism within the Corbyn led Labour party in the UK. Also in my own country, the thorny issue of how to draw the line between legitimate (not meaning necessarily sound) criticism of decisions made by the government of Israel and judgements that deny jewish people equal rights or has taken public stage, connected to repeated reports of antisemitic harassment and hatespeech in the city of Malmö, and an harassment case regarding Jewish phycisians at the Karolinska University Hospital in Stockholm. All of these cases have actualised tricky issues on how to define the line between legitimate political criticism against acts of the Israeli government, and (ethno)racist harassment or hatespeech targetting jewish people.

The issue has become extra complicated with the rise of a new "nationalist" far-right conservative political (more easily, Fascist) movement across Europe. Albeit targetting muslims and "migrants" has been a main theme in the political rhetorics in these circles, antisemitic themes and tropes are commonplace. This regards, of course, the now well-known cases of the Fidesz-ruled Hungary, and the PiS-ruled Poland (both countries with a long history of widespread antisemitism in the culture, no matter the regime). But also in Sweden, where antisemitic attitudes have a comparably weak hold, open hatred against Jews and open antisemitic attitudes have been a standing occurrence from the Sweden Democrats party, even its highest circles of leadership. Even political pundits linked to the more traditional conservative side of politics have been starting to flaunt obvious antisemitic tropes in their public statements. The perhaps most well-known and obvious case being the former op-ed editor, now mainly op-ed writer, of the Göteborgsposten daily, and ideaological consultant of the Moderaterna classic conservative party, Alice Teodorescu, who shortly before the Swedish general election of 2018 labelled holocaust survivors who went public with parallels between the current political development in Europe and Sweden and that in 1930's Germany as "agents of the political left", ironically proving said holocaust survivors right by using the classic trope of porttraying Jews as spokespersons and forerunners of a leftwing conspiracy.

In this landscape, it has become increasingly difficult to navigate, as the Israeli government marks any criticism as antisemitic, obvious antisemitic hatespeech, tropes and images within the Palestine movement and other critics of Israel are shrugged off as legitimate criticism of Israel, while many feel an increasing need to protest against the increasing antisemitism from the new fascism and politically conservative right. As the fight over the concept of antisemitism continues, Jews as well as all anti-racists are being caught in the middle. At the heart of the problem is that there is no well-designed and generally approved definition of "antisemitism". In fact, I was stunned to find out, the only thing there is, is a "non legally binding working defintion" issued by the International Holocaust Remembrance Alliance (IHRA) in 2016. As no alternative determination of the concept exists, this definition has been used (though not officially adopted or approved) by the European Commission and Parliament, and adopted by the federal US government.

However, the definition has also drawn criticism for confusing the line between legitimate political criticism of the Israeli government, and hatespeech, harassment etc. targetting jews. I agree with portions of this criticism and, in addition, as a philosopher, I find the definition poorly constructed from a technical point of view. In this post I will therefore use the IHRA working defintion as a stepping stone for presenting a more accurate and better constructed defintion. The result, I will call a "Model Definition of Antisemitism", thereby signalling that I believe this suggestions to move the work of defining "antisemitism" from the "working" stage to the stage of presenting an actual prototype for use in legislation and political and moral judgement.

2. Improving the IHRA Working Definition
The IHRA definition starts off with a generic characterization of "antisemitism", and this is the part that a philosopher would call an actual definition:

Antisemitism is a certain perception of Jews, which may be expressed as hatred toward Jews. Rhetorical and physical manifestations of antisemitism are directed toward Jewish or non-Jewish individuals and/or their property, toward Jewish community institutions and religious facilities.

Immediately following this rather vague statement (what counts as "hatred", and what "manifestations" are implied?) comes a generic clarification, which must be sen as part of the diefinition.

Manifestations might include the targeting of the state of Israel, conceived as a Jewish collectivity. However, criticism of Israel similar to that leveled against any other country cannot be regarded as antisemitic. Antisemitism frequently charges Jews with conspiring to harm humanity, and it is often used to blame Jews for “why things go wrong.” It is expressed in speech, writing, visual forms and action, and employs sinister stereotypes and negative character traits.

Thus far, the definition looks pretty ok. However, one unclarity can be found in the first two sentences of the second quote. Together, these may be read to imply that the state of Israel is "a Jewish collectivity", not only that criticising the Israeli government's actions in terms of condemnation of "jews" is antisemitic. This muddle is unfortunate. Of course, jews may be citizens of any country, and the state or government of Israel cannot be assumed to represent jews everywhere, and citizens of Israel need not be jews (so the collectivity of Israel is thereby not "Jewish", albeit a lot of israelis are jewish and Jewish culture is central to israeli life).

Additionally, these descriptions fail to make a distinction that, if ignored, often causes confusion in debates on whether or not some phenomenon or person is antisemitic. This is the distinction between, on the one hand, a person harbouring antisemitic ideas, and, on the other, some manifestation communicating, expressing and/or spreading antisemitism. For instance, when I pointed out on Twitter how Alice Teodorescu's inciting attack on holocaust survivors fitted several counts of the IHRA definition of "antisemitism", I had a storm of responses from her supporters that it was preposterous to suggest that she is antisemitic. This is, of course, is completely irrelevant when assessing her statements – a person may express antisemitism without being antisemitic. At the same time, if the antisemitism of some manifestation is pointed out but the person behind them continue to use them, this will be empirical evidence supporting the idea that this person actually endorses antisemitism.

To improve the definition in this respect, I therefore suggest the following revision:

Antisemitism is a certain perception of Jews, which may be expressed as hatred toward Jews, or rhetorical and physical manifestations directed toward Jewish or non-Jewish individuals and/or their property, toward Jewish community institutions and religious facilities. This perception may be held by a person, and communicated through different types of manifestations. While criticism of the government of Israel similar to that leveled against any other government cannot be regarded as antisemitic, manifestations that has such criticism take the form of targeting Jews or Jewish people rather than political decisions and holders of political offices is antisemitic. Antisemitic manifestations frequently charges Jews with conspiring to harm humanity, and it is often used to blame Jews for “why things go wrong.” It is expressed in speech, writing, visual forms and action, and employs sinister stereotypes and negative character traits.

Following this opening, generic characterization, the IHRA working definition then adds a list of examples of what may be included in contemporary antisemitic manifestations. In tghis quote, I have added numbers for more easy referral to items on the list, in the original the items are seprated by dots:

Contemporary examples of antisemitism in public life, the media, schools, the workplace, and in the religious sphere could, taking into account the overall context, include, but are not limited to:

1. Calling for, aiding, or justifying the killing or harming of Jews in the name of a radical ideology or an extremist view of religion.

2. Making mendacious, dehumanizing, demonizing, or stereotypical allegations about Jews as such or the power of Jews as collective — such as, especially but not exclusively, the myth about a world Jewish conspiracy or of Jews controlling the media, economy, government or other societal institutions.

3. Accusing Jews as a people of being responsible for real or imagined wrongdoing committed by a single Jewish person or group, or even for acts committed by non-Jews.

4. Denying the fact, scope, mechanisms (e.g. gas chambers) or intentionality of the genocide of the Jewish people at the hands of National Socialist Germany and its supporters and accomplices during World War II (the Holocaust).

5. Accusing the Jews as a people, or Israel as a state, of inventing or exaggerating the Holocaust.

6. Accusing Jewish citizens of being more loyal to Israel, or to the alleged priorities of Jews worldwide, than to the interests of their own nations.

7. Denying the Jewish people their right to self-determination, e.g., by claiming that the existence of a State of Israel is a racist endeavor.

8. Applying double standards by requiring of it a behavior not expected or demanded of any other democratic nation.

9. Using the symbols and images associated with classic antisemitism (e.g., claims of Jews killing Jesus or blood libel) to characterize Israel or Israelis.

10. Drawing comparisons of contemporary Israeli policy to that of the Nazis.

11. Holding Jews collectively responsible for actions of the state of Israel.

It is important to note that this kind of list is, from a conceptual analytical standpoint, an entirely different animal than the proper definition given earlier. A list like this is more like an amendment, or implementation guide, and not really part of the definition itself. The list must therefore not serve to arbitrarily expand the concept, as it has already been characterised in the generic definition. Moreover, the list shoud ideally be brief, and items that could be subsumed as instances of other items should be taken off the list to avoid confusion. With these aspects in mind we may match the items on the list against the revised generic characterisation, and the other items of the list. I will start with the question if some items can be sorted under others.

Of the items, 1-4 seem perfectly legitimate. No. 5, however, while being an accurate example of typical antisemitic manifestations, it falls under the domains of items 2-4, as one of many specific examples. Likewise, item no. 6 falls under item 2 and 3. Furthermore, item no. 11 seems to be a particular instance of item 3, especially if item 3 is clarified to include states. Finally, item 10 would seem to sort under item 4. A first revision of the list in view of making it more coherent and brief, would therefore read:

Contemporary examples of antisemitism in public life, the media, schools, the workplace, and in the religious sphere could, taking into account the overall context, include, but are not limited to:

1. Calling for, aiding, or justifying the killing or harming of Jews in the name of a radical ideology or an extremist view of religion

2. Making mendacious, dehumanizing, demonizing, or stereotypical allegations about Jews as such or the power of Jews as collective — such as, especially but not exclusively, the myth about a world Jewish conspiracy or of Jews controlling the media, economy, government or other societal institutions.

3. Accusing Jews as indivuals or a people of being responsible for real or imagined wrongdoing committed by another Jewish person, group, institution or state, or even for acts committed by non-Jews

4. Denying the fact, scope, mechanisms (e.g. gas chambers) or intentionality of the genocide of the Jewish people at the hands of National Socialist Germany and its supporters and accomplices during World War II (the Holocaust).

5. Denying the Jewish people their right to self-determination, e.g., by claiming that the existence of a State of Israel is a racist endeavor.

6. Applying double standards by requiring of it a behavior not expected or demanded of any other democratic nation.

7. Using the symbols and images associated with classic antisemitism (e.g., claims of Jews killing Jesus or blood libel) to characterize Israel or Israelis.

We come now to the question if all the remaining items can be supported by the generic characterisation. Here, I find only one item problematic, namely no. 5. The problem with this item is that it is perfectly possible to hold the political philosophical view that no people of any kind have any right to self-determination without being antisemitic in the sense of the generic characterisation. This view is a general scepticism to the notion of the nation state as a moral (rather than practical) category. This view implies that also Jewish people lack such a right (thus falling under item no. 5), but without in any way treating Jewish people worse than any other people, or discriminate against jews. What would be antisemitic would be to afford a right of self-determination to other peoples, but not to the Jewish people. A case in point would, for example be, if the Palestinian people is afforded a right to self-determination while the Jewish people is denied such a right (conversely, affording the right to the Jewish people but not to the palestinian people would be "anti-palestinianism"). But if the item is rephrased to that effect, it will fall under item 6 (regarding double standards). Therefore, my suggestion is that also item 5 on the revised list is removed.

3. A Model Definition of "Antisemitism"
The outcome of this little exercise is, then, the following proposal for a model definition of the notion of "antisemitism". This definition provides a more coherent, brief and applicable guide for determining whether or not some phenomenon is antisemitic or not. For example, the Teodorescu statement about holocaust survivors who bear witness of the 1930's being "agents of the political left" clearly falls under item 2, and possibly also under item 4 (if historical facts regarding the Holocaust include its political precedence. many of the examples from islamist propaganda, as well as propaganda within the Labour party of the UK (such as classic antisemitic trope images that have been used for centuries for antisemitic purposes). But claims from any of these parties regarding the justification of, e.g., Israeli settler policy on occupied land, or the "shoot to kill" policy of IDF forces at the border between occupied territory and Israel proper would not be antisemitic at all. I believe this definition, unlike that of IHRA, to be fit for incorporation into actual legal statute, as well as policy declarations that guide the actions of international institutions, states, business as well as NGO's.

Antisemitism is a certain perception of Jews, which may be expressed as hatred toward Jews, or rhetorical and physical manifestations directed toward Jewish or non-Jewish individuals and/or their property, toward Jewish community institutions and religious facilities. This perception may be held by a person, and communicated through different types of manifestations. While criticism of the government of Israel similar to that leveled against any other government cannot be regarded as antisemitic, manifestations that has such criticism take the form of targeting Jews or Jewish people rather than political decisions and holders of political offices is antisemitic. Antisemitic manifestations frequently charges Jews with conspiring to harm humanity, and it is often used to blame Jews for “why things go wrong.” It is expressed in speech, writing, visual forms and action, and employs sinister stereotypes and negative character traits.

Contemporary examples of antisemitism in public life, the media, schools, the workplace, and in the religious sphere could, taking into account the overall context, include, but are not limited to:

1. Calling for, aiding, or justifying the killing or harming of Jews in the name of a radical ideology or an extremist view of religion

2. Making mendacious, dehumanizing, demonizing, or stereotypical allegations about Jews as such or the power of Jews as collective — such as, especially but not exclusively, the myth about a world Jewish conspiracy or of Jews controlling the media, economy, government or other societal institutions.

3. Accusing Jews as indivuals or a people of being responsible for real or imagined wrongdoing committed by another Jewish person, group, institution or state, or even for acts committed by non-Jews

4. Denying the fact, scope, mechanisms (e.g. gas chambers) or intentionality of the genocide of the Jewish people at the hands of National Socialist Germany and its supporters and accomplices during World War II (the Holocaust).

5. Applying double standards by requiring of the state of Israel a behavior not expected or demanded of any other democratic nation.

6. Using the symbols and images associated with classic antisemitism (e.g., claims of Jews killing Jesus or blood libel) to characterize Israel or Israelis.

Welcome Retraction Decision from the Indian Journal of Medical Ethics, and Hopefully Future Policy Revisions to Be Announced

noreply@blogger.com (Christian Munthe) — Sun, 27 May 2018 12:26:00 +0000

I have posted two times (here and here) about the deeply misguided decision by the editorial management team of the Indian Journal of Medical Ethics not to retract a fraudulent, obviously "antivaxx" propaganda piece, article. On invitation, I have also summarised my opinion on this matter at the Daily Nous philosophy blog. In all of these posts, I have strongly underscored the otherwise very promising track and strong reputation of this journal, the importance of this for the critical place of global health and developing country perspectives in bioethics scholarship, and my strong wish for a revised course by the IJME editorial management. It is therefore with the greatest satisfaction I have been reached by the news that the same management has now revised its judgement, and decided to retract the article in question, inviting publicity also from the widely read Retraction Watch blog.

The retraction note is rather brief, but open and honest, and it speaks well of the integrity of the editorial management that it does not try to hide its own mistakes, or that the retraction occurred only as a result of pressure from the journal's editorial board and external commentators. It signs off by promising further elaborations in coming editorials. My hope is that these will set out clarified policies and routines that ensure that the journal in the future will keep strictly within its own declared area expertise and scholarship of "all aspects of healthcare ethics and the humanities, relevant to and/or from the perspective of India and other developing countries". This simple policy will save the IJME from any further scandals of the sort it has just escaped, and be a pillar for what I hope will be a further positive route of development of this otherwise excellent journal.

However, on one point, I strongly disagree with the position set out by the editorial management, and that is its apparent decision to continue to hide the identity of the proven fraudulent author that used to call him-/herself "Lars Andersson", falsely claiming affiliation to Karolinska Institutet. The editors are hereby promoting further research fraud by this person, undermining both other journals and research institutions from protecting themselves against this person's future activities. It also impedes appropriate disciplinary action to be taken by the academic or other institution to which the person formerly known as "Lars Andersson" is indeed affiliated. Finally, it impedes any analysis into the vested or other conflicts of interests linking to this person's activity to attempt to peddle fraudulent antivaxx articles. The argument by the editors, that it has promised the author to keep his/her identity a secret is not only invalid. The action makes the editors complicit in any further research fraud undertaken by this person. The promise itself is morally void, as the editors had no business making it in the first place, their primary obligation being to the research community, and not to proven research fraudsters. It is my sincere hope that the further elaborations on editorial policy promised, possibly by help of further dialogue with the journal's editorial board, will lead to revision of judgement also regarding this particular point.

***

Indian Journal of Medical Ethics Troubles Deepen as Editorial Team Responds to Criticism

noreply@blogger.com (Christian Munthe) — Wed, 23 May 2018 14:34:00 +0000

Only the other day, I posted about "highly problematic" publication ethical decisions of the Indian Journal of Medical Ethics, and even more problematic positions taken when challenged. After having raised the issue in some closed facebook groups in my field, the initial concerns I had about the direction taken by the journal, have now deepened considerably.

First, the entire managing editorial team – excluding the main editor of the journal, Amar Jesani – has now responded for a second time to the criticism of the Karolinska Institutet president Ole-Petter Ottersen, in a facebook post. I'm quoting it verbatim here, and adding screenshot below as proof of authenticity:

IJME Working Editors Respond to Prof Ole Petter Ottersen, President, Karolinska Institute, Sweden.
Response to the blog post of Prof Ole Petter Ottersen, President of the Karolinska Institutet, Sweden: http://blog.ki.se/…/comments-from-indian-journal-of-medica…/
Prof Ottersen has raised important issues on the role of journals and of research institutions in ensuring ethical research and informing medical practice. However, his attack on The Indian Journal of Medical Ethics in the name of publication ethics is flawed, and indicates a reluctance to engage in discussion on the scientific issues. He has also conveniently ignored the Karolinska Institutet’s own role in permitting misconduct by its researchers.
Good editorial practice:
While journals should make every effort to confirm the author’s identity and affiliation, this is not routine editorial practice even among well-established journals. The Journal of Internal Medicine (published by Wiley) and Vaccine (published by Elsevier) have carried material by “Lars Andersson”, without checking his institutional affiliation and despite his use of a non-institutional id.
Editors’ accountability:
The comment by “Lars Andersson” ( http://ijme.in/…/increased-incidence-of-cervical-cancer-in…/ ) was reviewed by an external, international subject expert, an external statistician, a working editor with expertise in research methodology (Mala Ramanathan) and the manuscript editor (Sandhya Srinivasan) before being accepted for publication. When we were notified of the deception regarding the author’s identity and affiliation, we immediately removed the KI affiliation from the journal. We have explained our justification ( http://ijme.in/articles/statement-on-corrections/… ) for retaining the article on our website, and maintaining the author’s anonymity.
The need to enable scientific debate:
Prof Ottersen does not explain how anonymity prevents scientific debate on an analysis of publicly available data. And he does not explain how “false affiliation” is relevant in the context of the IJME article which no longer carries any affiliation. He says that “leading researchers with intimate knowledge of the vaccination field have identified serious flaws in the published report and its conclusion, thus questioning the quality of the review process”. However, neither he nor these unnamed researchers have stated what those flaws are. The attack on IJME for maintaining the author’s anonymity appears to be to avoid scientific debate. We invite critical commentaries on the paper by “Lars Andersson” towards advancing the scientific debate on the issue at hand.
The suggestion that false affiliation and anonymity are preventing scientific debate is a red herring. Does Prof Ottersen’s indignation comes from his inability to personally target the person questioning the HPV vaccine?
The need for institutional accountability:
We suspect that, in addition to using the author’s anonymity as a red herring to prevent scientific debate on the article, KI has reasons to whip up sentiments against IJME to hide glaring failures of governance in the institute in relation to "Lars Andersson".
Between 2014 and 2017, two internationally reputed journals, JoIM and Vaccine, published correspondence from "Lars Andersson" who reported affiliation to KI. The letters in JoIM were in response to a paper in the same journal. A perusal of the JoIM articles shows that "Lars Andersson" had filed a complaint of research misconduct in 2016 against six authors of this paper, five of them affiliated to KI. The complaint was with KI for about a year, after which it investigated these allegations without confirming the identity of the complainant. Let alone a journal published from India, KI did not verify, on its own, the existence of a person on whose complaint it was acting. It would not be wrong to assume that the complainant made a prima facie case for the allegations; without this, KI would not have launched the investigation. In this background, and with KI providing legitimacy to "Lars Andersson", how could JoIM and Vaccine have suspected that "Lars Andersson" did not exist in KI? And how could this question have ever occurred to IJME?
The prevention of deception by an author on the name or affiliation requires the joint efforts of many stakeholders, including journals. While IJME has taken full responsibility for what has happened, the attacks on it in the name of publication ethics cannot wish away the ongoing governance failure in the KI, and cannot be used to prevent scientific debate on an article which nobody has proved to be unscientific, except by innuendo.

Sunita V S Bandewar, PhD, MHSc (Bioethics), Independent Senior Research Professional; Working Editor, IJME. Email: sunita.bandewar@gmail.com
Rakhi Ghoshal, PhD, Assistant Professor, United World School of Law, Gandhinagar INDIA, Consultant Researcher, King’s College, London, UK; Working Editor, IJME. Email: rakhi.ghoshal@gmail.com
Vijayaprasad Gopichandran, MD, PhD, Primary Care Physician, Reproductive Health Cliic, Rural Women's Social Education Centre, Kancheepuram District, Tamil Nadu; Assistant Professor, Department of Community Medicine, ESIC Medical College and PGIMSR, Chennai, INDIA; Working Editor, IJME. Email: vijay.gopichandran@gmail.com
Sanjay A Pai, MD, Working Editor, IJME. Email: sanjayapai@gmail.com
Mala Ramanathan, MSc, PhD, MA; Working Editor, IJME. malaramanath@gmail.com
Sandhya Srinivasan, MA, MPH, Independent Journalist, Mumbai; Consulting Editor, IJME. Email: sandhya199@gmail.com

Screenshots (click to enlarge):

This response demonstrates the obvious fact that the editorial team of IJME is apparently unaware of the most elementary principles of academic publication ethical principles. They are unaware of the importance of why proven research fraudsters should have their publications retracted, and they believe that the importance of being able to correctly identify authors and their academic affiliations of research articles is "a red herring" (see my former post for some of the most obvious reasons for why it is not). This leads me to conclude that the editorial team lacks the necessary competence to manage a well regarded bioethics journal. Which helps to explain why IJME has gone so sadly astray.

However, it does not end there. In the closed Facebook group Bioethics International - a forum for explicit professionals and dedicated researchers in bioethics, or advanced students on track to become any of those, a number of additional points were importantly raised, in addition to the ones in my original post. First, the fact that IJME decides to publish an epidemiological article in a politically highly contested field, where research fraud from "antivaxxers" have been numerous, in an ethics journal. The whole point of having journals organised by fields is that this can guarantee appropriate scientific competence among the journal editorial management, e.g., to select suitable reviewers for manuscripts, and to appropriately evaluate reviewer comments. This is very obviously not the case regarding the fake author paper in the IJME: One of the working editors that is named as having handled the paper, Sandhya Srinivasan, does not hold a PhD, while the other, Mala Ramanathan, is a reproductive health specialist with nil research competence in the topical area of the paper (albeit she does hold an Msc in statistics according to informal reports). The only quality screening of the paper was made by one unnamed external expert on statistics, andMala Ramanathan. That is, no research expertise on vaccination, on HPV and cervical cancer, or on epidemiology ever assessed the paper, despite the fact that this was the topic of the article, and the fact that there is plenty of expertise available in those fields. This is, I would say, serious and willful editorial mismanagement of the publication process of a bioethics journal.

In the further discussion in the same Facebook group, several members of the editorial team engaged themselves, and demonstrated some further causes for concern, besides what has already been mentioned. First, there were repeated assurances about Amar Jesani, the IJME editor who was responsible for the decision not to retract the fraudulent article, and who also made the initial, ill-conceived response to Ole-Petter Ottersen, having the highest of ethical competence and integrity. When people reacted to that with the appropriate "so what, that does not justify what he's done", the working editors started to rave about a lot of other journals being conned too, basically trying to say that, because of that, the IJME would be right not to retract a proven fraudulent article. All of this, of course, just adds to the already amassing reasons to view the IJME as an unserious academic journal, that has sadly departed from its formerly very promising track for becoming a well regarded publication forum in bioethics. I sincerely hope that the journal's editorial board can swiftly step in and set this sad development right, and if it so does, I will be happy to revise my judgement.

But before I end, there is a final twist to the ongoing scandal. As is made clear by the editor, Amar Jesani's first response to Ole-Petter Ottersen, he now is aware of the real identity of the fraudulent author calling him-/herself "Lars Andersson" and claiming affiliation to Karolinska Institutet in order to peddle an antivaxx junk article to what has now proven to be a substandard journal. However, instead of disclosing this identity – what expertise this author supposedly possesses and what research affiliation he or she holds – the editor Amar Jesani continues to keep this a secret. As I said in my former post, the bogus after-the-fact excuse that the author must be shielded from criticism isn't worth the paper it was written on. In addition, as this is a proven research fraudster, it is in the publiuc interest and the interest of the entire research community, to be informed about who this person is. What is worth noting, however, is this: Amar Jesani very obviously finds the combination of the following three actions very important to sustain: (1) let a fraudulent antivaxx article stay in an ethics journal, (2) shield the proven fraudulent author of this article from public exposure, (3) have is editorial team do its best to deflect further critical inquiry into this matter, especially critical assessment of Jesani's own actions. I just let that stay there as food for thought until this matter develops further.

***

Highly Problematic Stance on Fake "Antivaxx" Authorship By the Indian Journal of Medical Ethics

noreply@blogger.com (Christian Munthe) — Mon, 21 May 2018 11:25:00 +0000

It is a recognised challenge of my research field, bioethics, to include and empower researchers and institutions from low- and midlle-resource settings. Since a few years, the leading journal of Bioethics, runs the side journal Developing World Bioethics to address this issue, and over the past few years a number of journals have appeared, based at institutions outside of the most affluent parts of the world with a natural focus on bioethical issue of relevance to such settings, as well as global health related issues. One of these is the Indian Journal of Medical Ethics, that has quickly been rising in the ranks and attracting respect for its consistent work.

However, very recently the IJME has been dragged into potential scandal. First, the editor, Amar Jesani, decided to publish an article by a fake author, claiming fake credentials and affiliations, of an obvious antivaxx junk article of the sort that antivaxxers – just like tobacco-industry sponsored scientists used to do regarding the dangers of smoking – are constantly trying to peddle to various journals to create an image of "scientific controversy" around the use of vaccines to fight infectious disease and build public health. The fakes were all very easy to detect, and already the fact that the "author" was not using the email-domain of, and has no profile at the webpages of, the institution (Karolinska Institutet) to which he claimed affiliation should have rung immediate alarm-bells. But then, when this is pointed out, and the journal is alerted to this research fraud, the editor Amar Jesani decides not to retract the article! Instead, the editor appears to have decided to trust the author's obviously bogus explanations for his (?) fraud, and to attempt to counter a, to my mind, quite sound statement on the matter from the Karolinska Institutet president, Ole-Petter Ottersen.

The bogus explanations and Jesani's expression of sympathy with them, and Ottersen's stringent response, is to be found here. This very surprising and ill-conceived action of Jesani is potentially extremely damaging for the IJME, and in effect risks to soil the reputation of the entire field of bioethics. The fake author's attempt at justifying the fraud is that he/she has to be anonymous to protect him-/herself from persecution for unpopular views. This, of course, is not even worth the scrap of paper it was scribbled on. The real role of the fraud is to block any investigation into conflicts of interests (the antivaxx movement is nowadays a flourishing industry of quackery), other activities of the author that would undermine confidence in the article's content, and the fact the author lied to the editor, and offered the explanation only in retrospect when the scam had been uncovered should, of course, mean that the editor should have no trust in what the author is claiming. This is a proven fraudster, and should be treated as such. Just as authors lying about ethics approval should have their papers taken out, authors who lie about other things of relevance to the evaluation and assessment of the research have their papers removed. As Ottersen says in his second blog post: an editor of an ethics journal should know this. The editorial board of the journal should immediately and strongly recommend its editor, who has obviously let his personal prestige lead him astray in this matter, to revise his position and act according to the high publication ethical standards expected of a bioethics journal that aspires to be well regarded.

Let me, lastly, comment on the possible need for author anonymity for research articles. The afterconstructed reason brough forward by the fake author and that Jesani surprisingly buys, is the idea that is often practices within news reporting. Where, eg., a newspaper may protect sources by keeping them confidential. However, that also means that whatever story is built on this, needs to present suffient additional public evidence, that is open for scrutiny, in order to compensate for the loss of control following source anonymity. This has not taken place in the case of the fraudulent article. Also, the whole spinn about author/source confidentiality is obviously a lie in the present case: Had the author had any such plan, he/she would have honestly and openly contacted the IJME editor about it, and Jesani could have pondered - bringing in the editorial board - the issue. Had they decided to approve such a request, this would have brought with it extraordinarily strong obligations to check the author credibility, CoI, etc. This is not what occurred, however. What occurred is that a con-man defrauded the journal, and the journal editor then decides, against any common sense, to trust said con-man. Unbelievable!

****

On the "One State Solution" to the Israel-Palestine Conflict

noreply@blogger.com (Christian Munthe) — Sat, 16 Dec 2017 12:59:00 +0000

Since the Oslo Accords of 1993 and 1995 initiated what has become known as the "Oslo Process", the recognised vision of how to resolve the longstanding violent conflict between the state of Israel and Palestinian representatives, organisations and people have been the so-called Two State Solution, where the state of Israel is to mostly withdraw to its original 1947 borders, and a state of Palestine reign over the remaining territory of what used to be the British colonial "protectorate" of Palestine. This resulted in the creation of the Palestinian Authority reign over the Westbank and Gaza territories, pending final negotiations about nation state borders, which have never so far taken place. In the meantime Israeli seizure of Palestinian property and land, and colonial settlements in occupied territory have continued, as have violent rhetoric and activities both within the Palestinian territories (since the militant islamist Hamas movement seized power over Gaza and effectively put a stop to democracy there), and between the Israeli army and various militias and activists from the Palestinian side. Of course, mostly with the result of massive domination and show of force from the Israeli side, to the repeated disbenefit of people living in the areas, especially the blockaded Gaza strip. Very recently, some initiatives from Hamas has signaled attempts to overcome the infighting with the Palestinian Authority, but so far with no notable political result. Even more recently, US president Donald Trump stumbled into the conflict in the rogue elephant manner he has made himself known for and designated Jerusalem from now on to be the recognised capital of Israel, albeit the US (or the UN) does not recognise the territory where Jerusalem is located as part of Israeli territory, but as occupied land. Not surprisingly, this gave rise to a new wave of violence from military, militants and activists on both sides. The idea of the two state solution seems less politically realistic than it has ever done.

Against this background, a number of debaters have suggested an alternative idea, The One State Solution, which to a lot of people makes a lot more sense than the fiasco and resulting mayhem that has been going on since the creation of the state of Israel in 1947. This idea, simply put, is that all of the territory currently contested is made into one single state, that this state is made ethnically unaligned (abolishing ideas about a Jewish or Palestinian homeland), democratic, and secular, and that a deal is struck on the question of how people in various forms of exile may return (or not return) to the area to settle. One idea would here be to allow Palestinians housed in refugee camps, e.g., in Syria and Lebanon, since generations a "law of return", just as the present state of Israel allows a "law of return" for Jews who can prove appropriate lineage. Another notion is to stop the current Israeli practice, and to instate normal migration laws based on ethnically and religiously neutral criteria. All who discuss this idea recognise that no such deal will be satisfying chauvinists and extremists on either side, as it means abolishing the notions of a "Jewish", a "Muslim" or "Islamic", a "Palestinian", an "Arab", etc. state. Nevertheless, having one state, with one administration, one judicial apparatus, one police force and one military, will be in a better position to control such elements than in the current state of a nasty mix of virtual anarchy and martial law, where extremist on both sides continue to perpetuate a state of chaos and violence to no benefit for most people on either side. Some examples of proponents and critics of this idea can be found here, here, here, here.

However, the practical way towards a one state solution is making a lot of people uneasy, as it necessitates breaking with some cherished ideas and longstanding practical solutions. The most obvious way to instigate the one state solution is for the current state of Israel to simply annex the territory it presently illegally occupies; the West Bank, Gaza and Jerusalem. Thereby, these areas are declared to be parts of the state of Israel, its settlers are recognised as Israeli citizens, with the same rights and obligations as any other current Israeli citizen. Those who want to hold on to ethnic or religious chauvinist political ideas don't like this, of course. Besides the obvious dissatisfaction from islamist camps (such as Hamas), there is also a lot of Israeli orthodox chauvinists and rightwing politicians, who quite like the present situation of occupation, as it allows the military to rule with martial law style arbitrary discretion. The whole Jewish settlement and land grabbing operation pretty much rests on this situation of (lack of) law enforcement. That, by itself, should be excellent reason for reasonable people to like the one state solution. But also many people of this sort I have talked to hesitate to support the one state road ahead, and I have heard two reasons for this: First, the fear of enlarged interstate military conflict though having surrounding countries interpret the move as hostile and react accordingly. This is an important point, but this risk is present also – if not more – with the current two state debacle. Whatever solution for the Israel-Palestine conflict is reached needs to contain agreements with neighbouring countries in the region that guarantee sustainable, stable and peaceful conditions for all.

The second reason for hesitation is a distrust of the current state of Israel's ability to maintain itself as the kind of democratic, ethnically neutral and secular state, committed to rule of law and equal treatment, that is necessary for the one state solution to function. This reason, in contrast to the first one, is a game changer issue. This since it will force the state of Israel – and its present government – to finally put down its foot with regard to its political identity. With the one state solution, either Israel takes the consequences, and abolishes all notions of ethnic or religious identity as its basis, or it will have to abolish its often held out liberal democratic aura and turn itself into a bona fide apartheid state within its own lawful borders (in contrast to the virtual apartheid currently practiced via the partition into "real" Israel and occupied territories). Likewise, should citizens of Palestinian origin reach political power in the new one state of Israel/Palestine, they will face a similar choice between maintaining the ethnically neutral and secular democratic solution of a one state Israel/Palestine, or pursuing the islamist/Palestinianchauvinist agenda lurking within the notion of this territory "belonging to" a certain "people", thereby promoting their own apartheid solution. That is, the very same basic notion that drives the Jewish chauvinist notion of present day Israel, only with another "people" as the supposedly chosen one. Both, of course, can only lead to genocide, should they prevail.

This, I suggest, is what makes the one state solution both very scary for many people, and at the same time immensely attractive. It is the best solution under ideal conditions, but given the still apparently strong commitment of dominant parties involved to ethnic/religious chauvinism, and the infantile notion of a possibility to "win" over the opposing side, it may seem politically infeasible. At the same time, the alternatives of continued anarchy and war or one or the other version of genocide are hardly more appealing. I'm torn.

***

Increasing Critical Questions Amid Mexican Mitochondrial Replacement Therapy Experiment

noreply@blogger.com (Christian Munthe) — Mon, 21 Aug 2017 15:10:00 +0000

Mitchondrial Replacement Therapy (MRT) – sometimes referred to with its headline name "Three Parent Babies" – is an innovative, in humans yet unproven, reproductive genetic technology, by which it is hoped that a more effective avoidance of having children with severe mitochondrial hereditary disease (as a rule extremely severe, untreatable and lethal). MRT is controversial both as assisted reproductive technologies are controversial, primarily among certain religious groups, and because it is the first example of hereditary genetic modification of human beings – so-called germline genetic modification – that has been seriously contemplated. A nice summary of the scientific and ethical complexities involved can be found here. The last couple of years, ethical, legal and scientific debate about whether or not human trials of this experimental technique should be allowed has surged, and special legal provisions have been created for this purpose in the U.K., as well as some US states. However, the leading reproductive researchers in the UK and US just stepping up to make an opportunity out of this new legal room were quickly overtaken by the less prominent colleague of Dr. John Zhang, from a US private fertility clinic, who almost a year ago reported a human MRT experiment conducted at a Mexican clinic in order to duck US regulatory oversight.

Already from the start, ethical and regulatory questionmarks have surrounded this experiment. First, objections have been raised about the ethics of Dr. Zhang to create MRT embryos in the US to then be moved to foreign soil in order to circumvent US regulatory frameworks and scientific guidelines for MRT. Second, while Dr. Zhang had described why Mexico was chosen as the country to host the experiment by claiming that “there are no rules” regarding MRT there, subsequent legal analysis by my bioethics scholarly colleagues César Palacios Gonzalez and María de Jesús Medina Arellano has revealed that the experiment very likely breached a number of Mexican legal statutes related to research and reproductive medicine. A popular presentation of this finding can be accessed here.

In the meantime, the US Food and Drug Administration, yes, the mighty FDA, has apparently been silently probing the matter with regard to Dr. Zangh's relationship to US federal law. For just a few days ago, Mary A. Malarkey, Director of the FDA's Office of Compliance and Biologics Quality, sent a briskly phrased (to say the least) official letter to Dr. Zhang, enumerating a number of US federal legal violations allegedly involved in the Mexico MRT adventure. I have uploaded the letter to to Google and made it available for anyone to view and share, here. Among the allegations made in this letter are the following:

... you are using MRT to form a genetically modified embryo, which is subject to FDA’s regulations with respect to human cells, tissues, or cellular or tissue based products (HCT/Ps) under 21 CFR Part 1271, issued under authority of section 361 of the Public Health Service Act (PHS Act [42 U.S.C. 264]). HCT/Ps that do not meet all of the criteria in 21 CFR 1271.10(a) and do not qualify for any exceptions in section 1271.15, are subject to additional regulation, including appropriate premarket review.

The genetically modified embryo that you formed using MRT does not meet all the criteria in 21 CFR 1271.10(a) and does not qualify for any exceptions. /... /

[The HCT/P is] also regulated as a drug as defined under section 201(g) of the Federal Food, Drug, and Cosmetic Act (FD&C Act) [21 U.S.C. 321(g)], and a biological product as defined in section 351(i) of the PHS Act [42 U.S.C. 262(i). Specifically, your processing constitutes more than minimal manipulation of cells or nonstructural tissues, as defined in 21 CFR 1271(f)(2)

To lawfully market a drug that is also a biologic, a valid biologics license must be in effect [42 U.S.C. 262(a)]. Such licenses are issued only after a demonstration of safety, purity, and potency. While in the development stage, such biological drugs may be distributed for clinical use in humans only if the sponsor has an IND application in effect as specified by FDA regulations (21 U.S.C. 355(i); 42 U.S.C. 262(a)(3); 21 CFR Part 312). The MRT-produced HCT/P is not the subject of an approved biologics license application (BLA) nor is there an IND in effect. / ... /

Nor is exportation permitted unless it meets the requirements of an applicable export exemption.

/ ... / your export at issue here did not meet the requirements of any of these export exemptions. / ... /

The Director signs off by noting:

This letter is not intended to be an all-inclusive list of violations. It is your responsibility to ensure full compliance with the FD&C Act and the PHS Act and their implementing regulations.

We request that you notify this office, in writing, of the steps you have taken or will take to address the violation noted above and to prevent recurrence.

While I am cautiously positive to having well-regulated legal room for MRT trials, I have to say I found Dr. Zhang's maverick action very ill-conceived from the start. While the experiment has been subsequently reported scientifically, it is not part of any controlled and planned experimental series that could contribute to the formation of a solid body of scientific evidence to either substantiate or rebut the hypothesis that MRT is a viable medical procedure. Nor was it done in response to any sort of dire medical need, but solely as an attempt to overcome efficiency problems in IVF, thereby lacking any of the ethical justification usually cited as the main reason to allow for human MRT trials. Moreover, as there was no research ethical review, no check has been applied to the consent procedure, making it very likely that the couple who were the patients have been exposed to what is known as the therapeutic misconception. Therefore, the experiment brings to mind the sorry tale of what has become of the once red-hot scientific field of stem cell therapy, nowadays mostly ruined and disreputed by gung-ho experimenters and unchecked, semi-fraudulent commercial operations preying on vulnerable people's desperation in a hunt for money and personal glory. If germ-line gene therapy is to be allowed and able to develop out of MRT experiments, it has to proceed within a very rigid and tight oversight, both scientifically and ethically. Stunts like the one of Dr. Zhang constitute a threat to that. Therefore, I'm very pleased to see FDA yank whatever legal leash it has as hard as it can, and I hope the scientific community will do the same. As a first step, a retraction of the article in Reproductive Biomedicine Online due to false statements regarding ethical and legal status of the reported trial may be in order?
***

Registration Open for Our Free of Charge Symposium on Ethics and Antibiotic Resistance!

noreply@blogger.com (Christian Munthe) — Sun, 04 Jun 2017 13:50:00 +0000

As I reported before, the Centre for Antibiotic Resistance Research, CARe, at the University of Gothenburg, is organising a free of charge symposium this fall on the theme of Ethics and Value Challenges in Antibiotic Resistance Management, Policy and Research.

Participation is free and open to professionals, officials, policy makers, researchers and interested members of the public, but requires pre-registration. Get more information and sign up here.

Taking place November 15-16, this is a unique opportunity for anyone interested in the topic of antibiotic resistance to learn from and interact with world-leading researchers in this area, representing disciplines such as bioethics, law, medicine, philosophy and public health, including Michael Selgelid, Clare Chandler, Marcel Verweij, Alena Buyx, Jonathan Anomaly, Steven J. Hoffman, Julian Savulescu, Otto Cars, and others.

Below is a flyer for the event - please share it as much as you like!

Save the date! Symposium on Ethics and Value Challenges in Antibiotic Resistance Management, Policy and Research, November 15-16, 2017

noreply@blogger.com (Christian Munthe) — Wed, 08 Mar 2017 17:02:00 +0000

Ethics and Value Challenges in Antibiotic Resistance Management, Policy and Research, symposium in Gothenburg, November 15-16, 2017. Save the date!

The World Health Organization identifies antibiotic resistance as a global challenge so serious that it threatens the fundamental achievement of modern medicine. Ethics and value conflicts are at the centre of this challenge: understanding its nature and stakes, identifying adequate social responses, understanding why policies and actions can be more or less accepted by stakeholders. Underlying issues regard conflict between individual interests and long term interests of society; as well as national as opposed to global societal interests in the short- and long term, how to manage the distribution of benefits and burdens coming out of efforts to mitigate further resistance development and managing consequences of established resistance, and responsibly balancing uncertainty in the face of major public health threats.

The Centre for Antibiotic Resistance Research (CARe) at the University of Gothenburg started in 2016 as a cross disciplinary hub for research, education and public outreach across six faculties, including collaboration with societal and private actors. More information about CARe is found here: http://care.gu.se

The original CARe team at its inaugural conference in April 12016

Now CARe presents a 2 day symposium on the theme of Ethics and Value Challenges in Antibiotic Resistance Management, Policy and Research, November 15-16, 2017. This symposium will house up to 300 participants, and assemble internationally excellent keynote presenters in ethics, law, public health and related areas engaged on this topic – including leaders of recently started major research projects– from Australia, Canada, the Netherlands, Germany, Sweden, the United Kingdom, and the USA (see program below). The conference is open and free of charge, but will require pre-registration, details of how to register will follow.

Preliminary program (all speakers confirmed):

DAY 1

Otto Cars (Uppsala University): Global political response to the antiobiotic resistance challenge

Michael J. Selgelid (Monash University and WHO): Ethics and value challenges created by antibiotic resistance: a roadmap

Marcel Verweij (Wagenigen University): What is responsible care for ABR carriers?

Clare Chandler (London School of Hygiene & Tropical Medicine): What is care in the wake of antibiotics? Experiences of global health in low resource settings.

Michael Millar (Queen Mary University of London): Antibiotic resistance: a threat to capability security

Jonathan Anomaly (UNC Chapel Hill & Duke University): Antibiotic resistance is a public goods problem

DAY 2

Julian Savulescu (University of Oxford): Collective responsibility and its ethical implication related to ABR

Steven J. Hoffman (University of Ottawa): What is required of effective legal mechanisms in the ABR area?

Jasper Littmann (Robert Koch Institute): Institutional ethics when responding to global security threats, such as ABR

Alena Buyx (Christian-Albrechts University of Kiel): How should policy makers, business and professional practitioners think about the ethical aspects of ABR management?

Christian Munthe (University of Gothenburg): Do we have reason to adjust standard precautionary rules for introduction of new interventions and methods in ABR policy and other public health emergency settings?

Sverker Jagers (University of Gothenburg): The role of public trust to balance ethics and effectiveness in the implementation of global political action

Organizers: Joakim Larsson (director of CARe), Christian Munthe (PI for ethics in CARe), and the CARe steering committee.

Independent Science Journalist Who Exposes Research Fraud, Ethics Breaches & Corruption Threatened by Lawsuits: Here's How You Can support Him!

noreply@blogger.com (Christian Munthe) — Tue, 28 Feb 2017 13:51:00 +0000

As I have been reporting before, no holds barred independent German science journalist Leonid Schneider, who runs the blog For Better Science to expose and call out science fraud, ethics breaches and general scientific hype and institutional corruption, particularly in the life and medical sciences, has recently been hit by civil lawsuits to silence his reporting. Besides the couple of Thorsten and Heike Walles, another exposed former Paolo Macchiarini associate and likely co-fraudster and ethics villain, Philipp Jungebluth, is now also suing Schneider for libel. In both cases, court injunction have already been made threatening Schneider with massive monetary fines or prison time, and he is now facing the substantive economic cost of defending himself in two separate proceedings and, if the court so decides, pay the fines and the legal costs of the plaintiffs. Note that what Schneider has been reporting is only already publicly available and proven facts, so he is not in any way slandering these people, but rather providing an important information service to universities, hospitals, research funders, and potential patients (and possible guinea pigs) of the dear doctors. Of course, the whole thing is a so-called SLAPP operation, to shut Schneider up by scaring him with the financial consequences of continuing his reporting.

To help Schneider manage through this challenge, you may first of all sign this letter of support of his reporting. If you're in such a position, you may also engage Schneider professionally. But he has also set up this crowd funding page, to help everyone who dislike science fraudsters and unethical researchers, as well as the practice of silencing important public reporting by abusing civil law, to pitch in financially. I've become a monthly "patron", but there are many options and you may chose your contribution freely, with more generous amounts providing you with a steady stream of Schneider's homemade satirical science cartoons, such as this one:

The Leadership Moral Qualities of President Donald "So-called POTUS" Trump

noreply@blogger.com (Christian Munthe) — Sat, 18 Feb 2017 14:42:00 +0000

Holders of political positions of high office, such as presidents or prime ministers, always attract controversies due to the content of rivaling political aims, agendas and visions. But one thing you would expect of any holder of such a position is that this person possess the ability to lead. For this is what such offices are ultimately about. The new US president, Donald Trump, has now been in office for some – very brief – time. Mostly these beginning days of a new US presidency – or a new cabinet in a parliamentary democracy – are ones of relative calm and ease; of settling in and attending to the formalities necessary to, thereafter, be able to rule for real and do one's best to realise whatever political program one has been elected on. Not so this time. Donald Trump has in a very short time managed to (I'm not giving any specific links here – all you need to do is to do a bit of Googling):

a) ... issue an unlawful (according to some court decisions even unconstitutional) executive order on one of his central deliveries to those who elected him: the so-called travel ban, aka Muslim ban, in spite of the fact that his closest legal adviser, the acting attorney general, had advised him against the design of the order;

b) ... fire said acting Attorney General for having done her job and extended said advise, before being forced by the legal system to back down;

c) ... attacking the federal courts that decided said order is unlawful for doing their constitutional job and applying and interpreting the law – openly mocking them as "so-called" judiciary, earning himself the epiteth of the "so-called POTUS" – rather than realising that said order needs to be redesigned to achieve legal compliance;

d) ... appointing a personal security adviser, Michael Flynn, who already from the start was heavily in question from a national security standpoint due to dodgy Russian contacts, and who then lied about that to his own administration, making himself into an even worse threat to national security, before being exposed as a liar and finally fired just a few days after his appointment, but apparently as long as two weeks after the President had been briefed about the question marks hanging over him;

e) ... apparently openly lying about this documented foreknowledge when asked by a reporter;

f) ... fire the acting Attorney General (same as b above), who – again! – had done her job, and advised the President about the national security threat posed by Flynn;

g) ... trying to surpress the unsurpressable and increasingly credible information about his campaign staff having had potentially illegal contacts with Russian intelligence agents and officer prior to his inauguration;

h) ... failing to have one of his central ministerial appointments confirmed by Congress, in spite of having a secure GOP majority in both houses;

i) ... making a number of apparently unplanned and ill thought-through international political attempts (Mexico, Russia, China, Europe, Israel, Nato, Yemen ...), which so far have only weakened the international standing of the USA due to their apparent lack of systematic strategy, and their confusing lack of grounding in the US diplomatic and international affairs ministry;

j) ... appoint a press secretary, Sean Spicer, of such questionable competence and skill that he has already managed to antagonise more or less the entire news media corps and made himself the laughing stock of the world;

k) ... apparently for this reason elevated his former campaign manager, Kellyanne Conway, to some form of unspecified advisory capacity, whose role now seems to be to second guess Spicer when he seems to be botching up 8which happens frequently), but who has already herself been caught with open lying and fabrication of facts, all of which just serves to deepen the confusion and lack of credibility of the new administration;

l) ... himself, personally!, as well antagonising and attacking the same media for criticising his actions, via Twitter or actual press conference, rather than learn from his obvious mistakes and take action to bring them onto his side. His first solo press conference is, in this respect, a stuff of legends in its exhibit of confusion, lies and complete lack of judgement – even the formerly good media dog of the GOP and alt-right, Fox News is decrying the spectacle, and counting the lies;

m) ... apparently also antagonising, rather than allying, large parts of the very federal administration that is meant to help him execute his policies, e.g., by derailing or ignoring its expert opinion and intelligence, among other things regarding all of the items above;

n) ... continued to openly and blatantly lie, and antagonise all that point this out for doing so.

Ok, so all of this in just a few weeks, and long before any real policy making has begun. Everybody know that several of Trump's central promises that got him elected will run into severe trouble in the process of making actual law, confirm the federal budget, et cetera. For a large portion of his GOP majority of course sees that several of his ideas will not be of benefit to either the American people or the Republican party – such as starting trade wars, or radically increase the federal financial deficit and lending to be able to realise the combination of the promised infrastructure and industry projects, the increased military spending in combination with decreased federal taxes. One would have supposed that the Trump inner circle knew about this, and therefore would take some care to prepare to ground well for the very real political battles that lie ahead, especially as this would mean using a period of relative calm, when new administrations are usually left comparably alone in terms of critical scrutiny. If they don't €#%+ up, that is. Which is what Donald Trump has apparently been doing from day one. But this is already clearly set out in any number of reports and commentaries available all over, and not any kind of original point of mine.

What I would like to comment on is what moral qualities of President Donald "So-called POTUS" Trump are revealed by how he has chosen to handle these early challenges, troubles and setbacks. For such qualities are, of course, central to any leader's prospect of success, both regarding central projects one is set to realise (whatever these are), and regarding one's ability of holding together whatever organisation one is set to lead in order to effect that realisation. I am thus not reviewing the moral quality of his political aims, vision or agenda, but rather how well is is equipped to lead an attempt to realise those aims, that vision and agenda.

1. Carefulness
This quality is about a leader's ability of preparing actions well – its antonym is carelessness. As related above Donald "So-called POTUS" Trump scores very low in this dimension of leadership. many of the chaotic blunders during these first few weeks could have been easily avoided by better preparation. The ability of exhibiting carefulness depends on several of the qualities listed below.

2. Wisdom
This quality is about several things, bounded together by the importance for a leader to be able to learn from mistakes, revise opinion in view of misjudgement, and design his or her administrative support to secure this ability. Well-known obstacles to the achievement of wise leadership is for a leader to surround him-/herself with advisers that are "yesmen" and/or loyal rather than competent, to be prone to assume people who object to one's propsals are conspiring, rather than carefully considering the content of criticism. So far, Donald "So-called POTUS" Trump has demonstrated very little on this front. Possibly the only sign so far is the final, at great pains, forcing out of Flynn, and the final, again at great pains, grumbling contention that, possibly, the travelban order will have to be entirely redrafted and rule of law respected after all. A wise leader would, of course, never have hired Flynn in the first place, or acted immediately on the incriminating information, and would immediately have accepted the court decision regarding the travelban, and gone back to work to do better, rather than firing the foremost adviser who had told him how the land lay and mock the same constitution that gives him the power he is so amateurishly attempting to execute.

3. Responsibility
This is about two things. First, to accept the link between power and accountability for the consequences of its wielding. Second to communicate this sense of responsibility to the surrounding world. This means not, e.g., blaming underlings for one's own mistakes (e.g., of appointing them) or ignoring their advise, or others for their predictable reactions to what one does. Again, Donald "So-called POTUS" Trump has a long way to go to even approach the minimal standard of a half-decent leader.

4. Perspective
This is the ability to assume and see the reason of the points of views of others, as well as be able to think strategically and long-term, acknowledging the complexities of an heterogeneous world. This could, for instance, imply accepting some adaption to opponents' and critics' points of view in order to realise larger objectives further on, or to think once or twice about how other around you might respond when you threaten them. As a case in point on both fronts, while Trump may very well chose to tax Mexican imports to pay for the so-called border wall that Trump has promised to build (as he has hinted that he plans), this will, of course, have an effect on the consumption of said goods, undermining the revenue in question, while at the same time it is predictable that Mexico can easily offset the damage by taxing US imports to a similar degree to offset the damage. As there's a more or less 50/50 import/export trade relationship between the two countries, the netto effect would mainly be a shrunken economy on both sides, and it would seem that the Trump threat has pretty much nothing going for it, unless one fails to think two or three steps ahead. Donald "So-called POTUS" Trump once again fails to exhibit such qualities,

5. Restraint
This is basically about keeping one's cool in the face of opposition and complications. To keep a clear mind in order to be able to realise one's plans, to forestall opposition to read one's hand, to avoid unnecessarily antagonising those with which one may in the future be forced to attempt negotiation and compromise, and to secure a basic understanding and respect also of those who have a critical stance to one's attempts (such as the press). Above, I didn't even mentioned specifically the Twitter activity that Donald "So-called POTUS" Trump, I may add that now, to underscore how magnificently he is failing also on this point.

6. Effectiveness
Now, a leader who is lacking in any of the qualities 1-5, may be excused if he/she, as the saying goes, gets the job done. The problem is that Donald "So-called POTUS" Trump is not, and to a great extent due to his very lack of the moral qualities needed for great leadership. As mentioned, so far, all of the circus created has been far from any real policy making challenge – it's been about the elementary preparations for those. And Donald "So-called POTUS" Trump isn't even able to pull that off. Partly because of this failure, partly because of the lack of qualities 1-5 so far demonstrated, it is highly unlikely that he will be able to realise any of his rather ambitious campaign promises, although there will, of course, be an expected policy swing to the right – with known negative consequences for the core supporter groups of Trump. Where that will leave US politics four years from now is not an entirely comfortable thought.

***

Attend our summer school on the Ethics of Family in Health- and Social Care!

noreply@blogger.com (Christian Munthe) — Thu, 05 Jan 2017 12:00:00 +0000

One of my commitments is as active member and member of the steering group of an international network on family ethics research, headed by Marian Verkerk, Professor Ethics of Care of the University Medical Centre Groningen. The network has a forthcoming volume (to which I contribute two sections), edited by Marian, Hilde Lindemann and Janice McLaughlin, on Oxford University Press, with the preliminary title Where Families and Health Care Meet.

Another output is a new summer school, organised by the UMCG, on the broad topic of ethical complications and issues in health and social care due to various aspects of family and how patients and clients, as well as professionals, are inescapably embedded in webs of close personal relationships and the fact that society and institutions are all built on assumptions of such webs being in existence. The course is open to masters as well as PhD students and goes under the heading of What About the Family? Besides myself and Marian, the featured speakers/tutors include Ulrik Kihlbom (Uppsala University), Hilde Lindemann, Jamie Nelson (both Michigan State University), Veerle Provoost (University of Ghent), Jackie Leach Scully, Simon Woods (both Newcastle University) and Kristin Zeiler (Linköping University), and others yet to be confirmed members of our network from the universities of Göttingen and Lübeck.

Here is the course webpage. Below is a 2 page flyer that you are more than welcome to share in your networks and with whoever you think maybe interested. Hope to see you in Groningen in August!

***

Remembering Derek Parfit

noreply@blogger.com (Christian Munthe) — Thu, 05 Jan 2017 10:50:00 +0000

Unexpectedly, Derek Parfit died on new year's day 2017, an event sending shock-waves throughout the global philosophy community, as he was no more than 74 years old. For you who don't know who he was, it can be summed up in terms of the most important moral philosopher of the 20th and, so far, the 21th century. With his book Reasons and Persons (Oxford UP, 1984), he single-handedly redrew the intellectual maps of normative ethics, philosophy of action and rationality, value theory and existential philosophy, partly by making intriguing revelations of how they interconnect, and demonstrating puzzles and challenges coming out of that, which a lion's share of the philosophy world is still grappling with in one way or the other. He followed that up with the monumental On What Matters, of which two volumes have been published and a third is rumoured to be on its way later this year. In 2014 Parfit was awarded the Rolf Schock Prize in Logic and Philosophy, which I celebrated with this little parody piece of his distinctive writing style.

There's already a fair portion of good in memoriam pieces out there, featuring personal reminiscence, summaries of his life and works, as well as links to videos of his lectures. A nice listing can be found on Harvard University's (one of the top institutions to which Parfit was linked) memorial webpage.

I never had the pleasure of meeting Derek Parfit in person (and many bear witness of that this would indeed have been a pleasure), but his philosophical work has had a large impact on my own philosophical explorations, for what they're worth. When I started to attend the "higher seminar" in practical philosophy at Stockholm University in 1985, Reasons and Persons was on the reading list for a full term, and the seniors took turns introducing the different parts, sucking me and the other "youngsters" into sophisticated philosophical reasoning and argument on a level way above what we had ever experienced before. I choose, as a consequence, to write my B.A. thesis on a few pages of part 2 of the book, where Parfit defends what he calls the "Critical present aim theory" of practical reason or rational action, according to which certain individual desires may be irrational in themselves due to their very content. I was critical of Parfit's way of supporting "CP", as I found it putting the cart before the horse by invoking what to me looked like a fundamental moral conviction (that it's not justified to prefer suffering just because it occurs on certain weekdays) as its basis, which would be problematic in a question begging manner given Parfit's aim of using CP to support the idea of objective moral truths. But this was more importantly a formative experience of how well made philosophy will always be open to questioning if only you work hard enough on understanding its details – gaps for criticism are only absent when the work is marked by obscurity and ambiguity, and therefore you should never fear obvious openings for disagreement in your own work, they are unavoidable. Later, I wrote my Ph.D. thesis on the morality of abortion (in Swedish), and there both the discussion of personal identity over time, and (more importantly) the moral importance of future people came to provide very important input. These aspects of his work then continued to have an impact of my later work in bioethics, e.g., on embryo research, reproductive ethics and gene technology. Later, Parfit's musings over problems of collective action, value aggregation and the pragmatics of applying ethical theories in practice (part 1 of Reasons and Persons) added important context and basis for my contributions to public health ethics and the ethics of risk and precaution.

Now, it should be underlined, that Parfit's influence has never been that of a prophet – someone's whose teachings one accepts and then spends one's life as a follower of, working out the details with the assumption that the master's words must never be doubted. Parfit's strength was never the thesis, but the argument and its analysis – often leading to initially apparently clear positions falling apart into zillion variants, each of which in need of their own little set of arguments. When he pursued a substantive thesis, I often disagreed with him, albeit acknowledging much of the analytical landscape created to reach it. Parfit was a philosopher who ingeniously created intellectual context and complication for others to freely move about within. In that way, much of whatever I have ever managed to contribute to my own little corners of the vast world of philosophy wouldn't have been there for the picking, had it not been for the context of problematisation and complexity provided through Parfit's prior achievements. This, I'm convinced, is true of a great many other currently active philosophers as well. And I believe that this will continue to be the case for a fair amount of time ahead.

***

German Macchiarini-linked researchers Thorsten and Heike Walles bully blogger with libel threats to surpress information about their apparently irregular experimental transplant surgery

noreply@blogger.com (Christian Munthe) — Wed, 04 Jan 2017 13:11:00 +0000

As you may imagine, the research ethical and misconduct scandal around Paolo Macchiarini's surgical experiments at the Karolinska Institutet (a radio summary is here, text ones are here and here) has been a big deal for anyone engaged in bio- and research ethics in Sweden the past year. But not only here, as Macchiarini has had many international links and seemingly hopped between employers and affiliations all over the place for many years, where he has inspired others to work with similar techniques as himself.

Now, some of these people and institutions apparently do all they can to wash their hands free of any Macchiarini-stains, attempting to suppress and silence any public mention of the past associations and stall potential inquiries, especially to impede them to stimulate big news media to take an interest. Possibly for short-sighted reasons of protecting reputation, but possibly also for the reason of preventing more in-depth investigations of research ethical breach, possible scientific misconduct or, as has happened in the Macchiarini case, violent crime. Actions taken usually include unwillingness to share relevant documentation with external inquirers, or refusal to answer their queries, thus undermining the basis for objective public reporting. Lately, however, some have escalated to aggressive legal actions against inquirers, in order to threat them with financial damage to have them stop reporting and even to withdraw already published material. The rationale of such actions is, of course, not to establish wrongdoing or actual libel (that would take years of legal procedure all the way up to the European court of human rights), but to strategically use the law to construct a financial threat that already at the preliminary investigation and hearing phase undermines the practical possibility of further critical inquiry, as the very economic cost of the legal process itself (regardless of its outcome) will often be impossible to bear for independent inquirers. This, of course, adds to the reason of the tainted researcher to have the tooth paste back into the tube before Big Media gets a whiff, as those would have the financial muscle not to be liable to these kinds of bullying tactics.

Photo source: https://www.uni-wuerzburg.de/sonstiges/meldungen/einblick_vorschau/single/artikel/lesung-pi/

A recent example is the German team of Thorsten Walles and Heike Walles (formerly Mertsching) at the university hospital of Wurzbürg, who have recently taken action against critical science blogger Leonid Schneider, who runs the blog For Better Science. Citing their fundamental legal right to be able to freely use their talents ( ≈ pursuit of happiness) – in this case meaning, having successful scientific careers, being able to have better salary, accrue research funds, get new jobs, etc. – they have demanded that Schneider stops reporting about their past experimental trachea transplants, and also won an emergency court injunction that threatens Schneider with jail unless he removes a section of a Macchiarini-report, where the link to the Walles-team is made explicit, and to pay the legal fees for the process leading up to this result. The court order has been made without any hearing of Schneider's side of things, and this is apparently (possibly) OK under German civil law, as he has the right to appeal (provided he can raise the money to pay a lawyer). Schneider has, of course, accepted the injunction and removed the paragraph awaiting an appeal, as can be viewed in this updated version of the original post (linked above), with the relevant section as screenshot here (double click to enlarge):

The original section (cashed here) looked like this (the removed paragraph highlighted by me):

The action has been discussed extensively in a Twitter thread, to be found here. There, among other things, it is made clear that the Walles trachea surgery experiments – like those of Macchiarini – have been retrospectively found to be against European regulation. Moreover, it seems that the information that the Walles so desperately want to be removed from public view is essentially already available for any curious German, through the book Patient meines Lebens – Von Ärzten, die alles wagen by prized journalist Bernard Albrecht, cited by Schneider in his blog post.

I can, of course, acknowledge the vested self-interest of the Walles to suppress publicity around their past Macchiarini-association, and the fact that they apparently have performed very similar type of irregular trachea surgery experiments as he did at the Karolinska. However, it is clear that there is an overwhelming public interest of having this information publicly available – not only in Germany, but internationally; for potential employers, funders and – not least – patients, who have every right to avoid the risk of consulting a doctor that may make them into guinea pigs in irregular experiments.

Had the Walles acted out of honest and honourabe scientific and medical professional motives, they would, of course, have seen to this themselves long ago, initiating and welcoming transparent inquiries and press reporting the very minute that the Macchiarini scandal emerged. Instead, they have done their best to blinker the public and has, ultimately, resorted to petty threats against those trying to make public the professional actions for which they are, without doubt, responsible and which there is an overwhelming public interest in having open to public view. This course of action, especially the court order to Schneider to censor his past posts, makes it highly likely that this is the path they will continue to thread. Leonid Schneider will undoubtedly do his best to fight back, but as the basis here is financial muscle, not moral or legal righteousness, it is unlikely that he will be able to (afford to) prevail, and the Walles of course know this. Here are the actions those who disapprove of this development can take to make their dishonourable actions moot:

1. Continuously report in social media about the Walles' legal bullying of Schneider (and others), taking every piece of news about the processes as a reason to recite the details of their Macchiarini-association, their experimental surgeries, etc., thus keeping this information in the public domain.

2. Link to existing cashed versions of the original reports. However, it is likely that the Walles will take action to have these scrubbed, so therefore it is also desirable to:

3. Reposting the original, uncensured blog posts on public Google+ and other pages, blogs, etc. I have done so here (uncensured Macchiarini post), and here (detailed post on the Walles history of human experimentation).

CROSSPOST: Untangling forgotten tracheal transplants of Heike and Thorsten Walles, who set a lawyer upon me

noreply@blogger.com (Christian Munthe) — Wed, 04 Jan 2017 13:01:00 +0000

This is a crosspost of the original, uncensored version of a post relating facts and developments related to past surgical human experiments by the German researchers Thorsten Walles and Heike Walles, linked to scandal surgeon Paolo Macchiarini, from the For Better Science blog. The crosspost has been prompted by legal threats having forced Leonid Schneider to remove relevant details regarding the German researcher team from another post, making it likely that such claims will be extended also to the article here crossposted. More details and background on how I view this development can be found here.

A similar crosspost has been made of the For Better Science post on Macchiarini that the Walles have already managed to bully Schneider into censoring, and is available here.

*** BEGINNING OF CROSSPOST (All of this is citation, of the original version of this post by Leonid Schneider):

This is the story of three tracheal transplants, performed by the husband and wife team Thorsten Walles and Heike Mertsching (now Walles), former collaborators of Paolo Macchiarini. My investigation quickly led to the Walles couple setting their lawyer on me, demanding almost €3000 immediately and up to €100,000 later. All because of a single short paragraph from this Macchiarini story, which mentioned their earlier activities. None of their current or former employers nor their lawyer chose to share any specific information about the 3 tracheal transplants, and the fate of these 3 patients.
Macchiarini and the Walleses started their tracheal transplant activities at the Medical University Hannover (MHH), under the regenerative medicine enthusiast Axel Haverich. Together, the team implanted in 2003 a tracheal patch into a cancer patient using a piece of pig intestine, and moved their separate ways soon afterwards. Macchiarini went in 2004 to Barcelona, where he had his famous trachea transplant breakthrough in 2008 (see my report here). The Walles couple went in the same year to Stuttgart in southern Germany. The thorax surgeon Thorsten to the Robert Bosch Hospital, Clinic Schillerhöhe, the regenerative medicine-specialising biologist Heike (back then carrying the name of her previous husband, Mertsching) became professor at the Fraunhofer Institute for Interfacial Engineering and Biotechnology (Fraunhofer IGB). There, the husband and wife team transplanted between 2007 and 2009 two more patients with tracheal replacements made from pig intestine. The clinical success and the actual performance of these transplants is unclear, it is also not helpful that authors chose to omit certain key aspects when the two cases were eventually published.

The bill I received from Walles’ lawyer , with threat of up to €100,000 more to come

Heike Walles developed at her Fraunhofer Institute a technology to grow any kind of tissues and even organs in her high-tech safety bioreactors: skin, liver, intestine, bone and of course the trachea, all according to this scientist and her husband, with its own bioreactor-grown vasculature. This is how the technology works, according to Thorsten Walles as posted on ResearchGate:

“We developed a bioartificial tissue (TraVaSc-TERM ®) for the surgical reconstruction of extensive tracheo-bronchial defects including circumferent airway replacement. The tissue is generated from a xenogene biological scaffold [pig intestine, -LS] that is decellularized, preserving the structure of the vascular network. For transplant generation, these vascular structures are reseeded with autologous endothelial precursor cells of the recipient. Two more autologous cell types are needed to generate a functional airway substitute. Our approach results in a vascularized autologous transplant tissue that can be connected to the recipient’s blood supply at time of implantation to guarantee transplant survival. Tissue generation takes about five weeks. The TraVaSc-TERM ® was applied successfully in three patients between 2006 and 2009 [actually, it seems one patient was counted as two, -LS]. As a result of the ATMP-legislation in Europe the TraVaSc-TERM ®-generation process had to be transferred from an F&E environment into GMP. This task was finished in 2015 and we wait for regulatory approval”.

After her 3 allegedly successful tracheal transplants, Heike Walles became a member of the German Ethics Council (Ethikrat) In June 2010 and served the nation by safeguarding patient protection and medical ethics in Germany until September 2012. Mightily impressed by her research achievements, the federal state of Bavaria dumped in 2014 €10 Million over Heike Walles and invited her to head the new translational centre for “Regenerative Therapies for Oncology and Musculoskeletal Diseases” in Würzburg. The new director remained affiliated with her Fraunhofer institute, but additionally became in August 2009 professor at the University Clinic Würzburg. Her husband Thorsten received a professorship at the same place in January 2012. There, the couple began to collaborate with the technology giant Siemens and are apparently almost ready to churn out tissues and organs to save hundreds of patients, based on their previous success stories. As Walles’ co-worker Jan Hansmann from Fraunhofer declared in Siemens-magazine article from September 2016:

“Hansmann describes one of the major successes of tissue engineering in Würzburg: “Working with the University Hospital and the Robert Bosch Hospital, we recently produced a complete section of a human windpipe in the bioreactor and successfully implanted it into a very seriously ill patient as part of a ‘compassionate use’ program.” In fact, no other research group in the world has to date produced such a complex biological implant”.

Silent night

The case of that and other two tracheal transplants was very tangled. At points, my perception was that the publicly owned German research institutions deliberately wanted me to follow false leads I picked up on internet, in order to discredit my reporting. Indeed, the fact that the Walleses used their official University Clinic Würzburg affiliations in the lawyer’s letter suggests an involvement of their employer, who received (but never really answered) my questions 2 weeks before my previous article appeared. That would be indeed an interesting new way for a German university to react to a blogger’s inquiry.
The current Walles employers, University of Würzburg and the Fraunhofer Institute for Interfacial Engineering and Biotechnology (Fraunhofer IGB) chose not to share any useful information with me. Würzburg categorically denied their University Clinic’s involvement in the operation described by Hansmann above, Siemens magazine refused to explain and Hansmann never replied to my email. Thorsten Walles’ former boss, head of thorax surgery at Schillerhöhe Clinic in Stuttgart, Godehard Friedel, who co-developed the technology, forwarded my email to his PR spokesperson, who refused to share any information citing protection of patient privacy. Thus, no thanks at all go to them. In the end however, I think I could reconstruct the three trachea transplants made by the Walles couple quite truthfully.
It got that bad that the press relations offices of the Fraunhofer IGB, whose job it is to promote the institute’s research and publications, repeatedly refused to name me the papers where Walles’ three trachea transplant patients had been described. I found those anyway, and I also found out that some very important aspects have been omitted from the publications. Small issues like the suspected failure of the transplants, or these patients being long dead at the time when the papers were published.
The same Fraunhofer PR officer Claudia Vorbeck who denied me any information whatsoever, also by insisting that the federally-sponsored public research institution is exempt from Freedom of Information inquiries, authored in 2009 a press release hailing one of these Walles trachea transplants (see 3rd patient below). All I was made understand was that the Fraunhofer Institute takes enormous pride in the research of their professor Heike Walles:

“Prof. Walles develops and uses methods of tissue engineering to produce the most diverse, complex human tissues that are used for risk assessment in chemical and pharmaceutical research as well as in regenerative medicine. Prof. Walles and her team use biological carrier materials for the production of these human tissues. In the course of her research at the Fraunhofer IGB, Prof. Walles has developed a biological matrix consisting of a decellularized pig intestine as a scaffolding structure for a potential trachea implant”.

Vorbeck then added:

“The research work of Prof. Walles for the development and production of trachea grafts on a biological matrix was carried out at the Fraunhofer Institute IGB according to the requirements of the German medicinal product (https://www.gesetze-im-internet.de/amg_1976/). The authorities responsible in this context were always involved in accordance with legal requirements. These authorities also have all the necessary documents on good scientific practice, such as ethics or animal welfare applications”.

The University of Würzburg refuse to comment on anything which happened before Walleses became their professors. At least I managed to get this out, after some yanking:

“The professors Walles declare that the cooperation with Mr. P. Macchiarini ended already in early 2005. The last common publications stems from the year 2006“.

From H. Walles presentation to German Ethics Council presentation to German Ethics Council, October 2010

The first patient, or Macchiarini-led kick-off in Hannover

I reported previously about this Macchiarini operation in my article about his patients. As the local newspaper, Hannoversche Allgemeine Zeitung (HAZ) reported on September 6^th 2003, Macchiarini and the Walles couple transplanted the cancer patient Ernst Fromhage with a tracheal patch of decellurised pig intestine seeded with patient’s own muscle cells. The intervention was published as MacChiarini (sic!) et al 2004 and the method as Walles et al, 2004. Macchiarini is corresponding author on both publications and thus the principal investigator chiefly responsible for the development of that technology. However, Thorsten Walles claimed the credit in a 2009 interview for himself and his wife:

„In 2003, I specialized in thoracic surgery for my surgical training. Here, I first met patients with tracheal injuries that could not be treated anymore. I was able to convince my then-boss Paolo Macchiarini of the concept of treating such injuries with bioartificial tissues. Together we modified the procedures for the production of human bioartificial tissues for trachea transplants, originally developed by Prof. Mertsching and myself. Already in 2004 we were able to successfully treat the first patient”.

Not everyone was impressed. The famous late thorax surgery specialist Hermes Grillo took an issue with this method (Grillo, 2005):

“One must also question placement of a free graft of any tissue over an area that is still contaminated, even if not grossly infected, by the bacteria that necessarily are present in such a situation, despite all cleanup treatment before repair. More to the point, however, is the fact that defects of this sort have long been closed by vascularized pedicled autogenous tissues (omentum, pericardium, intercostal muscle, and other muscle flaps). Addition of an engineered tissue graft seems superfluous”.

Yet according to Walles, the 2003 operation on the patient Fromhage in Hannover was a success for regenerative medicine:

“The implant healed easily into the airway and there were no problems. The patient lived for 16 months a self-determined life. Unfortunately, his cancer caught up with him and he died”.

Now it makes sense why back in spring 2016 the Hannover hospital refused to share with me any information about the fate of that patient, claiming that his medical records were not available.

The second patient and his half-story

Of the second patient, a 63-year old man, we do not know the name, and we do not know exactly what kind of transplant he received. This is what the 2013 book by the German journalist Bernhard Albrecht, “Patient of My Life” in its chapter “Breathing” (see Google-Books version), tells us about Walles’ tracheal transplants:

“Twice they operated patients whose windpipes were corroded by cancer. Both did not live long after the operation. The first patient [Fromhage, operated together with Macchiarini in 2003, -LS] died on his main disease, but the second one began to question all their efforts. The artificial trachea rotted namely inside his body. The fault lied with the absence of own blood supply in the artificial tissue”.

As Walles lawyer made clear, the artificial material was not plastic, where “the blood supply does not function”, but based on a biological scaffold. But the lawyer did not specify how the capillary blood supply inside dead decellurised scaffold is supposed to succeed. Macchiarini and his partners in Spain, Italy and UK transplanted many patients with such, using decellurised donor tracheas. It seems all these transplants either rotted and collapsed or were overgrown with scar tissue, unless you trust those authors’ own claims of vascularisation and full regeneration. It would be nice to know more about Walles’ pig intestine transplant and how it fared inside that 63-year old man’s throat, but alas, this is none of public’s business apparently. There was however this very informative interview from 2009 with Thorsten Walles with the German magazine The Stem Cell (Die Stammzelle):

“Dr. Walles: The technology was ready for operation from 2007 onwards. In the same year a patient with a combined injury from the trachea and esophagus was arrived to us from another clinic. The 63-year-old has been unable to eat, drink or speak for three years. He therefore had a tracheostomy and took his food through a stomach probe, which was introduced through his nose. In the 3 years, a total of 14 surgeries were performed by the various clinics on the patient in order to close the defect. Unfortunately, all unsuccessful. A surgeon who treated this patient had heard of our new procedure and referred the patient to us.
The stem cell: And you implanted a piece of the air tube?
Dr. Walles: Not immediatedly. Due to the large defect, it was necessary to use an implant with its own vascular supply. We had never done this before in a human being and we were honestly afraid to use these new implants in the chest and risk that they would fail and cause serious complications.
The stem cell: So what did they do then?
Dr. Walles: We grew a bioartificial tissue as we needed it for the repair of the airway defect and implanted it into the left upper arm of the patient.
The stem cell: Why exactly there?
Dr. Walles: The blood vessels in the upper arm are easy to reach and do not require any major surgery. We have connected the graft to the upper arm vessels with two microsurgical vascular anastomoses. After one week we removed the transplant again and it was examined by the researchers in the Fraunhofer IGB.
The stem cell: Why?
Dr. Walles: We wanted to make sure that the artificially produced vessels work in the implant and that the transplant does not die. We have therefore clinically checked whether our implant has the function we expect at all. We also wanted to ascertain whether there were any side effects, such as, for example, inflammatory reactions occurring after rejection. We had prepared a second implant for the reconstruction of the airway and esophageal end defect, which would be ready for use 1 week after explantation of the arm implant. So we had 1 week to prove how well our technology works in humans. For this the researchers at the Fraunhofer IGB had to do night shifts. The studies showed that the transplant was fully functional even after one week. The results have now been published in the scientific journal Transplantation”.

The paper appeared as Mertsching et al 2009, but it never mentions that the one-week in-arm experiment was followed up by the actual trachea transplant into the throat. Surely that bit would have been most interesting for the worldwide community of thorax surgeons and stem cell researchers? According to Heike Walles presentation to the German Ethics Council, the transplant was “fully functional over a short period of time”.
When the Mertsching et al 2009 paper was published and when Thorsten Walles gave that interview to “The Stem Cell”, the patient had been dead for almost 2 years already. This was indirectly suggested by Heike Walles’ Ethics Council presentation, confirmed by the 2013 dissertation of her PhD student Iris Dally (page 126), as well as by a press release of the state of Baden-Württemberg from October 2008 which quoted Thorsten Walles:

“Walles does not want to rush: “We want to approach the clinical application of this method slowly.” Despite all the initial successes, transplantations are still an experimental and risky intervention. There will always be setbacks. The last patient implanted with a piece of bioartificial tissue died a few weeks after surgery as a result of unexpected complications”.

Whatever their reasons to be modest, the ground-breaking tracheal replacement operation and the ensuing unexpected demise of the patient were omitted in the Mertsching et al 2009 article. What lead to his death? In his available interviews, Thorsten Walles never mentioned anything about cancer (but the Albrecht book did, see above), only a physical injury to the trachea and oesophagus, and everyone involved refused to divulge any information. It is not clear therefore why the patient died so soon after a piece of pig intestine was inserted into his chest as his new breathing tube.

The 3^rd patient and another puzzle around the transplant

The interview in The Stem Cell is from August 2009, yet Walles does not mention his 3^rd patient, the Indian Pavninder Singh, whom he and his wife transplanted just half a year before with a “regenerated” piece of pig intestine. Not a single word. Instead, Walles speaks of new European regulations and changes in German medicinal product regulations, which stopped his big plans:

“In July 2009, we received funding from the German Federal Ministry of Education and Research (BMBF) (FKZ 0315575) to fund a clinical trial for the treatment of patients with tracheal and esophageal defects with our bioartificial transplants. First, we must provide the regulatory authorities with the information they need in order to get a manufacturer’s license at the end. Our aim is to obtain a European approval for our bioartificial tissue implants within the framework of the study”.

The trial obviously never happened, lacking approval from authorities. The Walles methodology suffered a major setback when the new German medicinal produce legislation (Arzneimittelgesetz) became officially binding on July 17^th 2009, less than three months after Walleses performed the third (and apparently last) trachea transplant. According to Albrecht book, the investigations by the authorities into suspected breach of regulations were therefore aborted.
Singh originally came to Germany illegally, but integrated quickly, married a German wife and learned German language. On December 9^th 2008, the young man in his twenties attempted suicide by swallowing oven cleaner fluid. Singh survived, but his oesophagus and trachea were damaged irreparably. He had to be saved by tracheostomy, a permanent hole in his throat. Because of his burned epiglottis, the patient had to keep an erect posture at all times to avoid stomach acid flowing into his airways and lungs. In April 27^th 2009, Singh received a tracheal transplant from the Walles couple, fashioned from pig intestine. This is how the University of Würzburg described the breakthrough achievements of their new professors:

“Thorsten Walles and his colleagues carried out the successful transplantation of the replacement trachea at the Schillerhöhe Lung Clinic in Gerlingen near Stuttgart in April 2009. The artificial organ was accepted by the body without rejection and adequately supplied with blood. Unfortunately, after this encouraging world premiere, the further development and dissemination of the procedure has been stalled due to European changes in the drug legislation”.

Now however, the PR person of the University of Würzburg, Esther Knemeyer Pereira replied to my inquiry that all three tracheal transplant operations by Walles took place before 2009, and had nothing to do with the university or its clinic. At the same time, the Würzburg professors Walles operated until 2014 a personal website “Bioartificial organs”, where patients were invited to contact Thorsten Walles at Clinic Schillerhöhe about “bioartificial implants for reconstructive thoracic surgery” (screenshots of the website here). This might explain why my inquiry if further tracheal transplants are intended in Würzburg went unanswered. Meanwhile, a legal action against me was being prepared.
What Walles or their academic employers never ever mentioned: Singh’s trachea transplant most likely did not work. Shortly after the operation, Walles re-opened the tracheostomy, the hole in the throat remained until Singh’s suicide death in December 2011. This information is only available in the Albrecht book (“the hole in his throat was his misery”), because the author met the patient personally in November 2011, shortly before Singh’s accomplished suicide:

“Why does he need the hole [tracheostomy, -LS] still? Dr. Walles initially closed it, told Singh. But then he had always been chocking, food and saliva entered the windpipe. The oven cleaner had also corroded the epiglottis in his throat. Due to heavy scarring, it did not close properly when swallowing.”

We do not know for sure if the transplant integrated as announced, but given the tracheostomy, it was unlikely to be of any use even if it did. Heike Walles declared to the Ethics Council in 2010 that the patient Singh “has no problems whatsoever”. Also her lawyer now sternly told me:

“The patient described in the book by Mr Albrecht lived self-determined life over a long period of time after the operation”.

No mention of tracheostomy, again, but the lawyer did declare that all information in the Albrecht book was correct. Thorsten Walles himself spoke in a 2014 interview (which was recently removed from the BioRegio-Stern website, backup copy here):

“We have used a method for the treatment which we have been researching on since 2000 and where we already had initial successes in the application. Since the patient wanted the treatment and we also had the impression that he can make it, we grew a trachea from the cells of his body and implanted it successfully. Unfortunately, however, this has not improved his private situation and a few years later he then took his own life”.

Asked about Singh’s suicide despite the miracle cure which allegedly restored his health, Walles elaborated:

“In the first moment, this pulled the ground from under our feet. We asked ourselves why we carried out this elaborate treatment in the first place. This experience prevented us so far from publishing our scientific results of the applied technology, because we were questioning the rationale of the treatment in this case”.

The next year however, a paper was published which described a patient case perfectly fitting that of Singh. With one exception: the patient in Steinke et al, Tissue Engineering Part A, 2015, is seemingly alive and well. Where Singh killed himself 2.5 years after the operation, his published doppelgänger was examined just after the same period and was found that he “could eat and drink normally and was also able to play soccer”. No tracheostomy was mentioned, instead:

“The early postoperative course was uneventful and the transplanted airway tissue was integrated into the host. 2.5 years after transplantation, a bronchoscopy confirmed the scar-free reconstruction of the former airway defect. Histological work-up documented respiratory airway mucosa lining the bronchial reconstruction, making it indistinguishable from native airway mucosa. After transplantation, our bioartificial airway tissue provided perfect airway healing.”

Was it indeed a biopsy as the authors report, or possibly an autopsy of a suicide victim? I tried to find out from the paper’s authors if the patient was indeed Singh. Walles’ PhD student Dally (who herself declared Singh as dead in her dissertation), threw down the phone on me, the corresponding author Maria Steinke, Chair of Tissue Engineering and Regenerative Medicine in Würzburg, did the same after telling me she is not entitled to comment. The Fraunhofer PR person Vorbeck declared to me that the responsibility for the content and correctness of the two discussed Walles publications featuring Fraunhofer affiliation lied predominantly with the clinicians who treated these patients. But not with Fraunhofer or their own scientist Heike Walles, who according to Vorbeck never performed any “human experimenting”.
In that Steinke et al, 2015 publication, the authors state that they did not replace a segment of trachea, but introduced a large pig-intestine-made patch of “membranous part of the trachea”. This is strange, all other sources (like this Spiegel magazine article from 2011, or even Fraunhofer own press release) clearly suggest a replacement of the tracheal tube, not a patch. What did the second patient receive then, the one who died so soon after the operation? The corresponding Mertsching et al 2009 paper clearly showed a tubular piece of pig intestine. Yet all information is kept secret by the Fraunhofer Institute, the Clinic Schillerhöhe and the University of Würzburg. Also the Walles lawyer does not speak of that unlucky 63-year old man at all.

Clinical trial cancelled?

A scheduled clinical trial with 5 patients, funded since July 2009 by the German Federal Ministry for Education and Research, and to be carried out at Clinic Schillerhöhe (see 2013 Dally dissertation, page 139) was apparently not approved and never performed (Heike Walles spoke of 15 patients in her Ethics Council presentation in 2010). A tragedy, certainly for the Fraunhofer Institute and their clinic partners, maybe less so for the patients.
After the hype, these alleged successes became almost forgotten. In 2010, Thorsten Walles received a Von-Langenbeck-Award of the German Surgery Society (DGCH). The press release mentions only the first patient from Hannover, the merits are shared with Heike Walles. Paolo Macchiarini, the corresponding author of that publication, is someone whom the Walleses seem to be most reluctant to be associated with, as also the lawyer’s letter made clear.

*** END OF CROSSPOST

CROSSPOST: Professor Macchiarini, because Medical University of Hannover wants it so

noreply@blogger.com (Christian Munthe) — Wed, 04 Jan 2017 12:52:00 +0000

This is a crosspost of the original, uncensured version of a post relating facts and developments related to the research ethical and scientific misconduct scandal surrounding Paolo Macchiarini from the For Better Science blog. The crosspost has been prompted by legal threats having forced Leonid Schneider to remove relevant details regarding the German researcher team Thorsten Walles and Heike Walles from the post. More details and background on how I view this development can be found here.

A similar crosspost of a For Better Science post on the specific Macchiarini-linked history of the Walles themselves can be found here.

*** BEGINNING OF CROSSPOST (All of this is citation, of the original version of this post by Leonid Schneider, fetched from this cash version):

Professor Macchiarini, because Medical University of Hannover wants it so

If these days you should bump into the miracle surgeon Paolo Macchiarini, do not just greet him with some offhand “Ciao Paolo”. But also “Hello, Doctor Macchiarini” would not be respectful enough. As a saying goes among German clinicians: you must take your time, namely by addressing the great man in full as “Professor Doctor Macchiarini”. As we know, after investigations into the deaths and mutilation of a large number of his patients, the former star of regenerative medicine was sacked from his professorship at the Swedish Karolinska Institutet (KI), so that title is now definitely gone. Macchiarini’s other professorships which he used to convincingly carry in his CV, namely those from the University of Paris in France and University of Florence in Italy, proved to be fictional (see also KI report here). However, his adjunct professorship from the Medical University of Hannover (Medizinische Hochschule Hannover, MHH) in Germany is very much real. Here for a change it is not Macchiarini who is cheating, but the German university which allows him to carry that academic title against the state’s law on adjunct professorship, which binds it to ongoing teaching duties. Fortunately, the federal state of Lower Saxony (which owns this Hannover university) doesn’t seem to mind either. In fact, their officer for data protection told me it was none of my business asking whether Professor Macchiarini had been giving any lectures at MHH in the last years.
Macchiarini was awarded the title of adjunct (ausserplanmässiger) professor by the MHH in 2001 (some background here). Using this faculty association, he was also able to bring his loyal acolyte Philipp Jungebluth to a prize-winning medical doctorate at MHH in 2010. Whatever the legal frame has been back in 2001, the higher education law (Hochschulgesetz) of the federal state of Lower Saxony stipulates in its current version from 2007, §35a, “Adjunct Professors”:

“1. Junior professors who meet the requirements of § 30 para. 4 sentence 2 and who are not employed as professors after the end of their employment are entitled to have the title “adjunct professor”, as long as they engage in student teaching. 2. Other persons who fulfill the prerequisites for professors may be awarded the title of “Adjunct Professor” for the duration of their engagement in student teaching if they prove a previous successful teaching activity of several years. 3. The details are regulated by the guidelines on habilitation”.

In a nutshell, this means MHH can only grant the adjunct professorship to Macchiarini for as long as he is teaching their students. Well, is he? The Italian surgeon departed from MHH in 2004 for Barcelona, and left behind a research project, freshly funded by the German Research Society DFG, with the title “Development of a bioartificial trachea”, part of the larger DFG-funding scheme “Lung Transplantation”, organized by his MHH clinic head, heart surgeon and founder of a large centre for “Biotechnology and Artificial Organs”(LEBAO), Axel Haverich. Apparently, the creation of artificial tracheas was carried on in Macchiarini’s absence by his LEBAO collaborators Heike Mertsching (now Walles) and her future husband Thorsten Walles. MHH’s head of press communications Stefan Zorn told me Haverich’s team aborted that research already in 2006. Apparently they did not mind receiving its DFG funding for 3 more years afterwards.
The Walles couple eventually moved to the University of Würzburg and tested their Macchiarini-co-developed method (Macchiarini et al 2004, Walles et al, 2004) on two more human patients (as reported in a book by a journalist Bernhard Albrecht). One died shortly after receiving a pig-intestine-based trachea transplant, another one (an Indian immigrant) received a piece of decellurised pig intestine, which apparently quickly failed as evidenced by re-opened tracheostoma. That patient eventually committed suicide.

Update 10.12.2016. My investigations led to a legal action of the Walles couple against myself. Details in the main story here.

So much for Macchiarini’s research at MHH after his departure. But what about his student teaching and medical activities? I was informed that Macchiarini hasn’t been visiting Germany since 2013, but this may have changed in the meanwhile, since he recently claimed to have operated patients in Germany in an interview with one of his Russian sycophants.
I placed these questions to Zorn, the PR responsible at MHH:

which courses have been offered by Prof Macchiarini at MHH since 2013?
should Prof Macchiarini not comply with his mandatory teaching obligations at the MHH, how does the MHH intend to react?
is Prof Macchiarini still clinically active at the MHH, and if not, since when?

Unfortunately, Zorn completely stopped communicating with me long ago. Most probably because I published two critical articles about the MHH’s patriarch and patron saint Haverich, who promised to grow a living heart in his lab before his upcoming retirement and whose private company developed growing heart valve transplants which Haverich’s own papers somehow failed to convincingly prove as actually growing.
Since all my previous emails to Zorn went unanswered, I forwarded my original inquiry as a complaint to the responsible authority, namely Office for Data Protection of the state Lower Saxony. Then Zorn suddenly wrote back, presenting as evidence a confirmation of receipt email which he actually originally addressed not to me, but to himself. In any case, Zorn chose not to reply to my questions. Instead, the state’s officially independent and utterly unbiased officer for data protection, Christoph Lahmann, wrote to me. Lahmann declared that my inquiry on Macchiarini’s teaching activities should not be answered by MHH since it concerns the professor’s personal sphere:

“On the admissibility of the transfer of personal data from authorities to third parties outside the public sphere, I refer to the Lower Saxony Data Protection Act (NDSG), §13. Here, the conditions under which a transmission is permissible from the point of view of data protection are determined. As a so-called authority standard, §13 NDSG allows data transmission under the stated conditions, but does not oblige the public authority to transmit this data. The authority may, for example, reject the data transmission with regard to the administrative burden, even if the legal requirements of the NSDG are fulfilled. […]
In your application, you refer to the freedom of information act (FOIA) of Lower Saxony. A FOIA is indeed a standard for public sector information, provided the requested information is actually available to the public authority and there are no grounds for refusal (eg protection of personal data, protection of company and business secrets, employee data protection, copyrights, etc.). 12 federal states and the Federal Government [of Germany, -LS] have issued freedom of information acts. There is no such freedom of information act in Lower Saxony.
I hope to have helped you with these explanations”.

That was indeed helpful, certainly for MHH. Lahmann basically rushed to warn Zorn that he doesn’t have to tell me and my readers anything, while instructing me and everyone else that one professor’s university curriculum is nobody’s business. Basically, even if Prof. Macchiarini should be currently teaching students on trachea regeneration (personally, I think any such lecture at MHH should be televised worldwide) or even be operating patients at the Hannover university clinic, we are not entitled to find out. Most likely however, neither is happening. The MHH is probably simply quietly breaking the state law, but thanks to the kind Dr Lahmann from the state’s authority, we are now denied the evidence.
In fact, Lahmann has excellent colleagues elsewhere in Germany who took upon themselves the heroic task of protecting their local universities from nosy inquires (see my reporting here). These brave data protection officers basically declared to me that every single thing happening on the university campus falls under “research and teaching”, and as such exempt from FOIA. That’s because in Germany, we trust doctors and scientists so much that we sometimes put them above the law. Anyone wants to place a bet on how the University of Würzburg will answer my FOIA inquiry about the trachea transplants done by the Walles couple?

**** END OF CROSSPOST

New article on the possibility of machines as moral agents online

noreply@blogger.com (Christian Munthe) — Thu, 01 Dec 2016 08:12:00 +0000

One of the real perks of supervising PhD students is that they tend to force you outside your established academic comfort zone, and explore new territories of philosophical inquiry. This is what has happened when I have followed the footsteps and eventually joined the work of Dorna Behdadi, who is pursuing a PhD project in our practical philosophy group on the theme of Moral Agency in Animals and Machines. She has led the work on a new paper, where I am co-authour, that is now available online as a so-called preprint, while it is being considered for publication by a scientific journal. The title of the paper is "Artificial Moral Agency: Reviewing Philosophical Assumptions and Methodological Challenges", and deals with the notion of machines or any artificial entity (possibly a very advanced not yet existing one) could ever be ascribed agency of a moral sort, that might imply moral wrongdoing, responsibility for such wrongdoing (by the machine), or similar things.

Tts abstract runs thus:

The emerging field of "machine ethics" has raised the issue of the moral agency and responsibility of artificial entities, like computers and robots, under the heading of "artificial moral agents" (AMA). We analyze the philosophical assumptions at play in this debate and conclude that it is characterized by a rather pronounced conceptual and/or terminological confusion. Mostly, this confusion regards how central concepts and expressions (like agency, autonomy, responsibility, free will, rationality, consciousness) are (assumed to be) related to each other. This, in turn, creates a lack of basis for assessing either to what extent proposed positions and arguments are compatible or not, or whether or not they at all address the same issue. Furthermore, we argue that the AMA debate would benefit from assessing some underlying methodological issues, for instance, regarding the relationship between conceptual, epistemic, pragmatic and ethical reasons and positions. Lastly, because this debate has some family resemblance to debates on the moral status of various kinds of beings, the AMA discussion needs to acknowledge that there exists a challenge of demarcation regarding what kind of entities that can and should be ascribed moral agency.

The paper can be viewed and downloaded for free here and here.

***

Come and Join our team in Practical Philosophy: One or more senior lecturers sought!

noreply@blogger.com (Christian Munthe) — Fri, 25 Nov 2016 08:22:00 +0000

Our practical philosophy group at the Department of Philosophy, Linguistics and Theory of Science at the University of Gothenburg is hiring. We are presently seeking one or several senior lecturers in practical philosophy. This subjects includes all aspects of philosophy relating to human action and social practices, such as applied and general normative ethics, ditto political philosophy and philosophy of law, metaethics, philosophical esthetics, and the philosophy of religion and the social sciences.

Read more and submit your application here.

***

New article on the ethics of risk online

noreply@blogger.com (Christian Munthe) — Sat, 29 Oct 2016 10:18:00 +0000

Just a little heads-up that a few days ago I submitted a new article for a coming special issue on the ethics of risk, and has made the "preprint" (my msubmitted manuscript before peer review and editing) available for free reading and download. The article critically assesses the notion of basing an ethics of risk on the core assumption of "defeasible" basic individual moral rights against being exposed to risk by others, and the abstract runs like this:

This article critically assesses recent proposals that an ethics of risk developed independently of standard "factualistic" ethical theory should be based on the assumption of a basic moral right of individuals against being exposed to risks. I argue that core elements that have to be present if the notion of a moral right is to uphold the classic Rawlsian requirement of "taking seriously the distinction between persons" and of preserving the notion of waiving rights means that an ethics of risk based on this axiom will fail to address its most paramount issues. This, in turn, is due to the nature of the most ethically important risks to be collectively produced, and the subsequent consequence that an ethics of risk needs to be able to acknowledge the moral importance of security against risks as a public good. The article ends by charting three broad theoretical strategies that an ethics of risk may take to face up to this challenge, and discuss the place for rights within these respective theoretical landscapes with mostly skeptical results.

The article itself can be accessed here and here.

***

New article on prenatal screening online

noreply@blogger.com (Christian Munthe) — Thu, 13 Oct 2016 18:33:00 +0000

Yesterday I received word that the American Journal of Bioethics has accepted a so-called open peer commentary by myself on a coming so-called target-article that presents a seemingly drastic proposal regarding the ethics and policy of prenatal screening using non-invasive sample techniques and so-called whole genome sequencing technology for analysis. I am partly in sharp disagreement with this proposal, partly in full agreement, and rather critical of how the authors of the proposal have ignored crucial parts of the literature and linked complications. The response where I set out my reasons can now be accessed in its original form, before peer review or editing here and here.

***