Browsing by Author "Brody, Baruch A."

Now showing 1 - 5 of 5
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    Are Surgical Trials with Negative Results Being Interpreted Correctly?
    (Elsevier, 2013) Brody, Baruch A.; Ashton, Carol M.; Liu, Dandan; Xiong, Youxin; Yao, Xuan; Wray, Nelda P.
    BACKGROUND: Many published accounts of clinical trials report no differences between the treatment arms, while being underpowered to find differences. This study determined how the authors of these reports interpreted their findings. STUDY DESIGN: We examined 54 reports of surgical trials chosen randomly from a database of 110 influential trials conducted in 2008. Seven that reported having adequate statistical power (b 0.9) were excluded from further analysis, as were the 32 that reported significant differences between the treatment arms. We examined the remaining 15 to see whether the authors interpreted their negative findings appropriately. Appropriate interpretations discussed the lack of power and/or called for larger studies. RESULTS: Three of the 7 trials that did not report an a priori power calculation offered inappropriate interpretations, as did 3 of the 8 trials that reported an a priori power < 0.90. However, we examined only a modest number of trial reports from 1 year. CONCLUSIONS: Negative findings in underpowered trials were often interpreted as showing the equivalence of the treatment arms with no discussion of the issue of being underpowered. This may lead clinicians to accept new treatments that have not been validated.
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    Do Surgical Trials Meet the Scientific Standards for Clinical Trials?
    (Elsevier, 2012) Wenner, Danielle M.; Brody, Baruch A.; Jarman, Anna F.; Kolman, Jacob M.; Wray, Nelda P.; Ashton, Carol M.
    Unlike medications, the dissemination of surgical procedures into practice is not regulated. Before marketing, pharmaceutical products are required to be shown safe and efficacious in comparative clinical trials that use bias-reducing strategies designed to reduce the distortion of estimates of treatment effect by predispositions toward the investigational intervention or control. Unless an investigational device is involved, the corresponding process for surgical innovations is usually unregulated and therefore may not be based on adequate evidence. Given these differences, we sought to evaluate the state of clinical research on invasive procedures. We conducted a systematic review of publications from 1999 through 2008, which reported the results of studies evaluating the effects of invasive therapeutic procedures, focusing on trials that appeared to influence practice. Our objective was to determine what proportion of studies evaluating surgical procedures use a comparative clinical trial design and methods to control bias. This article reports our results and raises concerns about the methodologic, and therefore the ethical, quality of clinical research used to justify the implementation of surgical procedures into practice.
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    Doubly distributing special obligations: what professional practice can learn from parenting
    (BMJ Publishing Group Ltd?& Institute of Medical Ethics, 2016) Tilburt, Jon; Brody, Baruch A.
    A traditional ethic of medicine asserts that physicians have special obligations to individual patients with whom they have a clinical relationship. Contemporary trends in US healthcare financing like bundled payments seem to threaten traditional conceptions of special obligations of individual physicians to individual patients because their population-based focus sets a tone that seems to emphasise responsibilities for groups of patients by groups of physicians in an organisation. Prior to undertaking a cogent debate about the fate and normative weight of special obligations and a traditional ethic for contemporary healthcare, we need a deeper examination of what the traditional ethic of special obligations really means. Here we offer a conception of ‘doubly distributed’ special obligations. Physicians and similarly minded healing professionals abiding by a traditional ethic have always spread their devotion and attention across multiple patients and have shared responsibilities with physician and non-physician colleagues in much the same way devoted parents have frequently distributed their special obligations across multiple children and across multiple parents. By taking up the extended analogy of parent we argue that doubly distributing special obligations need not contradict the possibility of special obligations in restructured collective forms of healthcare delivery and financing.
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    Models for morality: Temporal semantics for deontic logic
    (1985) Hess, Stephen Andrew; Grandy, Richard E.; Brody, Baruch A.; Sistare, Christine
    This work addresses several topics in the semantics of deontic logic. In Chapter One I introduce a standard branching temporal model to serve as the basis for deontic logics and I define three tense operators. I argue that none of the three corresponds to a popular view of the 'will* operator, that the 'will' operator cannot be defined on the model provided, and finally, that the truth conditions for will are exactly those of must.1 In Chapter Two I introduce the monadic and dyadic operators ’O' and ’(-/-)' and review arguments for taking the dyadic as primitive. I show that those arguments do not prove that a dyadic operator is necessary, and that the considerations which led to its introduction are better served by defining conditional obligations with a tense operator 'will always' and the standard truth-functional connectives. I also argue that the 'set of morally acceptable worlds' which deontic semantics use should be construed as a set in which some particular agent fulfills all her obligations. In the third chapter I demonstrate how temporal semantics enable deontic logicians to choose among several formulations of the principles that what is necessary is obligatory and that what is obligatory is possible. I review arguments for rejecting the former as a principle of logic and note a problem which arises when it is rejected. In Chapter Four I demonstrate that an attempt by Richmond Thomason to relate 'dutiful' choices to morally perfect worlds on the temporal model cannot succeed. Finally, I conclude the thesis by investigating the broader implications of the results from the first four chapters.
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    Nagel's theory of the subjective and objective : implications for rationality in ethics
    (1985) Goodin, Susanna Lee; Kulstad, Mark A.; Brody, Baruch A.; Grandy, Richard E.
    In this thesis, I consider the consequences of applying Thomas Nagel's theory of the subjective and objective to rational decision-making in ethics. In chapter one, I am concerned with the notion of rationality. I discuss a common assumption man has about rationality and analyze the four necessary conditions for rationality. In chapter two, I present Nagel's theory. I draw out implications which are important in connection with rationality. In chapter three, I examine the implications of Nagel's theory for the notion of rationality. I focus on two problem cases which are designed to highlight a conflict between Nagel's theory and rationality. I use an analogy to Derek Parfit's work on prisoner's dilemmas to support my claim that the acceptance of Nagel's theory rules out the possibility of performing actions based on rational decisions. Finally, I argue that the type of rationality which is possible under Nagel's theory is deprived of any action-guiding force.