MBBS Curriculum 2020

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Placebo-Controlled Surgical Trials
1 October 2015 - 18:30-20:00

Lecture: David Beard, Professor of Musculoskeletal Sciences, University of Oxford
Comment: David Papineau, Professor of Philosophy, King’s College London

K2.31, King’s Building, Strand, King’s College London

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Lies, Damn’d Lies, and Statistics: Is it possible to communicate cancer risk accurately?
15 October 2015 - 18:30-20:00

Lecture: Steve John, Lecturer, History and Philosophy of Science, University of Cambridge
Comment: Deborah Ruddy, Consultant in Clinical Genetics, Guy’s and St. Thomas’ Hospital

Henriette Raphael House, Function Room, Guy’s Campus

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Abstract:

 

The fact that different ways of presenting the same risk information can have very different effects on patients’ choices raises an ethical challenge: how, if at all, should medical professionals use such “perlocutionary knowledge”? In this paper, I suggest that reflection on the nature of risk estimates poses an even harder problem: which reference classes should physicians use to calculate patients’ risks in the first place? I then sketch one answer to this challenge, based on an account of rational gambling. Unfortunately, this answer seems to conflict with much current medical practice. In the final part of the paper, I try to justify current practice. I conclude with some remarks on the implications of my argument both for clinical ethics and for the philosophy of science.

Abstract
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Surviving the Sirens: Should there be advance directives for people with Bipolar? -- CANCELLED
29 October 2015 - 18:30-20:00

Lecture: Tania Gergel, Visiting Research Fellow in Ancient Philosophy (Dept. of Classics) and Philosophy of Psychiatry (IoPPN)
Comment: Alexander Ruck Keene, Barrister and Honorary Research Lecturer at the University of Manchester

This event has been cancelled due to illness. It will be rescheduled for a later date.


”Just because I’m paranoid doesn’t mean they’re not out to get me”: The Problem of Defining Delusion
12 November 2015 - 18:30-20:00

Lecture: Dr. Abdi Sanati, Consultant Inpatient Psychiatrist, North East London NHS Foundation Trust
Comment: Dr. Luis Flores, MD, MA, MPhil

King’s Building, K2.31, Strand

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Abstract:

 

Delusions have long been seen as a hallmark of madness, but what makes something a delusion? People have mistaken beliefs without being called deluded, and the beliefs of deluded people can be true. In this talk, these and other difficulties with defining delusion will be explored from the points of view of both theory and clinical practice.

Abstract Video Recording


Cause or Correlation? Causal Evidence in Medicine and Law
28 January 2016 - 18:30-20:00

Lecture: Brendan Clarke, Department of Science and Technology Studies, UCL
Comment: Nicki Cohen, Neuropathologist, GKT Department of Medical Education, KCL

Anatomy Lecture Theatre, Hodgkin Building, Guy’s Campus

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Abstract:

 

How can medical researchers generate reliable knowledge about treatment outcomes? The usual answer to this question is that randomised clinical trials are the best way of doing this. But there are many cases where doing a trial is not possible. In such cases, researchers must rely on other kinds of evidence. However, as is well-known, these kinds of evidence have many shortcomings, such as suffering from confounding and various species of bias. This talk uses methods drawn from the law to explore improved ways of working with imperfect evidence in medicine.

Abstract Video Recording


In Defense of the Social Value Requirement for Clinical Research
11 February 2016 - 18:30-20:00

Lecture: Annette Rid, Department of Social Science, Health, and Medicine, KCL
Comment: Benedict Rumbold, Department of Philosophy, UCL

Anatomy Lecture Theatre, Hodgkin Building, Guy’s Campus

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Abstract:

 

Many commentators and guidelines endorse the view that clinical research should be permitted only when it is socially valuable, meaning that it collects data which can be used to improve health. Despite this widespread endorsement and codification, there has been no systematic analysis of why social value is a necessary condition on acceptable clinical research, and a recent article even suggests it is not necessary. I evaluate the relevant ethical arguments and policy considerations and provide justification for the view that social value is an ethical requirement for the vast majority of clinical research trials, and should be mandated by guidelines and policies for clinical research.

Abstract


Configuring the Participants in Clinical Research
25 February 2016 - 18:30-20:00

Lecture: Norma Morris, Department of Science and Technology Studies, UCL
Comment: John Craven, Philosophy, KCL

K2.31, King’s Building, Strand, King’s College London

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Abstract:

 

Empirical work on participation in clinical research (using qualitative methods) has highlighted some of the configuration work being carried out by and on those taking part. Lay contributors try out different identities and behaviours, and develop conceptions of their role in response to circumstances. Clinical staff have to reconcile the professional demands of research and of care, and adjust as necessary their pre-formed expectations of participants’ needs. They must additionally comply with professional, legal, ethical and governance frameworks and rules. The presentation discusses tensions emerging for the actors, meeting at the confluence of these three streams, in the performance of clinical research.

Abstract


Pain: survival, science and suffering
10 March 2016 - 18:30-20:00

Lecture: Emma Briggs, Florence Nightingale Faculty of Nursing and Midwifery, KCL
Comment: Shawn Vigil, Philosophy, KCL

K2.31, King’s Building, Strand, King’s College London

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Abstract:

 

Our understanding of the nature, mechanisms and meaning of pain has evolved significantly over the last century but its complexity still presents many clinical, ethical and philosophical challenges. Pain is widespread; a universal human experience and the most frequent reason people seek healthcare. Pain has a demonstrable impact on the individual, the family and health and social care systems. This presentation sets the scene for the discussion by exploring the impact and role of pain and the unpredictable relationship between the science and suffering.

Abstract


Mortality
29 September 2016 - 16:30-18:00

LectureDavid Galloway, KCL Philosophy

Anatomy Lecture Theatre, Hodgkin Building, Guy’s Campus

Abstract:

Would it be a good thing for us if we were able to lengthen our lives indefinitely, in excellent physical health? Or would we all, even in the most favourable circumstances, choose eventually to die? If we would so choose, then our mortality is not in itself a bad thing, and immortality is not to be desired. I will discuss factors we might consider in making this choice.

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Essay Contest
Reading Group Video Recording


Were you a part of your mother? The Metaphysics of Pregnancy
13 October 2016 - 16:30-18:00

LectureElselijn Kingma, Department of Philosophy, University of Southampton
Comment: Dr. Shree Datta, Consultant Obstetrician and Gynecologist, King’s College Hospital

New Hunt’s House, G.12, Guy’s Campus

Abstract:

What is the metaphysical relationship between the gestating organism and its embryo/fetus? I compare two views: (1) the fetal container model: the fetus is not part of but merely contained within or surrounded by the gestating organism; (2) the part-whole model: the fetus is part of its gestator. The fetal container model appears to be the received view. It is widely assumed but, I argue, without good argument; this model needs substantial support if it is to be taken seriously. The part-whole model is not presently defended, but I argue that it derives considerable support from a range of biological and physiological considerations. I conclude that the part-whole model has the upper hand and that, if true, this has important consequences for the metaphysics of persons and organisms and, perhaps, ethics and law.

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Video Recording


Delusional Reasoning
27 October 2016 - 16:30-18:00

LectureMatthew Parrott, KCL Philosophy

King’s Building, K-1.56, Strand Campus

Abstract:

In psychiatric textbooks and diagnostic manuals delusions are typically characterized in terms of impaired reasoning or as manifestations of irrationality. Yet it remains unclear what precisely is irrational about delusional patterns of thinking. In this presentation, we will examine several styles of reasoning exhibited in cases of delusion, some of which, as we shall see, appear surprisingly rational. This suggests, I shall claim, that delusional cognition is far more nuanced than standard textbooks and manuals might lead us to believe.

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Video Recording


Surviving the Sirens: Should there be advance directives for people with bipolar?
10 November 2016 - 17:00-18:30

LectureTania Gergel, IoPPN
Comment: Alex Ruck Keene, Barrister

New Hunt’s House, Lecture Theatre 2, Guy’s Campus

Abstract:

Bipolar Affective Disorder is a cyclical condition, with periods of remission and periods of illness, which often involve loss of decision-making capacity and damaging behaviour. For people with Bipolar, a self-binding (advance) directive (SBD), which commits them to treatment during future episodes, even if unwilling, can seem the most rational solution for an imperfect predicament. Nevertheless, efforts to establish a provision for SBDs are hampered by valid, but also paralysing, ethical, clinical and legal concerns. Paradoxically, the rights of people with Bipolar are being ‘protected’ through being denied an opportunity to protect themselves. We will present and discuss a model of an SBD which could represent a legitimate and ethically coherent form of self-determination.

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Video Recording


What's wrong with pragmatic trials?
26 January 2017 - 17:00-18:30

LectureNancy Cartwright, University of Durham and University of California, San Diego (Work with Sarah Wieten)

Video Recording

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Abstract:

In principle nothing is wrong with pragmatic trials: trials that ‘seek to determine the effectiveness of an intervention in a real-world setting to inform clinical decision making’ (Roland and Torgerson, 1998). In aid of this, pragmatic trials eliminate some of the exclusion conditions that are usual in what are labelled ‘ideal’ or ‘explanatory’ trials. The trouble comes with the concepts of ‘effectiveness’ and ‘external validity’. Positive results in well-conducted trials, whether ideal or pragmatic, show only that the treatment has worked for some members of the population enrolled in the trial. They cannot establish that it works in general nor what other factors help or hinder. Similarly, a pragmatic trial can establish that the treatment worked in the particular ‘real world’ setting – the one in which it was conducted, not that it works in ‘real world clinical practice’. Nor can they tell us what, if anything, is causally relevant in those settings. What can they do then? We shall argue that pragmatic trial results can be used in just the same way as ‘explanatory’ trial results: in tandem with a great deal of other evidence and theory, especial ‘midrange’ theory, to build credible local claims about how specific populations – or possibly even a specific individual – in specific places and circumstances may respond.
 


Manic Temporality and Decision-Making: A Phenomenological Approach
2 March 2017 - 17:00-18:30

LectureWayne Martin, Department of Philosophy, University of Essex.

Video Recording

Abstract:

The symptom scales and diagnostic criteria for mania are peppered with temporally inflected language: increased rate of speech, racing thoughts, flight of ideas, hyperactivity. But what is the underlying phenomenological structure of temporal experience in manic episodes? We identify a set of hypotheses about manic temporality formulated by two pioneers in 20th century clinical phenomenology: Eugène Minkowski (1885-1972) and Ludwig Binswanger (1881-1966). We then test, critique, and refine these hypothesis using methods of “second-person phenomenology” in an interview-based study of persons with a history of bipolar disorder and a current diagnosis of mania. We show that Minkowski and Binswanger were wrong to claim that persons experiencing acute mania are somehow trapped in the present moment. But we provide evidence that supports their hypothesis that disturbance in the formal structure of temporal experience is a core feature of mania. Developing a suggestion from Binswanger, we propose an interpretation of manic temporality as involving a distinctive form of protention. We identify consequences of this temporal disturbance for the assessment of decision-making capacity under conditions of mania.

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Privacy, consent and health data: using identifiable health data for secondary purposes ethically, but without consent
16 March 2017 - 17:00-18:30

LectureJames Wilson, Department of Philosophy, UCL

Video Recording

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Abstract:

A number legal regimes (e.g. England’s section 251 of the NHS Act 2006), have a mechanism that allows research involving identifiable health information to proceed without consent for a large population on grounds of the impracticability of gaining consent, even though the same research project would require the consent of all participants were the number of participants significantly smaller. This paper examines the cogency of the reasoning involved in such decisions, arguing that it seems difficult to justify on the assumption that in usual circumstances individuals have a right that their identifiable health information not be used without their consent. If using someone’s identifiable information without their consent would violate their rights if they were a member of a small group, why should it stop being a violation of that person’s rights if the group they are in becomes sufficiently large? I propose instead a new ethical justification for such use of health data, which I call the reasonable trespass account.


Too much medicine: Not enough trust?
6 February 2018 - 17:00-18:30

LectureZoë Fritz and Richard Holton, University of Cambridge.

G.12 New Hunt’s House, Guy’s Campus

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Abstract:

We suggest that ‘too much medicine’, in the shape of both investigations and
treatments, is sometimes offered as a substitute for a trusting relationship. We investigate the
nature of such a relationship, arguing that at its core it involves a transfer of discretion. We
show that there is substantial empirical support for the idea that more trust will reduce the
problem of too much medicine. We then investigate ways in which trust can be built quickly,
concentrating on issues of questioning, and of entrusting uncertainty and treatment. We
conclude by suggesting that using over-treatment as a way of generating trust may itself be an
untrustworthy way of proceeding.


Manufactured Values: Industry Front Groups, Looping Effects, and Regulatory Decisions
13 February 2018 - 17:00-18:30

LectureBennett Holman, University of Yonsei.

Classroom 6, Hodgkin Building, Guy’s Campus

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Abstract:

Evaluating a case to determine whether it is an example of overtreatment frequently
trades on values: “Which side effects are important enough to include in any measurement of
harm? Are some side effects more important than others? Who should decide—patients,
clinicians, or researchers? And what if they disagree?” (Carter et al. 2015). In an effort to deal
with just this issue, the FDA created the patient focus drug program. Combining philosophy
with qualitative methods from the social sciences, our research first examines the October
2014 patient meeting for Flibanserin and female sexual dysfunction. We show that industry-
funded participants presented a unified message that was almost completely distinct from
other participants. We argue that this process can be understood as an example of a “looping
effect” (i.e. women have internalized the industry’s narrative which now genuinely structures
their experience). Setting this case in context of broader efforts by industry to shape the
experience of patient groups, we argue that: At best this significantly complicates efforts to
incorporate patient values into risk/benefit judgments, and at worst, it belies the
presupposition that patient interests are an objective, immutable, and knowable factor to be
incorporated into medical decision making and regulatory decisions.


POSTPONED: Scientific Ecosystems and Research Reproducibility
20 March 2018 - 13:00-14:30

NOTICE: This lecture will be postponed due to the UCU strike. Please check back later for updates to when it will be rescheduled, our join our mailing list to be notified (in the footer of the website.)

LectureMarcus Munafò, University of Bristol.

Classroom 6, Hodgkin Building, Guy’s Campus

Abstract:

There have been a number of high profile cases of academic fraud, but a more insidious threat to the integrity of science is the extent to which distortions of scientific best practice increases the likelihood that published research findings are in fact false. There is growing evidence for a range of systemic problems within science, such as flexibility in the analysis of data, selective reporting of study results, publication bias against null results, influence of vested (e.g., financial) interests, and distorted incentive structures. A number of strategies for improving the situation will be discussed.


Is Suicide a Psychiatric Problem?
24 April 2018 - 13:00-14:30

Lecture: Hane Maung, Lancaster University

Room 4.16 Henriette Raphael House, Guy’s Campus

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Video Recording

Abstract:

Suicide is understood as being a complex outcome of multiple interacting factors at multiple levels of organisation, including diverse processes at individual, interpersonal, and environmental levels. Despite this complexity, suicide is commonly framed in contemporary health discourse as primarily being the causal outcome of mental disorder. Accordingly, mental health professionals are granted responsibilities for suicide prevention and can even be held legally liable when suicides occur. This selective emphasis on mental disorder raises philosophical problems. How do we make sense of the messy and murky interactions of factors that are involved in suicide causation? What accounts for our privileging of mental disorder over other factors as the primary cause of suicide? Is the connection between mental disorder and suicide wholly causal or partly the result of how mental disorder is defined? These questions are important, because they call attention to implicit assumptions involved in the way the issue of suicide causation is framed in contemporary health policy. In this talk, I draw on theory from the philosophy of science to unpack some of these assumptions and to explore the extent to which the contemporary view of suicide as being primarily a causal outcome of mental disorder can be sustained.