Friday, May 27, 2011

How Today's Success Can Create Challenges for Tomorrow's Success

Naturenews has this interesting story on the challenges facing drug innovation. New drugs might struggle to recruit volunteers for potentially superior treatments because patients prefer to use interventions that have been proven to be effective, though these interventions might actually be less effective than the experimental intervention.

The story is based on the findings of this working paper. Here is the abstract from the study:

Improvements in health have been a major contributor to gains in overall economic welfare. In this paper, we argue that previous economic research on R&D has overlooked an important difference between medical R&D and R&D in other sectors. The health care sector exhibits a unique linkage between product development and output markets. Participants in clinical trials for new medical products are also potential consumers of existing approved medical products. This overlap between input supply and output demand has non-standard effects on innovative returns over time and across geography. First, medical R&D has a self-limiting effect. Contemporary innovation discourages trial participation and slows down development necessary for future innovation. Thus, medical R&D suffers increasing costs over time, driven by improvements in the standard of care. Second, policies that affect output markets, such as universal coverage and price controls, affect the returns to innovation, not only by altering the firm’s variable profits, but also by increasing the length and cost of development. Third, the amount of medical R&D in a location is driven, not only by the local relative R&D talent, but also by consumer demographics and output market policies in that location. We provide evidence of the input-output linkage for the break-through HIV therapies introduced in 1996. We document the substantial drop in trial recruitment induced by these new innovations and argue that this has slowed down development and lowered returns to subsequent HIV-related innovations.


Thursday, May 26, 2011

Promotion (and some reflections on getting here)

Last week I received the final word that I have been promoted to full professor, which is very welcome and pleasing news. I thought I would take this opportunity to offer a few reflections on the past 11 years of my career and the road I have taken to get to where I am now.

I'm afraid my reflections don't really offer any "advice" per say, to junior faculty or grad students considering a career in political theory. But perhaps some readers can relate to some of my experiences.

I started my career back in 1999, having finished my PhD in a philosophy department in England. I can recall quite clearly the final year of my PhD and how eager I was to send off applications to all the jobs ("open" and in my area of specialization) that were advertised that year (Fall 1998). I bought a map of North America and put pins in all the cities where I had applied to.

I must have applied to 50+ jobs in total that year. And I was (naively!) optimistic that I would land a tenure track job back in North American to start in the fall of 1999. The months that followed were tough and, as my father is fond of saying, "character building". As I did not even have my PhD in hand at the time, and limited teaching experience and only a few papers in print (or forthcoming), I should have had lower expectations. So the months that followed was a real learning experience.

The worst experience that year was probably attending the famous "smoker" at the Eastern division meeting of the APA. The conference takes place over the winter holidays and attending the talks was fun. But the job interview component of the conference was much less pleasant. I had one job interview lined up that year so I decided to fly to Washington (I was visiting family in Canada anyways so I wasn't too far away) to attend the interview at the conference. The interview itself was fine, but during the "smoker" event job candidates have the awkward experience of hanging around the dept's table, conversing with other job applicants and faculty from the department. Most job applicants were from the US, and thus they had their advisors and other faculty and grad students to converse with and help them mingle. As a lonely grad student from the UK I pretty much wandered around aimlessly trying to make sense of this process and event. Needless to say I was not keen to experience the "smoker" again any time soon! (I have not attended it since that first experience)

As rejection letters began to come in I removed the pins on my map until there were none left. I gathered the large stack of rejection letters and had my wife take a picture of me lying down with them spread covering me from my toes up to my head! Luckily I didn't let these rejections in that first year get me down too much. In the winter and spring of my last year of the PhD I kept chipping away on the dissertation, taught my first lecture course (on Marx), and got a few more chapters published. I also turned my attention to one-year UK appointments that were coming out in the Spring of 1999.

I was very fortunate to land my first academic position, a one year lectureship, in the Department of Philosophy at Aberdeen University. The position started in July 1999, a month before I was to defend my dissertation. Aberdeen has a beautiful campus, and the philosophy department is housed in the "old Brewery". I recall fondly the old, small desk I worked on in the office I was given for that year. Allegedly it had been JS Mill's desk (there was a Latin inscription on the desk though I don't recall what it read), and I was told Mill gave it as a gift to (if memory serves me correctly) Alexander Bain, who held a Chair in the Aberdeen Philosophy Department at that time.

So there I was, fresh out of graduate school, working away (during the dark, cold afternoons and evenings) writing papers and preparing lectures on the desk of one of my intellectual heroes! Funny enough, I actually suffered some pretty bad back pain that year. The desk was very small, and the chair I sat on was not a proper desk chair. It wasn't until I left Aberdeen months later and the pain subsided that I realized it was sitting hunched over Mill's old desk all those hours a day that probably caused the back pain.

Over the winter and spring months I interviewed for a number of jobs (here are some reflections on one of them) and it wasn't until the week my eldest son was born in the spring of 2000 that I landed a 3 year appointment in the Department of Political Studies and International Studies at Birmingham University. Within the first ten days of my son being born I had to rush off to three different job interviews (in addition to doing grading for the term), and that was probably the most stressful time of my career as I only had a few months left on my job contract in Aberdeen and I had to financially support my wife and our new baby.

The stability the new Birmingham appointment offered was very appealing and so we moved back to England in 2000 and remained at Birmingham for the next two years.

The move to Birmingham marked a turning point in my career for many reasons. That job eventually became permanent (though I ended up leaving shortly after it became permanent) so we were freed from the immense financial stress of not having a secure income (though trying to buy a house in the UK proved to be a real challenge and headache, and if we weren't gazumped on a house in 2001 we might still be living in Birmingham!). Secondly, taking the appointment in Birmingham marked a turning point in my career as I switched from being based (primarily at least) in a Philosophy department to a Political Science department. I have stayed in the latter ever since. This switch has profoundly shaped my research and teaching. Perhaps I will expand on this point on another occasion.

Rather than trying to re-work my dissertation into a book, I decided instead to start writing this book and this edited volume. This really helped to broaden my interests.

In the fall of 2002 I joined the Department of Government at Manchester University, which had (and still does) a very strong theory presence in the UK. While at Manchester I had the opportunity to teach my "Genetics and Justice" course for the first time. And the course was co-taught with my colleague Hillel, which made it even more fun and interesting. Manchester was also the first time I taught large lectures. The first year "Introduction to Political Thought" course had 300 students, and the second year "Freedom and Equality" course had around 200 students. Learning how to teach large classes required developing a slightly different skill set than the one I developed early in my career. In large classrooms you don't have the opportunity to learn the names of the students and things are obviously less interactive than in small seminars. But in the years that followed I learned to appreciate the importance teaching large lecture courses has had on my intellectual development. Nearly a decade later and I still enjoy teaching large intro theory courses.

I left Manchester after only a year in order to take up a tenure-track position at Waterloo University back in Canada. I recall, shortly after receiving the Waterloo offer but before I decided to accept it, the then President (now GG of Canada) of the University phoned me long distance from Canada to the UK to persuade to join the University, and he even mailed me some copies of his published books! His generous gesture really made an impression on me, and brought home the importance social virtues can have to the success of higher education (something often unappreciated by academics). My wife and I didn't need much persuading to return to Canada. When we initially embarked on the journey overseas for my PhD in 1996 we thought it would be for just a few years and we always planned to return to Canada. We were eager to be closer to family and, with a young family to support, the lower cost of living in Canada would enable us to finally buy a home.

The years that followed marked the longest time we have lived somewhere since getting married. We stayed at Waterloo for 5 years (with a sabbatical year in Oxford in 2006/7). I enjoyed teaching an "intro to theory" course, a course on the history of political thought, a contemporary political philosophy course and my genetics and justice course while at Waterloo. I also had a great time debating Jan in the bi-weekly reading group we regularly ran during my time at Waterloo. While at Waterloo I also finished my work on this book, and continued chipping away on a new project on genetics and justice. I also co-edited this volume with Larry. I was promoted to Associate Professor in 2007.

Then in 2008 I moved here to Queen's as a QNS. Kingston is a great city and I enjoy teaching the large, full-year course on the history of political thought and my science and justice course. Over the past few years my research has focused on the ethical and social issues that arise with longevity science and, much more recently, play and happiness.

Looking back over the past decade of my research I have become much more critical of "ideal" and "abstract" methodologies in political theory/philosophy. This shift has come about because of my interests in topics that intersect the biological sciences and debates about justice, as well as my interests in virtue ethics and the fact that I switched from philosophy to political science. This shift also came about because I tend to prefer to tackle a disparate array of practical topics rather than working on just one or two "core" topics or issues. The topics I have published on include the basic income proposal, free speech, neutrality, genetics and justice (here, here, here, here and here), aging (here, here, here, here, here, here, here and here) , incest, historical materialism (here and here), judicial review (here and here), ideal theory, taxation, gender selection, deliberative democracy, and justice and incentives (here and here). Tackling these different applied issues has helped transform me from the ideologue I was when I started my career into the pragmatist than I am today. I believe this transformation has been for the better, though much of course depends on what we think political theory is for.

I believe the question "Why do political theory today?" is the most fundamental question a theorist can ask herself. And the answer, for me, has never been an inward, professionalized answer. Political theory is important because it is an intellectual activity that can help develop and hone those moral (e.g. empathy, humility) and intellectual virtues (e.g. adaptability of intellect, attention to details, understanding, etc) needed to achieve phronesis. Conceiving of the discipline in such a fashion has lead me tackle issues not traditionally addressed by the field (e.g. decriminalizing incest, the evolution of patriarchy, and, especially, longevity science- as someone recently joked to me "I have the field of aging and political theory to myself!"). Tackling issues not addressed by the field has risks and is challenging. But it can also be very enjoyable and rewarding.

So that wraps up some reflections on my progress from holding lectureships in the UK, to my time on the tenure-track in Canada, and then Associate and now full Professor. I'm afraid I don't have much to offer in terms of sage advice to those starting out early in their careers. But I suppose there is one important issue I wish someone had mentioned to me early on in my career- and that is to find a healthy balance between work and family. This has, at least for me, be a constant and ongoing learning experience and challenge. It is easy to feel that you are not doing enough, whether it be with publishing, reading, spending time with the kids, etc. Priorities need to be set and kept. For me, the highest priority is, hands down, my family (I have three young kids). The pressures of getting a job, then getting tenure and then promotion to full professor can place immense strain on an academic's relationships. And so it is imperative to realize that flourishing as an academic ought not to be confused and conflated with flourishing as a person. And the latter ought to remain one's #1 concern, though it is sometimes tempting to equate them and thus to pursue a course of action that comes at the cost of those things (i.e. relationships) that are constitutive of the latter. This is an occupational hazard worth noting, especially for those early in their career.

I also want to emphasize the importance of teaching. Sadly many academics see teaching as distinct from scholarship (as something that interferes and distracts them from publishing). But teaching has played an enormous role in my development as a scholar. I continue to learn from interacting with hundreds of bright young minds each year. They bring fresh ideas and new perspectives. Aspiring to engage students with political theory remains the most rewarding feature of being a professor. I have been fortunate to play a small role in the intellectual development of thousands of students from Scotland, England and Canada. Most of these students do not go on to be political theory professors. They go on to be teachers, journalists, lawyers, parents, taxpayers, spouses, etc. They take on diverse roles and identities. And I hope the skill-set I have tried to help develop and hone in my courses will prepare them for the challenges they face in life. Contemplating the big questions of theory, like "what is the good life?" or "what is justice?" has brought me so much happiness. And I have tried to pass on the joy of the "examined life" to my students. Teaching is a real privilege. And it has helped me develop as both a person and as a scholar.

So that completes these rather lengthy reflections on my road to becoming full professor. When I started my career in 1999, teaching philosophy in Scotland, I never would have dreamed that I would have the opportunity to meet such an interesting array of colleagues and students as I have at the 6 universities I have been affiliated with. I have been very fortunate. And I look forward to the new challenges that await the next stage of my career.


UPDATE: And if I had to pick just one of my publications to date that I felt came closest to the aspirations of Kant's 3 maxims of "public sense"- 1. “Think for yourself” (the motto of the enlightenment); 2. “To think from the standpoint of everyone else”; and 3. “always think consistently”- it would be 3 wishes. Below is the video version of that paper.

Friday, May 20, 2011

CPSA Conference (Waterloo 2011)

Yesterday I returned from 4 days at the CPSA conference at WLU in Waterloo. This year Loren and I were the panel chairs for political theory, which meant we had to organize and oversee the theory submissions and panels. It was a very enjoyable conference, with theory talks on topics as varied as the family and future generations, ancient Greek political thought, trade and taxes, federalism and territory and a session on this new book. We are grateful to the sponsors who helped fund the theory program- ACUNS, WLU and the CPSA.

We had a special workshop on "Global Justice and Global Governance" which spanned the 3 days of talks. The final workshop session featured the plenary talks by Virginia and Simon. We are very grateful to both of them for making the long trek to the conference and for the very stimulating presentations on, respectively, the ethic of care (as it pertains to international law) and the fair distribution of green house gas emissions.

Other highlights from the conference included the conference's plenary talk by Carole Pateman (on participatory democracy) on Monday, and Tuesday's conference dinner at KW's Concordia Club, which included a great schnitzel dinner and keg tapping ceremony.


Tuesday, May 10, 2011

Life Extension, "Sacred Values" and Taboo Tradeoffs

New substantive posts have been light these past months due to a very busy teaching and admin term. Attention is returning to research so I hope to add a series of new substantive posts over the coming months.

Here I will offer a few more thoughts on "sacred values" and how this pertains to my research on longevity science. A post on sacred values in political philosophy more generally is in the works.

For the past few years I have published a series of articles (see here, here, here, here, here, here, here and here) addressing the ethical and social challenges which the field of biogerontology faces.

Reflecting back over this work I think it is accurate to say that, for the past 5 years or so, I have devoted the bulk of my time and energy contemplating the following question- why hasn`t humanity undertaken an ambitious effort to advance the science that could help us redress the single leading cause of disease and death in the world today- namely, *biological aging*?

What I have found most surprising, and alarming, in my teaching and research on this topic is the extent to which people will go to justify their intuition that we should not aspire to modify the current rate of the molecular and cellular decline of humans. These reasons typically range from sentiments like “aging is natural“ and “doing so will exacerbate inequality“, to “it will cause overpopulation“ and “it will cause ecological disaster“.

And yet no one raises these same objections when the discussion is about supporting the science which could help redress just one specific disease of aging- like cancer, heart disease or stroke. No one objects to medical research on stroke by claiming “a disturbance in blood flow to the brain is natural“ or “preventing or curing strokes will exacerbate inequality“ or “all those people who would be saved from strokes will cause overpopulation or ecological disaster, so it is better they suffer a stroke“. Why not? Why is it that different moral sensibilities tend to be activated when the topic turns to modifying aging?

In this paper I suggested that prospect theory provides a plausible answer- we value the prevention of losses much more than we value perceived "gains". Dying of a specific disease of aging is commonly construed as "a loss", while dying of "aging" or "old age" is viewed as something that transcends our "aspiration level for survival" and thus its prevention is not accorded a high priority. So I think insights from human psychology can go a long way in terms of helping us understand (a) why we currently ignore the ultimate causes of disease and death and (b) why people tend to have a negative knee-jerk reaction to longevity science (what Miller called "gerontologiphobia").

Many of these problems could perhaps be remedied if the death certificates of people over age 60 identified both the proximate and ultimate causes. So the former would read: CAUSE OF DEATH: STROKE, HEART DISEASE, CANCER, etc., And the latter would read: CAUSE OF DEATH: EVOLUTIONARY NEGLECT. And most obituaries in the local newspaper would read something like the following "John Smith died Sunday after a painful but brave struggle against [insert chronic disease of aging] which he developed in late life because natural selection prioritized John's ability to reproduce over his ability to stay healthy for a long time".

Acknowledging the ultimate cause of disease and death would help people understand that, because natural selection does not apply to the post-reproductive stage of the human lifespan, their loved ones will most likely suffer prolonged periods of chronic pain, suffering and disability in late life. And we should all want to prevent or ameliorate that tragic state of affairs.

My interests in the neglect of biogerontology have also helped me reflect on methodological issues in political theory and philosophy. Why is it that political theorists interested in creating a more fair and humane world neglect the fact that a significant portion of human suffering in the world today is caused by the biological clocks we have inherited from our Darwinian history?

Lately I have been reading up on the topic of "sacred values", and thinking about how social-cognitive research on sacred values might help explain some of the challenges that face the field of biogerontology. Tetlock defines sacred values as "those values that a moral community treats as possessing transcendental significance that precludes comparisons, trade-offs, or indeed any mingling with secular values" (320). There are many different sacred values that people champion- libertarians take liberty to be the most fundamental value and are thus very sensitive to any government action (e.g. re-distributive taxation) that is construed as any incursion on liberty. The same could be said about egalitarians and other political ideologies (e.g. environmentalists).

So one reason that biological aging and the science that might help us modulate the rate of aging is neglected by political philosophers who trade in the intuitions of sacred values is that the stakes involved in such research do not easily map onto the sacred values the field concerns itself with. Aspiring to modulate the rate of human aging doesn`t activate the same moral sensibilities (e.g. concerns of equality, liberty, etc.) that aspiring to re-distribute wealth and income, for example, activates. Hence why most political philosophers in the past 4 decades have conceived of social justice as being primarily concerned with the patterns of wealth and income rather than being concerned with the advancement of knowledge and the fair diffusion of the benefits of technology.

As for the different kinds of objections that often arise in debates concerning life extension, many (though I concede not all) of these objections are little more than knee-jerk reactions of moral outrage (or repugnance) to a perceived threat to a sacred value. So egalitarians, for example, object to a new technology that they perceive would exacerbate inequality between the rich and poor. And many of the concerns about the environment and overpopulation are predicated on similar intuitions rather than actual factual empirical projections and a judicious balancing of the stakes involved.

So how can social-cognitive research on sacred values help us overcome the opposition to longevity science? What that research tells us is that people object to taboo trade-offs, which are trade-offs that pit sacred values against secular ones. When combined with insights from prospect theory, I believe this means that when the stakes involved in modulating aging are described as "life extension", "longevity", etc. they are likely to be construed as secular rather than sacred values. And when there is a perceived conflict between the goal of life extension and a sacred value (e.g. equality, the environment, etc.) this will result in moral outrage and thus opposition to the former. People will not want to entertain the question "what constitutes a reasonable balance between these values?"

There are number of ways of trying to overcome this impasse. One strategy is to frame the stakes at risk with biogerontology in terms of "sacred values". Other areas of the medical sciences, like research on cancer, AD, or stroke already enjoy the benefits of this. Preventing or curing specific diseases resonates with people because keeping people alive and healthy is a "sacred value". This tells us that describing an anti-aging intervention as "life-extending" versus "live-saving" or "health promoting" really matters. So the framing of the issues at stake for biogeronology is especially important. Framing the stakes so they resonate with sacred values will help quell the moral outrage against this science.

I have tried to do this in a variety of papers I have published on this topic. Framing an aging intervention as helping to "prevent a loss", for example, or as being a requirement of equality, helps people internalize the justification for aspiring to modify the inborn aging process in a way that coheres with their sacred values. So rather than opposing the science that might help keep the world`s aging populations healthy, people might actually start supporting it and demand a greater portion of scientific funding be devoted to this field.

The reality is that today's aging populations face what is called a "tragic tradeoff". Such tradeoffs pit sacred values against one another. This means it is extremely difficult for society to have a reasonable discussion about healthcare. One way of justly navigating this dilemma is to aspire to modulate aging itself. This would be a more humane and cost-effective strategy than trying to redress each specific disease of aging, which is the current course of action. But the current course of action has traction because it coheres with sacred values. So a great deal of thought must be given to contemplating how this situation can be overcome.