Motivation for participating in phase 1 vaccine trials: Comparison of an influenza and an Ebola randomized controlled trial

Introduction/Hypothesis

Recruitment of participants into phase 1 vaccine clinical trials can be challenging since these vaccines have not been used in humans and there is no perceived benefit to the participant. Occasionally, as was the case with a phase 1 clinical trial of an Ebola vaccine in Halifax, Canada, during the 2014–2016 West African Ebola virus outbreak, recruitment is less difficult. In this study, we explored the motivations of participants in two phase 1 vaccine trials that were concurrently enrolling at the same centre and compared the motivations of participants in a high-profile phase 1 Ebola vaccine trial to those in a less high-profile phase 1 adjuvanted seasonal influenza vaccine study.

How the social brain experiences empathy: Summary of a gathering

Explaining how, and even why, the social brain experiences empathy is a complex integrative endeavor that has been explored by scientists of several disciplines working with both animal and human subjects. Current thoughts on empathy and its connection to behavior—prosocial, altruistic, and cruel alike—were explored by scholars in the fields of biology, philosophy, psychology, and anthropology at a conference in Chicago. The speakers' individually unique perspectives merged to provide an inclusive overview of the biological basis of, and cultural influences upon, empathy. The nature of empathy in nonhuman animals, the endocrine requirements for empathy, the effects of empathy on moral behavior, the social nature of pain, the relation between empathy and altruism, the ethnography of empathy, and empathy in the medical setting were discussed. The interdisciplinary nature of the conference demonstrated the advantages of communicating findings across fields while also delineating the difficulties that can stem from the existence of multiple approaches to, and definitions of, empathy. Future progress will be aided by working toward common definitions for empathy, sympathy, altruism, and so on, in concert with cross-disciplinary dialogues that allow practitioners of each discipline to be informed by paradigms and findings from complementary disciplines.     

三军官兵利他主义及其心理社会影响因素研究

目的：探讨三军官兵利他主义观与心理社会影响因素的相关性,为部队官兵的心理健康教育提供依据。方法采用人性的哲学量表中的利他主义分量表、症状自评量表、卡特尔16种人格因素问卷、生活事件量表对1783名官兵进行心理测评。统计处理采用秩变换方差分析、Pearson 相关分析及 Amos 路径分析。结果不同文化程度官兵在负性利他主义组间差异具有统计学意义;新兵以及不同军兵种在正、负性利他主义方面差异均有统计学意义;官兵利他主义与个性因素、SCL-90总分及其各因子均具有高度显著性相关;Amos 路径分析显示存在7条显著路径,并发现通过人格因素的中介调节作用后,生活事件和心理健康因素对官兵利他主义的影响均得以放大。结论官兵利他主义在不同文化程度、军种、年代上具有差异性,并且受到心理健康、个性、生活事件因素的影响。     

Ronald Dworkin’s “Prudent Insurance” Ideal for Healthcare: Idealisations of Circumstance,Prudence and Self-interest

I will focus on Dworkin’s use of idealisation in his “Prudent Insurance” Ideal for healthcare. Dworkin identifies problems with the circumstances under which people make their insurance decisions in the current United States healthcare system and he sees these as being the cause of strange resource allocation outcomes. He therefore imagines idealising away these prima facie unjust circumstances to develop a hypothetical market in which people are able to make better decisions (Section “Idealisation of Circumstance”). I will identify two further idealisations that Dworkin relies on in his theory. The first is to idealise people to be perfectly prudent (Section “Idealisation of Prudence”), which I consider to be justifiable, but difficult to actually apply in practise. The second is to idealise people to be perfectly self-interested (Section “Idealisation to Self-interest”). I do not see this as a justifiable idealization since it ignores principles of altruism and citizenship, which would seem to be deeply relevant to a theory of justice.     

Challenges in achieving 100% voluntary blood donation

The call for voluntary non-remunerated blood donation has been echoing around the globe for many years. Progress has been very slow particularly in countries with limited resources. The long-term approach to build a sustainable supply of safe blood and blood products is often sacrificed when health facilities abdicate this responsibility to the patients and their relatives. The management of this community interface requires continued efforts, substantial resources as well as special studies and research in order to establish the appropriate approach to reach potential donors in these societies. The organisational role, plans and strategy for community education, recruitment, donor care and actual blood collection, are all important in establishing a committed well informed donor base, if not more, than the altruism and motives of individual donors.     

The virus stops with me: HIV-infected Ugandans' motivations in preventing HIV transmission

Few Positive Prevention interventions have been implemented in Africa; however, greater attention is now being paid to interventions that include messages of personal responsibility or altruism that may motivate HIV-infected individuals towards HIV prevention behaviors in Africa. We conducted 47 in-depth interviews in 2004 with HIV-infected men and women purposefully sampled to represent a range of sexual activities among clients of an AIDS support organization in Uganda. Qualitative interviews were selected from a cross-sectional survey of 1092 HIV-infected men and women. Clients were interviewed about their concerns around sexual HIV transmission, feelings of responsibility and reasons for these feelings, as well as about the challenges and consequences of actions to prevent HIV transmission. The reasons they provided for their sense of prevention responsibility revolved around ethical and practical themes. Responsibility toward sexual partners was linked to the belief that conscious transmission of HIV equals murder, would cause physical and emotional harm, and would leave children orphaned. The primary reason specific to preventing HIV transmission to unborn children was the perception that they are ‘innocent’. Most participants felt that HIV-infected individuals held a greater responsibility for preventing HIV transmission than did HIV-uninfected individuals. Respondents reported that their sense of responsibility lead them to reduce HIV transmission risk, encourage partner testing, disclose HIV test results, and assume an HIV/AIDS educator role. Challenges to HIV preventive behavior and altruistic intentions included: sexual desire; inconsistent condom use, especially in long term relationships; myths around condom use; fear of disclosure; gender-power dynamics; and social and financial pressure. Our finding that altruism played an important role in motivating preventive behaviors among HIV-infected persons in Uganda supports the inclusion of altruistic prevention and counseling messages within Positive Prevention interventions.     

Hero or has-been: Is there a future for altruism in medical education?

The term ‘altruism’ is often used without definition, leading to contradictions in what we expect from medical students. In this reflection paper, we critique the concept of ‘altruism’ from the perspective of moral philosophy and social psychology and challenge its unquestioned usage within the medical education literature, especially that emerging from the USA. We will argue that ‘altruism’ is a social construction with a particular history, stemming from Kantian philosophy and perpetuated within newer disciplines such as social psychology. As it currently stands, ‘altruism’ seems to mean utter self-sacrifice—a position contradictory to recent recommendations by regulatory bodies in the UK, which suggest that graduates should look after the ‘self’ and achieve a work-life balance. In this article, we argue that it is undesirable to have ‘altruism’ as a learning outcome for medical students and we also argue that ‘altruism’ is not an observable behavior that can be measured. Instead, we suggest that medical educators should employ a more balanced term, borrowed from the social psychology literature i.e. pro-social behavior. We argue that whilst ‘pro-social behavior’ focuses on actions that benefit others, it does not do so at the expense of the self. In addition, it focuses on students’ observable behaviors rather than their inner motivations, so is measurable. We conclude our article by discussing the formation of physicians based upon a virtue ethics, where society and the profession are in dialogue about the telos of medicine and its virtues, and where the character of the young physician is formed within the crucible of that dialogue. Thus, central to this pro-social behavior is the concept of phronesis or prudence, including the balancing of self-interest such as self-care, and the interests of the other.     

Making sense of behavioral irregularities of great apes

Psychopathology, mental illness, and psychiatric treatment are concepts relevant to modern medicine and medical psychology and replete with cumbersome intellectual and literary baggage. They bear the imprint of suppositions, world views, and general beliefs and values exemplified in the science, history, and general culture of Anglo European societies. The study in higher apes of phenomena addressed by such concepts raises conceptual dilemmas, usually termed speciesism and anthropomorphism, not unlike those encountered in comparative human studies of similar phenomena across cultures and historical periods, namely, ethnocentrism and anachronism. The authors’ synthesis of literature and their analysis of the implications of higher ape psychopathology represent an epistemically compelling account that broadens the scope of the comparative study of behavioral irregularities, a topic that provides a different slant for examining challenging questions in evolutionary biology and primatology, such as cognition, self awareness, intentional behavior, culture and behavioral traditions, social intelligence, sickness and healing, and altruism. Theoretical and empirical study of this topic expands formulation and can help provide informative answers about human evolution as well as essential features of human psychiatric syndromes, with potential practical implications. The study of psychopathology of higher apes and other non human primates represents an appropriate focus for neuroscience and bio-behavioral sciences.     

Does senescence promote fitness in Caenorhabditis elegans by causing death?

A widely appreciated conclusion from evolutionary theory is that senescence (aging) is of no adaptive value to the individual that it afflicts. Yet studies of Caenorhabditis elegans and Saccharomyces cerevisiae are increasingly revealing the presence of processes which actively cause senescence and death, leading some biogerontologists to wonder about the established theory. Here we argue that programmed death that increases fitness could occur in C. elegans and S. cerevisiae, and that this is consistent with the classic evolutionary theory of aging. This is because of the special conditions under which these organisms have evolved, particularly the existence of clonal populations with limited dispersal and, in the case of C. elegans, the brevity of the reproductive period caused by protandrous hermaphroditism. Under these conditions, death-promoting mechanisms could promote worm fitness by enhancing inclusive fitness, or worm colony fitness through group selection. Such altruistic, adaptive death is not expected to evolve in organisms with outbred, dispersed populations (e.g. most vertebrate species). The plausibility of adaptive death in C. elegans is supported by computer modelling studies, and new knowledge about the ecology of this species. To support these arguments we also review the biology of adaptive death, and distinguish three forms: consumer sacrifice, biomass sacrifice and defensive sacrifice.     

Pilot study to determine effect of an altruism intervention focusing on herd immunity to enhance influenza vaccination rates

ObjectiveA prospective, single-arm clinical trial was conducted to evaluate an altruism-tailored educational intervention to improve parental attitudes and vaccine uptake in vaccine-hesitant parents.MethodsVaccine-hesitant parents at two primary care sites, spanning two influenza seasons from 2020 to 2021 were provided an intervention (spoken and written communication) which highlighted altruistic benefits of accepting the seasonal influenza vaccine to optimize herd immunity to help protect pediatric cancer patients. Eligible parents included those with children eligible for the seasonal influenza vaccine, those who were proficient in English, and those with scores on the adjusted Vaccine Hesitancy Scale (aVHS) suggesting vaccine hesitancy (score ≥ 3). Enrollees completed a demographic questionnaire, underwent the educational intervention, and repeated the aVHS. Vaccination status at that visit was assessed. The primary outcome was change in aVHS scores obtained pre- and post-intervention. Influenza vaccine acceptance, along with demographic information, were also analyzed.ResultsWe enrolled 510 parents of influenza vaccine eligible children and identified 73 vaccine-hesitant parents. There was an overall trend toward lower aVHS score, with a mean change in hesitancy score of ?0.4 (P < 0.01). 43/73 (58.9 %) of the cohort experienced a positive effect toward a lower aVHS score, and 27/73 (37.0 %) of vaccine hesitant subjects became non-hesitant on the aVHS. Several demographic characteristics were associated with vaccine hesitancy in the screening population: educational level lower than bachelor’s degree (p = 0.03), household income < 400 % of federal poverty level (p < 0.01), unmarried (p = 0.02), and identifying with a political affiliation other than Democrat (p < 0.01). However, no demographic characteristics were significantly associated with an individual becoming non-hesitant. Our altruism-tailored communication approach carried the largest positive impact on the altruism-specific question on the aVHS, decreasing the post-intervention response value by nearly 25 % (P < 0.01).ConclusionsOur altruism-tailored communication approach significantly improved attitudes regarding childhood influenza vaccine among vaccine-hesitant parents.ClinicalTrials.gov Identifier: NCT04568590.