Therapeutic Use Exemptions and the Doctrine of Double Effect

Without taking a position on the overall justification of anti-doping regulations, I analyse the possible justification of Therapeutic Use Exemptions (TUEs) from such rules. TUEs are a creative way to prevent the unfair exclusion of athletes with a chronic condition, and they have the potential to be the least bad option. But they cannot be competitively neutral. Their justification must rest, instead, on the relevance of intentions to permissibility. I illustrate this by means of a set of thought experiments in which only an athlete’s intentions vary. I argue that the Doctrine of Double Effect (DDE) sheds some light on TUEs and illustrate this by applying different readings of the DDE to the thought experiment. This underpins a justification of anti-doping exemptions very different from the approach adopted by the World Anti-Doping Agency (WADA). I argue for three changes to bring TUEs in line with this understanding: rewriting of the regulations, transparency, and a greater role for athletes in determining what exemptions are allowed, and when

Geras on means and ends: the case for a prefigurative constraint

Norman Geras argues for the incorporation of elements from the just war tradition into the ethics of social change. But this does not go far enough. In this paper I argue for a prefigurative constraint: that action intended to bring about social transformation ought to prefigure that transformation, and bear those properties of the future state of affairs that make the future state of affairs morally valuable. I defend the idea of a prefigurative constraint against some objections and introduce a schema to relate political action to morally valuable end states

Why ‘Meaningful Competition’ is not fair competition

In this paper I discuss a new conception that has arrived relatively recently on the scene, in the context of the debate over the inclusion of transwomen (hereafter TW) in female sport. That conception is ‘Meaningful Competition’ (hereafter MC) – a term used by some of those who advocate for the inclusion of TW in female sport if and only if they reduce their testosterone levels. I will argue that MC is not fair. I understand MC as a substitute concept, as an attempt to substitute for the perfectly serviceable concept of fair competition. It is an attempt at conceptual engineering that should be resisted. This is important because some International Federations have accepted MC as good coin, and the underlying theory of MC, which I explicate for the first time, underpins the stance taken by the IOC (International Olympic Committee) in its Framework Document. To establish that the inclusion of TW in female sport meets the criteria of MC in the sense I explicate here, does not show that the inclusion of TW in female sport is fair. Such inclusion is not fair, and the proper currency of sport is fair competition. ‘Meaningful Competition’, on the other hand, is a snare and a delusion

Relationships between compulsive exercise, quality of life, psychological distress and motivation to change in adults with anorexia nervosa

Background: For people with anorexia nervosa (AN), compulsive exercise is characterized by extreme concerns about the perceived negative consequences of stopping/reducing exercise, dysregulation of affect, and inflexible exercise routines. It is associated with increased eating disorder psychopathology and poor clinical outcome. However, its relationships with two important clinical issues, quality of life (QoL) and motivation to change, are currently unknown. This study aimed to assess the cross-sectional relationships between compulsive exercise, QoL, psychological distress (anxiety and depressive symptoms, and obsessive-compulsive traits) and motivation to change in patients with AN. Method: A total of 78 adults with AN participated in this study, which was nested within a randomized controlled trial of psychological treatments for AN. At baseline (pre-treatment), participants completed questionnaires assessing compulsive exercise, eating disorder (ED) psychopathology, QoL, psychological distress and motivation to change. Results: Baseline correlational analyses demonstrated a moderate positive relationship between compulsive exercise and ED psychopathology, and a weak positive relationship between compulsive exercise and psychological distress. There was a moderate negative relationship between compulsive exercise and eating disorder QoL. Conclusions: These results indicate compulsive exercise is moderately associated with poorer QoL and weakly associated with higher distress. Targeting compulsive exercise in the treatment of anorexia nervosa may help reduce the burden of illness and improve patients’ engagement in treatment. Trial registration ACTRN12610000585022 . Taking a LEAP forward in the treatment of anorexia nervosa: a randomized controlled trial. NHMRC grant: 634922

Accuracy of self-reported physical activity in patients with anorexia nervosa: links with clinical features

BackgroundHigh levels of physical activity (PA) have long been described in patients with Anorexia Nervosa (AN). Despite the importance of measuring PA in this population, there are two important factors that remain unknown. First, it is not clear how accurate self-report measures of PA are among patients. Second, little is known about how clinical characteristics are associated with the accuracy of self-reported PA. Therefore, this study aimed to examine the accuracy of self-reported PA compared to an objective measure of PA in patients with AN. It also investigated whether levels of accuracy/inaccuracy were associated with compulsive exercise, motivation to change, and psychological distress.MethodData were analysed from 34 adult outpatients with AN. Patients wore an accelerometer device (ActiGraph) for 4 days and completed a retrospective self-report measure of exercise (Exercise Participation Screening Questionnaire). They also completed measures of compulsive exercise (Compulsive Exercise Test), motivation to change (The Anorexia Nervosa Stages of Change Questionnaire), and psychological distress (Kessler-10).ResultsOn the self-report measure, patients accurately reported their time spent in moderate and vigorous intensity PA, however, they significantly under-reported their light physical activity (compared to the accelerometer data). Accurate reporting of total PA was positively associated with higher levels of compulsive exercise. There was evidence to suggest that clinical features, such as motivation to change and psychological distress, may be associated with inaccurate reporting at some levels of PA intensity and not others.ConclusionsResults indicate that patients with AN are likely to under-report their light intensity PA. We also found preliminary evidence for how compulsive exercise, motivation to change, and distress are associated with self-reported PA accuracy. Clinical implications and directions for future research are considered

The relationship between environmental context and attentional engagement in podcast listening experiences

Previous research has shown that podcasts are most frequently consumed using mobile listening devices across a wide variety of environmental, situational, and social contexts. To date, no studies have investigated how an individual’s environmental context might influence their attentional engagement in podcast listening experiences. Improving understanding of the contexts in which episodes of listening take place, and how they might affect listener engagement, could be highly valuable to researchers and producers working in the fields of object-based and personalised media. An online questionnaire on listening habits and behaviours was distributed to a sample of 264 podcast listeners. An exploratory factor analysis revealed five factors of environmental context that influence attentional engagement in podcast listening experiences. The factors were labelled as: outdoors, indoors & at home, evenings, soundscape & at work, and exercise. The soundscape & at work factor suggests that some listeners actively choose to consume podcasts to mask disturbing stimuli in their surrounding soundscape. Five aspects of podcast listening engagement were also defined and measured across the sample, providing a comprehensive quantitative account of contemporary podcast listening experiences. Further analysis suggested that the proposed factors of environmental context were positively correlated with the measured aspects of podcast listening engagement. The results presented support the hypothesis that elements of a listener’s environmental context can influence their attentional engagement in podcast listening experiences. They are highly pertinent to the fields of podcast studies, mobile listening experiences, and personalised media, and provide a basis for researchers seeking to explore how other forms of listening context might influence attentional engagement

Improving public funding allocation to reduce geographical inequalities

This report proposes improved ways to allocate public funding within and between different areas in England to reduce geographical inequalities and enable more places to contribute meaningfully to national economic growth and renewal. It draws on the research of a multi-disciplinary team of academics, researchers and consultants undertaken between June 2024 and March 2025.This research included evidence reviews, international case studies, analysis of spatially targeted funding streams, ‘deep dives’ into specific topics, interviews with policy practitioners, and citizen engagement. Addressing the role of public funding in reducing geographical inequalities in England, the research identified ten guiding principles and ten key problems with incremental, moderate and radical proposals to help resolve them.The main messages for policy practitioners and decision-makers are:• prioritising and resourcing geographical inequality reduction within the national growth and renewal agenda are critical to improving public funding allocation• the problems in the existing funding allocation system are largely recognised and accepted by national, subnational and local policymakers and there is genuine appetite for reform. Early progress on positive reform – such as funding simplification – needs further support, acceleration and expansion to achieve meaningful change• meaningful and sustained decentralisation of powers and resources from national to subnational and local government is integral to building capacity and capability for improving funding allocation to reduce geographical inequalities• strengthened accountability is central to enhancing the effectiveness and wider transparency, oversight and scrutiny of public funding• monitoring and evaluation require substantive resources and strengthening alongside improvement of data and legibility for users, stakeholders and the wider publicThis report is for the Improving Public Funding Allocations to Reduce Geographical Inequalities project funded by the ESRC.The project brings together a highly experienced interdisciplinary team from the Universities of Birmingham, Bristol, De Montfort, Newcastle, Nottingham, Plymouth and Sheffield, together with the National Centre for Social Research and Metro Dynamics

Improving public funding allocation to reduce geographical inequalities

This report proposes improved ways to allocate public funding within and between different areas in England to reduce geographical inequalities and enable more places to contribute meaningfully to national economic growth and renewal. It draws on the research of a multi-disciplinary team of academics, researchers and consultants undertaken between June 2024 and March 2025.This research included evidence reviews, international case studies, analysis of spatially targeted funding streams, ‘deep dives’ into specific topics, interviews with policy practitioners, and citizen engagement. Addressing the role of public funding in reducing geographical inequalities in England, the research identified ten guiding principles and ten key problems with incremental, moderate and radical proposals to help resolve them.The main messages for policy practitioners and decision-makers are:• prioritising and resourcing geographical inequality reduction within the national growth and renewal agenda are critical to improving public funding allocation• the problems in the existing funding allocation system are largely recognised and accepted by national, subnational and local policymakers and there is genuine appetite for reform. Early progress on positive reform – such as funding simplification – needs further support, acceleration and expansion to achieve meaningful change• meaningful and sustained decentralisation of powers and resources from national to subnational and local government is integral to building capacity and capability for improving funding allocation to reduce geographical inequalities• strengthened accountability is central to enhancing the effectiveness and wider transparency, oversight and scrutiny of public funding• monitoring and evaluation require substantive resources and strengthening alongside improvement of data and legibility for users, stakeholders and the wider publicThis report is for the Improving Public Funding Allocations to Reduce Geographical Inequalities project funded by the ESRC.The project brings together a highly experienced interdisciplinary team from the Universities of Birmingham, Bristol, De Montfort, Newcastle, Nottingham, Plymouth and Sheffield, together with the National Centre for Social Research and Metro Dynamics