Precision public health-the Emperor's new clothes

Recently the Centre for Disease Control suggested that ‘precision public health’ presents significant opportunities to improve the health of the population,1 but what does this concept add and does it live up to the hype? The promise is that by harnessing the power of Big Data, particularly genomic data, we may indeed see early gains in public health as a result of ‘more-accurate methods for measuring disease, pathogens, exposures, behaviors, and susceptibility’ to guide targeted prevention strategies.2 However, the term ‘precision public health’ is susceptible to misinterpretation. Long before Big Data in the form of personalized genetic and epigenetic profiling arrived, much public health screening and prevention strategy was premised on varying degrees of targeting and stratification, so this is nothing new. Nevertheless, others in the UK have used analogous terms such as ‘personalized prevention’ or ‘personalized public health’, representing them as part of an urgent agenda in which we must ‘reap the benefits of the genomic revolution’.3 The purpose of this article is therefore to highlight some of the evidentiary and philosophical challenges for the concept of ‘precision public health’ which have not been exposed to sufficient scrutiny. It is also to argue for a more considered focus beyond the genome, lest we career headlong towards a diversion of resources, away from what really matters, to the detriment of population health. To do this, we structure our critique by aligning it with the so-called population perspective on precision medicine (i.e. the ‘P4 approach’), namely that precision public health should aim to be Predictive, Preventive, Personalized and Participatory.4 The advantage of taking this approach is that whereas it focuses on the key dimensions and parameters of the decisions that could help improve care both for individuals and populations, it has gained traction among precision medicine proponents themselves. Thereafter we return to the more philosophical and ethical arguments that should remind us of a bigger picture and the trade-offs that we might be making by investing in ‘precision public health’

Dynamic capabilities: the emperor's new clothes?

This study initially aimed to evaluate dynamic capability theory using a longitudinal empirical case of a highly successful FTSE-100 company operating within a volatile market. Using a range of rich qualitative data to open the “black box”, dynamic capabilities theory is extended through a detailed account of the process through which the case firm reconfigures and deploys their so-called zero-order or operational capabilities. Although there is a burgeoning literature, research findings remain diverse, disparate and largely conceptual. The limited examples of empirical work in the extant literature, tend to focus on what dynamic capabilities are with little attention in demonstrating how they actually operate. This study details several stages of significant change within the case firm as it moves from start up to its current MNE status. In-depth interviews with the senior team both past and present capture discussions of those factors underlying the success of this firm. Thematic development revealed examples of resource configurations and routines that matched dynamic capability as defined in literature. However, attempts to use Winter's (2003) hierarchy of capability to organize the data proved inadequate; far from being heterogeneous, the dynamic capability found looks like best practice; and whilst operational capability can be seen to evolve, the dynamic capability identified has not. Turning to the wider strategic management literature one can argue that the dynamic capability found in this firm fits better with a wider set of concepts such as knowledge management, absorptive learning, organizational change, leadership, HR practices, strategic decision making, team building, etc. Using a dynamic capability perspective, the findings might extend the under-developed notions of dynamic managerial capability and entrepreneurial fitness. Dynamic managerial capability, as described in the literature, can be articulated within the case firm. Managerial agency is key to competitive success in this firm and this study shows that the concept of agency is more encompassing than that of dynamic managerial capabilities and Teece’s (2007) vision of sensing, seizing and reconfiguring. There are cognitive aspects to creating the context for leadership action and the roles of sense-making and sense-giving to sustain the organizational culture and create the framework for innovation, learning and change. Yet, it is equally possible to account for competitive advantage within this case without recourse to dynamic capability theory. By linking the data gathered to the concept of "dominant logic" (Prahalad & Bettis, 1986; 1995), it is argued that traits and attitudes of the founders and senior managers of the case firm contribute to the “logic” that drives action. Over time these traits have been expressed as a series of simple rules that, in turn, have been operationalized in an organizational culture providing the context for the development of both routines and ad-hoc action. The thesis then demonstrates analytically how rules and their underlying traits act as a mechanism for the creation, sustenance and adaptation of operational capabilities traceable directly to actions taken in response to or in anticipation of environmental changes as well as actions taken in the context of an organizational culture which reflects these rules and underlying traits. It is through managerial agency that rules are created, the culture sustained and “entrepreneurial fitness” is achieved. As such, the research presented here contributes to the resource-based theory of the firm without recourse to the dynamic capabilities construct

Anti-Doping Policy: The Emperor's New Clothes

A sport or game is defined as a “voluntary attempt to overcome unnecessary obstacles” with rules developed to define and shape the goal of the game, control the means of obtaining the goal, and ensure or restore fairness. Anti-doping policy establishes the rules surrounding the testing and sanction of athletes and others for actions related to a Prohibited List of substances and methods. Substances appear on the Prohibited List if they meet two of three criteria: (1) harmful or potentially harmful to an athlete’s health; (2) performance-enhancing or potentially performance-enhancing; and (3) in violation of the ‘Spirit of Sport.’ In this thesis I examine the philosophical justifications for anti-doping policy that are connected to these three criteria. While there is a lack of empirical evidence that appropriately used performance-enhancing substances are harmful, there is evidence that the lack of medical supervision and access to safe medications is causing and allowing harm. There is also a lack of evidence that the substances on the Prohibited List enhance performance, yet they are imbued with this property by their presence on the list. Concerns that performance-enhancing substance use by successful athletes is coercive misplace the coercive influence. It may be that the strongest coercive influence comes from the labeling of a substance as performance-enhancing regardless of its biological effects. Modern, elite sport is a massive commercial enterprise that may itself violate the best intentions of an ill-defined ‘Spirit of Sport.’ Anti-doping policy has evolved and narrowed to serve an ideological purpose and in doing so has become a threat to the health and wellbeing of all individuals involved in fitness and sport

APIs and Researchers: The Emperor's New Clothes?

As part of the Europeana Cloud (eCloud) project, Trinity College Dublin investigated best practice in the use of web services, such as APIs, for accessing large data sets from cultural heritage collections. This research looked into the provision and use of APIs, and moreover, whether or not more customised programmatic access to datasets is what researchers want or need. In order to understand whether current patterns of API usage reflect a skills gap on the part of researchers or a mismatch of tool to purpose, we looked not only at the creators and developer/users of APIs, but also at humanists already re-using big data; approaches in cultural heritage institutions and other research infrastructures to bring API use to non-technical audiences; and the kinds of training and other support services available or emerging within the data-intensive humanities research lifecycle. We conducted both desk research and a series of 11 interviews with figures working as researchers, developers or data providers, including figures from both the API development and the data usage communities. This research, conducted under the eCloud project and supported by the European Commission’s ICT Policy and Support Programme (Grant number 325091), was begun in March 2014 and is now in its concluding validation stage. The results of the research are not yet finalised, but the contribution is already emerging of this work to the debate about APIs being either the way forward for digital cultural heritage collections, or the Emperor’s New Clothes (or maybe a bit of both)

The Emperor's new clothes: PDE5 and the heart

Phosphodiesterase-5 (PDE5) is highly expressed in the pulmonary vasculature, but its expression in the myocardium is controversial. Cyclic guanosine monophosphate (cGMP) activates protein kinase G (PKG), which has been hypothesized to blunt cardiac hypertrophy and negative remodeling in heart failure. Although PDE5 has been suggested to play a significant role in the breakdown of cGMP in cardiomyocytes and hence PKG regulation in the myocardium, the RELAX trial, which tested effect of PDE5 inhibition on exercise capacity in patients with heart failure with preserved ejection fraction (HFpEF) failed to show a beneficial effect. These results highlight the controversy regarding the role and expression of PDE5 in the healthy and failing heart. This study used one- and two-dimensional electrophoresis and Western blotting to examine PDE5 expression in mouse (before and after trans-aortic constriction), dog (control and HFpEF) as well as human (healthy and failing) heart. We were unable to detect PDE5 in any cardiac tissue lysate, whereas PDE5 was present in the murine and bovine lung samples used as positive controls. These results indicate that if PDE5 is expressed in cardiac tissue, it is present in very low quantities, as PDE5 was not detected in either humans or any model of heart failure examined. Therefore in cardiac muscle, it is unlikely that PDE5 is involved the regulation of cGMP-PKG signaling, and hence PDE5 does not represent a suitable drug target for the treatment of cardiac hypertrophy. These results highlight the importance of rigorous investigation prior to clinical trial design

Integrative advertising : the marketing 'dark side' or merely the emperor's new clothes?

This paper assesses the move towards more 'integrative advertising' methods which rely on the mixing of commercial and non-commercial content, and the suitability of the current EU legislative framework to deal with such developments. In essence, the paper examines the 'identification' and 'transparency' principles in the context of online advertising. This analysis allows for the drawing of conclusions vis-à-vis future policy initiatives and enforcement challenges. The paper states that for true advertising literacy mere identification of commercial communications is insufficient and that efforts need to be made in order to educate consumers (especially children) to allow for the continuing relevance and reliance on the notion of the average consumer

The emperor's new clothes : an epistemological critique of traditional chinese veterinary acupuncture

Research Areas: Veterinary Sciences.Article in International Journal.Simple Summary Complementary and alternative medicines have gained increased popularity in the veterinary field. Among them, Traditional Chinese Veterinary Medicine, including acupuncture, has emerged as one of the main alternatives to conventional veterinary medicine. This paper relies upon an epistemological approach to investigate conceptual, historical and scientific assertions about veterinary acupuncture made by their advocates. Argument by analogy is used to demonstrate that Traditional Chinese Veterinary Medicine is based on pre-scientific principles, similar to those of humoral medicine and bloodletting, and that acupuncture is, in effect, a placebo. The paper concludes with recommendations for veterinary regulators and colleagues. Abstract Within the last few decades, complementary and alternative medicines have gained increased popularity in the veterinary field. Although many authors have exposed the scientific fallacies and historical misconceptions used to justify such therapies, those efforts have not succeeded in detracting veterinary practitioners from embracing them. Notably, Traditional Chinese Veterinary Medicine (TCVM), including acupuncture, has emerged as one of the main alternatives to conventional veterinary medicine. In this paper, analogical reasoning is used to investigate conceptual, historical and scientific assertions made by the advocates of TCVM. The paper is divided into two parts: The first aims to appraise conceptual and historical claims made by veterinary acupuncturists. I defend that TCVM is a pre-scientific construct, similar to humoral doctrine, and that acupuncture is analogous to bloodletting. The second part is focused on scientific evidence of clinical application of acupuncture in the dog, showing how science is yet to validate veterinary acupuncture and defending that claims of efficacy are due to placebo effect. It is suggested that veterinary acupuncture needs to abandon Traditional Chinese Medicine and embrace science-based medicine tout court. On the other hand, high quality scientific studies, including randomized controlled trials, need to be presented. Veterinary regulators must bring the issue of non-conventional therapies into their agendas.info:eu-repo/semantics/publishedVersio

"The emperor's new clothes." Manoeuvre warfare and operational art

Wars can be categorised in a number of ways, for example according to the conduct during conflicts, the means used and with regard to the belligerents' strategy, aims and objectives. One reason for categorising is to add precision to the language so we can better develop proper theories and methods, thus aiming at improving our fighting capability. In the wake of these theoretical exercises, new terms and sometimes, old terms used in a new way, are introduced. Since the late 1970s, many lobbyists, military theorists and officers have described warfare in terms of a dichotomy: attrition and manoeuvre warfare. Manoeuvre warfare theory is a hybrid of selected historical examples and military theories developed under different contextual circumstances. The alleged paradigm shift in our approach to war has provided us with, or so we believe, a new methodology for conduct in war and the number of terms suited to describe an unambiguous theory. True manoeuvre warfare is expressed through operational art. This distinct approach to war has now been adopted by military forces throughout the western world. This thesis looks closer at what manoeuvre warfare aspires to be, in the context of its terminology, methodology and its different national expressions. The first part of the thesis is concerned with a comparative analysis of different national manoeuvre warfare doctrines by using general systems theory and non-linear dynamics. The analysis reveals that, what we call manoeuvre warfare theory, has expressions that contradict each other and differ to the extent that the theory exists only in name. The second part of the thesis is concerned with the historical substantiation of manoeuvre warfare. German military conduct, but first and foremost the Blitzkrieg-campaigns are often used to add credibility to the methods prescribed by manoeuvre theory. Some proponents of the theory have chosen General Guderian as the human manifestation of the true manoeuvrist. By using the Clausewitzian term "Centre of Gravity", essential in manoeuvre theory as a departure point, the second part of the thesis analyses German military conduct and thought prior to the Second World War and the campaign in France 1940. Emphasis in the second part is put on German planning prior to the campaign and the conduct of the Wehrmacht's Army Group A during the execution. The analysis reveals that the German military interpreted Clausewitz in a way that is not compatible with strategic thought in modem democratic societies. The German pursuit of military effectiveness led to a tacticisation of strategy. Battles of attrition were fought with the highest degree of mobility. German military thought in the 1930's, manifested in the field manual Truppenfihrung, reveals a pragmatic approach to war, which indicates that there was no Blitzkrieg concept as such. Army Group A's conduct during the campaign in France also contradicts many of the principles and the methodology prescribed by the manoeuvrists. It appears that the ambiguous terms and selective historical examples have been interpreted and distilled to a degree where they eventually conform to the manoeuvrist thought

The emperor's new clothes: the myth of indefeasibility of title in Saskatchewan

This thesis explores whether the doctrine of indefeasibility of title and its three associated principles – the mirror principle, the curtain principle, and the insurance principle – are mythical constructs, and not legal facts as they are portrayed in the dominant legal discourse and in traditional legal research sources. It is commonly understood that indefeasibility of title is the hallmark of land titles systems of registration, especially those based on the Torrens model, and Saskatchewan is a jurisdiction which operates such a system. When one examines the genesis of land titles systems and indefeasibility of title, Saskatchewan’s land titles statutes and recent court decisions, one discovers that there is a dichotomy between indefeasibility of title in practice and how it is portrayed in theory. Given that land titles systems of registration are statutory creations, it is more appropriate to utilize the language in the legislation and therefore to avoid reliance upon these constructs

Multiple instruments to change energy behaviour : the emperor's new clothes

Abstract: Over the last few decades, several instruments have evolved to deal with similar energy and environmental challenges. For instance, the economic literature prescribes separate tax or cap-and-trade systems to internalize negative environmental externalities and subsidies to internalize positive externalities such as R&D. However, policy is not straightforward because of the influence on cost and competition and concerns for regional employment, economic activity within certain industries, and any distributional effects. Tax discrimination, subsidies and regulations then undermine the efficiency of energy instruments. To balance any environmental concerns, other instruments, including green and white certificates, have been created. While innovative, these work as simple combinations of taxes and subsidies. While the extant literature thoroughly analyzes the partial effects of these instruments, there has been little focus on their basics and the effects of aggregate taxes and subsidies. This complexity calls for research on the efficiency of each instrument, including the administration and transaction costs associated with holding a large set of instruments. We should consider the coordination and simplification of policy tools before complicating the system further by introducing new, primarily equivalent, instruments. Keywords: energy instruments, taxes, subsidies, green certificates, white certificates, carbon taxesThe paper is based on a project partly funded by the Norwegian Research Counci