Covid-19 and the politics of hope: A comparative analysis of Greek and Ecuadorian letters from a desired post-pandemic future.

Covid-19 forced changes in everyday life upon large sections of the world's population, with lockdowns and social distancing measures effecting conditions of work and leisure for billions of people. In this context our research created a space in which people living in countries in Europe, North and South America, Asia, and Africa were invited to imagine what the future could look like - beyond the pandemic - by writing a Letter from the Future. In this paper we examine what these letters show about one particular relationship between the present and the future: a relationship of hope. In the context of major crises, and the complex experiences of loss they involve, the possibilities for hope becomes an urgent issue. We analyse a selection of responses from participants between 18 and 35 years-old, from Ecuador and Greece, to address two questions: (1) Do these letters express hope? (2) If so, in what ways is this hope political? Our answers to these questions have implications for understanding the nature, possibilities and politics of hope at times of crisis. They also have implications for futures studies: indicating the potential value of embedding the Letters from the Future method in a range of research contexts.

A meta-analysis of projected global food demand and population at risk of hunger for the period 2010-2050.

Quantified global scenarios and projections are used to assess long-term future global food security under a range of socio-economic and climate change scenarios. Here, we conducted a systematic literature review and meta-analysis to assess the range of future global food security projections to 2050. We reviewed 57 global food security projection and quantitative scenario studies that have been published in the past two decades and discussed the methods, underlying drivers, indicators and projections. Across five representative scenarios that span divergent but plausible socio-economic futures, the total global food demand is expected to increase by 35% to 56% between 2010 and 2050, while population at risk of hunger is expected to change by -91% to +8% over the same period. If climate change is taken into account, the ranges change slightly (+30% to +62% for total food demand and -91% to +30% for population at risk of hunger) but with no statistical differences overall. The results of our review can be used to benchmark new global food security projections and quantitative scenario studies and inform policy analysis and the public debate on the future of food.

Birth control policies in Iran: a public health and ethics perspective.

In less than one generation, a unique demographic transition has taken place in Iran. A population growth rate of 4.06% in 1984 fell to 1.15% in 1993 and a total fertility rate of 6.4 births per woman in 1984 declined to 1.9 in 2010. In 2012, Iranian policymakers shifted away from a birth control policy towards a pro-natalist policy. At first glance, this may seem reasonable since its goal is to avoid the consequences of an aging population. However, we argue that the policy package raises serious public health, socioeconomic, environmental and ethical concerns and is likely to fail on its own terms.

The views of quality improvement professionals and comparative effectiveness researchers on ethics, IRBs, and oversight.

Recently, there have been increasing numbers of activities labeled as either quality improvement (QI) or comparative effectiveness research (CER), both of which are designed to learn what works and what does not in routine clinical care settings. These activities can create confusion for researchers, Institutional Review Board members, and other stakeholders as they try to determine which activities or components of activities constitute clinical practices and which constitute clinical research requiring ethical oversight and informed consent. We conducted a series of semi-structured focus groups with QI and CER professionals to understand their experiences and views of the ethical and regulatory challenges that exist as well as the formal or informal practices and criteria they and their institutions use to address these issues. We found that most participants have experienced challenges related to the ethical oversight of QI and CER activities, and many believe that current regulatory criteria for distinguishing clinical practice from clinical research requiring ethical oversight are confusing. Instead, many participants described other criteria that they believe are more ethically appropriate. Many also described developing formal or informal practices at their institutions to navigate which activities require ethical oversight. However, these local solutions do not completely resolve the issues caused by the blurring of clinical practice and clinical research, raising the question of whether more foundational regulatory changes are needed.

Radically questioning the principle of the least restrictive alternative: a reply to Nir Eyal: Comment on "Nudging by Shaming, Shaming by Nudging".

In his insightful editorial, Nir Eyal explores the connections between nudging and shaming. One upshot of his argument is that we should question the principle of the least restrictive alternative in public health and health policy. In this commentary, I maintain that Eyal's argument undermines only a rather implausible version of the principle of the least restrictive alternative and I sketch two reasons for rejecting the mainstream and more plausible version of this principle.

Salvaging the concept of nudge.

In recent years, 'nudge' theory has gained increasing attention for the design of population-wide health interventions. The concept of nudge puts a label on efficacious influences that preserve freedom of choice without engaging the influencees' deliberative capacities. Given disagreements over what it takes genuinely to preserve freedom of choice, the question is whether health influences relying on automatic cognitive processes may preserve freedom of choice in a sufficiently robust sense to be serviceable for the moral evaluation of actions and policies. In this article, I offer an argument to this effect, explicating preservation of freedom of choice in terms of choice-set preservation and noncontrol. I also briefly explore the healthcare contexts in which nudges may have priority over more controlling influences.

The historical foundations of the research-practice distinction in bioethics.

The distinction between clinical research and clinical practice directs how we partition medicine and biomedical science. Reasons for a sharp distinction date historically to the work of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, especially to its analysis of the "boundaries" between research and practice in the Belmont Report (1978). Belmont presents a segregation model of the research-practice distinction, according to which research and practice form conceptually exclusive sets of activities and interventions. This model is still the standard in federal regulations today. However, the Commission's deliberations and conclusions about the boundaries are more complicated, nuanced, and instructive than has generally been appreciated. The National Commission did not conclude that practice needs no oversight comparable to the regulation of research. It debated the matter and inclined to the view that the oversight of practice needed to be upgraded, though the Commission stopped short of proposing new regulations for its oversight, largely for prudential political reasons.