Lupina Fellows 2003–2004

Kirstin Borgerson | Jillian Cohen | Oded Haklai | Sarah Hartley | Jyotica Kumar | Rodney Loeppky | Michael Pettit | Kathryn Trottier | Mark Zacher

Kirstin Borgerson
Lupina/OGS Doctoral Fellow

Biography: Kirstin Borgerson is a doctoral candidate in the Department of Philosophy at the University of Toronto. She completed her MA here at the U of T, and received her BA from the University of Saskatchewan. Kirstin’s research interests include philosophy of science, bioethics, feminist philosophy, and epistemology. She is the co-instructor of PHL100Y at the U of T this year. She is also a member of the U of T varsity women’s rowing team.

Project Abstract: “Understanding the Role of Scientific Evidence in Medicine”
The question of what counts as good evidence in medicine is of critical importance to both physicians and philosophers, and is vital to the future of health care. Given the current move toward ‘global bioethics’ and the need for standards of health-care treatments that can apply in a cross-cultural health care setting, determining what counts as good evidence is medicine is becoming more challenging. As a result of recent attention to ‘Evidence-based Medicine’, physicians have called for the development of a theory of evidence that encompasses the existence, nature and kinds of evidence, with particular attention to the medical field.

Much work has been done in philosophy of science on the project of defining ‘good evidence’. At the same time, the question of what counts as good evidence in medicine, especially given the current medical context, has yet to be fully addressed by contemporary philosophers, who have tended to focus their contributions to the field of medicine on issues arising within the scope of bioethics. In my research, I hope to clarify the requirements of 'good evidence' in medicine through 1) an in-depth investigation of the philosophical origins of 'evidence' and 2) a critical analysis of the more recent writing done on the subject of evidence from within the medical community.

In the first two years of my PhD program at the University of Toronto, I have applied myself to the task of understanding the philosophical issues at play in the contemporary debate over what counts as good evidence in medicine. My next challenge, in the final two years of my program, is to narrow my focus to the specific challenges presented to scientists by practitioners of alternative medicine who claim to have different standards of evidence.
I am interested in academic philosophy because I believe it has the potential to address the underlying differences that divide people on significant issues. Research into the role of evidence in medicine will increase understanding on the issues that tend to divide those within the medical community. I believe not only that this project is theoretically interesting, but also that it is practically relevant to Canadians, and to the future of health care in our multicultural nation. Go to Kirstin Borgerson's Working Paper.

Jillian Cohen
CPHS Lupina Post-Doctoral Fellow

Biography:Jillian Clare Cohen, PhD, is an Assistant Professor at the Leslie Dan Faculty of Pharmacy, University of Toronto. Her research is focused on drug access issues, the politics of international pharmaceutical policy, and ethics and corruption in pharmaceutical systems. In addition to her academic experience, Dr. Cohen has extensive “hands-on” experience in international pharmaceutical issues. She has worked on pharmaceutical policy for Unicef in New York City, the World Bank in Washington, DC, and she was the first person to be responsible for coordinating pharmaceutical policies between the World Bank and the World Health Organization in Latin America and the Caribbean. She has advised a myriad of governments on pharmaceutical policy issues including the Governments of Brazil, Bulgaria, Ecuador, Haiti, India, Ontario and Romania. She received her BA and MA in Political Science from McGill University and her PhD in Politics from New York University. She is a frequent lecturer on pharmaceutical policies in both Canada and abroad.

Project Abstract: In 2001, the global pharmaceutical market was estimated to be valued at over $397 billion at manufacturer’s selling prices - an increase of almost ten percent from 2000. The market is projected to grow at a healthy 7.8 percent annually to $406 billion in 2002 . Although these figures suggest a plentiful supply of pharmaceuticals, globally, the World Health Organization (WHO) reports that in 2000, over one-third of the world’s population still lack regular access to medicines for a myriad of reasons which includes financial barriers. If global public health demands are not being met by the pharmaceutical supply system today, the prospect for the future is of even greater concern given demographic trends, including the aging of the population and increased demand for pharmaceuticals which treat chronic diseases, such as tuberculosis and HIV/AIDS.

This research proposal seeks to set itself apart from other studies on drug pricing policy, by focusing on its determinants, rather than on its consequences. That is, it will examine how interest groups, institutions, and economics inform pharmaceutical pricing policies in two seemingly different jurisdictions – Canada and Brazil. By incorporating a political analysis methodology, I will investigate the political dimensions of pharmaceutical policymaking to investigate how well governments are providing drug coverage to marginalized groups in its population. Political analysis of health policy and pharmaceutical issues, more specifically, is not well-developed or applied in public health as health institutions are usually focused on epidemiological and economic analysis, and they rarely use systematic political analysis in policy reform efforts . This research will thus contribute to a nascent and important body of work that focuses on the politics of pharmaceutical policy. Go to Jillian Clare Cohen's Working Paper.

Oded Haklai
Lupina/OGS Doctoral Fellow

Biography: Oded Haklai is a doctoral candidate in the Department of Political Science at the University of Toronto. He completed his M.A. at UBC and his B.A at the Hebrew University, Jerusalem. Oded's research interests include: comparative politics, ethnic mobilization, nationalism, social and protest movements, state- society relations, and Middle Eastern politics. He published several articles in related fields and he has taught courses on Middle East politics in the Department of Political Science.

Project Abstract: My dissertation is entitled “Institutions, Institutional Change and the Evolution of Minority Strategies: The Palestinian Arab Citizens of Israel”. It deals with the impact of ethnic politics on the distribution of resources in Israel, primarily access to healthcare, education and land. I examine how the dynamics of intra-communal relations shape the constitution of the state, and how the norms embedded in the state, in turn, influence access to resources. The project also investigates how minorities respond to institutionalized disadvantage by trying to reconstitute the state so as to increase their access to resources. Go to Oded Haklai's Working Paper.

Sarah Hartley
Lupina/OGS Doctoral Fellow

Biography: I am (2003/4) in the fifth year of a PhD program in the Department of Political Science and The Institute for Environmental Studies at the University of Toronto. I work in the field of comparative politics and public policy with a focus on environmental risk. My thesis compares government responses to the environmental risks of agricultural biotechnology in Canada and the UK. But my interests extend to agricultural and environmental policy, science and public policy, ethics and public policy, international environmental policy, and the environmental impacts of trade policy.

I have a first class BSc Honours in Environmental Management and Policy from Middlesex University (UK), and received a distinction in a TransAtlantic MSc in Transatlantic Public Policy and the Global Economy from the University of Bath (UK) and the University of Toronto.

I have taught Topics in Comparative Politics: Values, Ethics and Public Policy at UofT and have worked as a TA for the Innis College Environmental Studies Program, the Division of the Environment, and the Department of Political Science. I have also been the recipient of a number of generous fellowships and awards, and have presented a number of papers at conferences.

Project Abstract: Advances in agricultural biotechnology during the 1980s produced new technological innovations in the form of genetically modified (GM) plants. The commercialisation Field trials and the ensuing commercialisation of these crops pressured governments to respond to new environmental risks. More than a decade later, clear differences in government policy responses have emerged across the Atlantic. In Canada, where the environmental risks associated with GM crops are considered to be minimal and manageable, commercial GM crops are now grown on over 3 million hectares of farmland. However, in Britain, a moratorium on the commercial planting of GM crops remains in place while farm-scale evaluation trials are conducted, alongside an innovative public debate about the broader risks of commercialisation.

In this doctoral research project, government policy responses in Canada and Britain are compared in order to better understand risk decision-making. I claim that the emergence of a “risk society” in Britain but not in Canada best explains the puzzle: it forced the British government into making institutional and policy changes. The idea of risk society has its origins in the work of Ulrich Beck, who claims that a risk society can be identified when the hegemony of science is undermined by the increasing development of risks in industrial society. The old structures from modernity lose legitimacy to be replaced by new decision-making mechanisms that address broader non-science considerations alongside scientific evidence. Beck's theory is a macro-sociological theory that has focused on social change. This project unpacks the concept of a risk society to increase its relevance for political decision-making, lays out the process of change, and investigates the factors that have facilitated or obstructed the causal relationship. Go to Sarah Hartley's Working Paper.

Jyotica Kumar
Lupina/OGS Doctoral Fellow

Biography: Coming soon!

Project Abstract: Ms. Kumar is completing a dissertation entitled, “Doctor-Patient Relationship in the Dynamics of Informed Consent: A Comparative Perspective on Judicial Decisions from India and Canada”. Go to Jyotica Kumar's Working Paper.

Rodney Loeppky
SSHRC & CPHS Lupina Post-Doctoral Fellow

Biography: Rodney Loeppky joined the Comparative Program on Health and Society in 2003, completing the second year of his SSHRC Postdoctoral Fellowship. Prior to joining CPHS, he was resident at the Department of Human and Community Development at the University of California, Davis. Rodney completed his B.A. at the University of Calgary, his M.A. at Carleton University and received his Ph.D. (Political Science) from York University in June, 2002. His research interests include: political economy and innovation; multilateral trade policy; the state in the advanced industrial context; biotechnology and genome science; and social policy (particularly health). His dissertation, entitled “The Political Economy of Large-Scale Science: The Emergence of the Human Genome Project,” is presently being reviewed for publication. He has been published in various academic journals, including Studies in Political Economy and Alternatives, as well as a recent edited volume, Globalization in the 21st Century (Palgrave).

Project Abstract: Currently, I am investigating ‘globalisation’ and multilateral trade regimes, as they relate to national approaches to economic innovation and health policy. My study focuses on the significance of the World Trade Organization -- especially the Agreements concerning Trade-Related Aspects of Intellectual Property (TRIPS) and Trade in Services (GATS) -- as an international framework for high-tech economic development and potential expansion of national health industries. The relationship between TRIPS and GATS may prove critical in a symbiotic way, as numerous advanced industrialized countries have pinned considerable expectations on biomedical economic development. Insofar as a multilateral agenda of technology-based growth relies on biomedical advance, it seems increasingly likely that there will be pressure to pry open the cost-containing elements of public health systems. In this regard, the historical, social and economic features of national approaches will also be crucial, to the extent that they are conducive or obstructive to such systemic change. Taking the U.S. and Germany as case studies, this research points to at least two critical developments: 1) that socio-historical structures in these states render highly differential effects from multilateral trade and economic pressures and 2) that the area of health may constitute one (perhaps there are others) powerful political brake on the global trend towards economic liberalization. Go to Rodney Loeppky's Working Paper.

Michael Pettit
Lupina/OGS Doctoral Fellowship

Biography: Mike Pettit’s research focuses on the history of the life and social sciences in the United States. His broader interests included the history of social movements, the American West, and the ‘social’ construction of human difference. Although historical in nature, his work is informed by the interdisciplinary approaches of science and technology studies (STS). In 2001, he completed his bachelor’s degree at the University of King’s College in Halifax where he graduated with first class honors in history and contemporary studies. Currently enrolled at the University of Toronto, he was president of the Graduate History Society 2002-3. He is a co-editor of www.racesci.org, a research and teaching resource dedicated to the critical study of the history of 'race' in science, medicine and technology. He is currently working on his doctoral dissertation in the history department at the University of Toronto: the historical ontology of deception in modern America.

Project Abstract: My dissertation research investigates the multiple meanings of ‘the science of deception’ in late nineteenth and early twentieth century America. I examine the historical framing of the cognitive state of deception in the arena between the social worlds of popular culture and science. During this period, a number of entrepreneurs produced a series of schemes and hoaxes involving significant scientific content. These public spectacles called upon the audience to inspect and engage with these objects in order to determine their nature and often their authenticity. This cultural practice expressed society’s confidence in the individual knower’s abilities, a faith that will largely erode by the early twentieth century. In a slightly later period, a number of psychologists, physiologists, and anthropologists were working out a scientific understanding of the processes by which the human body is deceived and deceives. Deception becomes an object of study for the emerging scientific disciplines whose subjects are medicine and society. As the state of deception becomes a scientific object its nature and definition change, a shift that generates new kinds of human subjects and experiences. My work relates these transformations to the discipline formation and institutionalization of these sciences. To gain both moral authority and economic support these sciences needed to establish their social utility. The culture of Progressive Era reform allowed these sciences to take on a social role in defining and detecting fraud, and preserving the moral health of the society. A central concern is the contested authority of expert knowledge in a democratic society. Go to Mike Pettit's Working Paper.

Kathryn Trottier
Lupina/OGS Doctoral Fellow

Biography: Kathryn Trottier is a doctoral candidate in the Department of Psychology. She received her M.A. degree in Abnormal, Personality and Social Psychology in 2002, also from the University of Toronto. Kathryn also works at the Toronto General Hospital’s Eating Disorders Program as a research associate and member of the treatment team. Dr. Janet Polivy and Dr. Peter Herman in the Department of Psychology supervise her research. In general, her research addresses the impact of society’s standards of thinness and beauty on the health and well being of young women. For example, her master’s thesis (which is forthcoming with the International Journal of Eating Disorders) addressed the impact of media messages about dieting and thinness on the eating behaviour and self-perceptions of undergraduate women. In this study, she found that exposure to unrealistic promises made in diet advertisements inspired young women to eat less in the laboratory relative to a control group. Moreover, a diet advertisement making more circumspect promises did not have an inspirational effect on these women. Her doctoral research is examining the impact of social comparisons of body weight on the eating behaviour, self-esteem, and body dissatisfaction of chronic dieters and non-dieters.

Project Abstract: In her doctoral research, Kathryn is examining the impact of social comparisons to others representing future possible selves on chronic dieters. The impact of social comparisons on self-evaluations and eating behavior has been considered in the dieting and eating disorders literature; however, these studies have focused on the effects of comparisons to idealized media images. Comparisons to peers may have an even greater impact on well being, as women are more likely to compare themselves to their peers and should be more likely to use peers as references for self-evaluation. In an initial study, participants read about a peer who was described as either average weight, overweight or thin. Participants then completed a series of self-perception measures followed by a taste-test wherein their food intake was surreptitiously measured. Results suggested that for restrained eaters, comparing oneself with a thin peer leads to diminished body satisfaction and appearance self-esteem, whereas comparing oneself with an overweight peer has no significant effects. One aim of subsequent studies will be to determine if the effects of comparisons to peers are equivalent to the effects of comparisons to media images. I expect that comparisons with peers will yield effects that are distinct from comparisons with media figures. This research aims to contribute to a better understanding of the maintenance of chronic dieting. Body-size related social comparisons may significantly contribute to restrained eaters’ decisions to diet, as well as to the breaking of their diets. Moreover, this research may elucidate a potential source of the lower self-esteem and body satisfaction characteristic of restrained eaters. Go to Kathryn Trottier's Working Paper.

Mark Zacher
Lupina Distinguished Visitor

Biography: Mark W. Zacher has a BA from Yale College and a PhD from Columbia University. Hehas been a member of the Department of Political Science at the University of British Columbia since 1965. He is presently Professor Emeritus. He was director of the Centre of International Relations from 1971-91 and is now a Research Fellow in the Centre. During the 2003-2004 academic year he is a Distinguished Visiting Fellow in the Comparative Program on Health and Society, Munk School of Global Affairs, University of Toronto. He is the author of Dag Hammarskjold's United Nations (1970) and International Conflicts and Collective Security, 1946-77: The United Nations, Organization of American States, Organization of African Unity, and Arab League (1979); the coauthor of Pollution, Politics and International Law: Tankers at Sea (1979), Managing International Markets: Developing Countries and the Commodity Trade Regime (1988), and Governing Global Networks: International Regimes for Transportation and Communications (1996); and the coeditor of Canadian Foreign Policy and the Law of the Sea (1979) and Canadian Foreign Policy and International Economic Regimes (1992). He is a fellow of the Royal Society of Canada and was the associate editor of International Organization from 1995-96. His main research interests are in the political development of international regimes and liberal international theory. His present research concerns the politics of international health cooperation and the design of decision-making institutions in international organizations and treaties. He has been a visiting fellow at the Centre for International Studies, London School of Economics; St. Antony’s College, Oxford University; and the Centre for International Studies and Clare Hall, Cambridge University.

Project Abstract: United by Contagion: The Political Evolution of Global Health Cooperation

Infectious diseases have been historically the most devastating transnational killer. States took measures (particularly quarantines in ports) to stem the spread of diseases, but they had little impact. Starting in 1851 the Western countries and a few Middle Eastern states began to convene international conferences to agree on measures that would stem the transmission of pandemic diseases, especially from South Asia to the Middle East and Europe. It was only in the 1890s that advances in medical science made it possible for states to agree on control measures, and they were integrated into the International Sanitary Regulations of 1903. The International Sanitary Regulations (retitled the International Health Regulations in 1969) contained physical health standards for ships and planes, behavioral standards of what port authorities should do and could do, and disease reporting rules for states and the International Organization for Public Hygiene (now the World Health Organization). The International Health Regulations (IHRs) flowed as much from Western maritime states’ desire to prevent excessive measures against infected vessels as it did from a concern to prevent the international spread of diseases. Over the following century the IHRs were revised regularly, but they had little support from most states.

This study traces the character and fate of the IHRs, related international efforts to stem the spread of infectious diseases, and international health assistance programs--and the conditions that account for the major dimensions of the regime. It portrays a rather weak and patchwork pattern of international cooperation and argues that the same advances in medical science that facilitated international health cooperation in the first place soon undermined states’ support for the regime. This weakening existed from 1903 through the 1970s.

The regime began to change in the 1980s with the emergence of HIV/AIDS—followed by the outbreaks of several traditional pandemic diseases and of several dozen so-called “emerging diseases. The latter included a number of hemmoraghic diseases such as Ebola and then SARS. SARS is particularly important because the disease spread to and killed people in industrialized countries. Also, SARS spread from a developed country to other developed countries as well as developing countries. SARS created a very different environment for international health cooperation that is like to change the nature and scope of international health collaboration for the rest of this decade. We are now the midst of fashioning a new and stronger pattern of international collaboration although its institutional character will encompass a very varied pattern of cooperation involving states, non-governmental organizations, and intergovernmental institutions.

The study sets the pattern of international health cooperation in the context of a variety of literatures concerning international regimes. It argues inter alia that modern scientific theories and technology can undermine international interdependence and cooperation as much as they can strengthen it. Also, non-governmental organizations can strength regimes as much as they weaken them. The roots of collaboration and unilateralism are multiple and complex. Go to Mark Zacher's Working Paper.