Dien Ho

Massachusetts College of Pharmacy and Health Sciences, School of Arts and Sciences, Faculty Member

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Dien Ho, PhD, is a Professor of Philosophy and Healthcare Ethics at the Massachusetts College of Pharmacy and Health Sciences. He is also the Chair of the Center for Health Humanities. His recent research areas include the philosophy of medicine, placebo study, healthcare ethics, and the philosophy of science. He was born in Hong Kong and emigrated to the US when he was 13. In addition to his love for philosophy, he is also passionate about bicycles and zombies.

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Books by Dien Ho

What Placebos Teach Us about Health and Care: A Philosopher Pops a Pill

Placebo effects raise some fundamental questions concerning the nature of clinical and medical re... more Placebo effects raise some fundamental questions concerning the nature of clinical and medical research. This Element begins with an overview of the different roles placebos play, followed by a survey of significant studies and dominant views about placebo mechanisms. It then critically examines the concept of placebo and offers a new definition that avoids the pitfalls of other attempts. The main philosophical lesson is that background medical theories provide the ontology for clinical and medical research. Because these theories often contain incoherent and arbitrary classifications, the concept of placebo inherits the same messiness. The Element concludes by highlighting some impending challenges for placebo studies.

A Philosopher Goes to the Doctor: A Critical Look at Philosophical Assumption in Medicine

Routledge, 2019

This book sheds light on important philosophical assumptions made by professionals working in cli... more This book sheds light on important philosophical assumptions made by professionals working in clinical and research medicine. In doing so, it aims to make explicit how active philosophy is in medicine and shows how this awareness can result in better and more informed medical research and practice.

It examines: what features make something a scientific discipline; the inherent tensions between understanding medicine as a research science and as a healing practice; how the “replication crisis” in medical research asks us to rethink the structure of knowledge production in our modern world; whether explanations have any real scientific values; the uncertainties about probabilistic claims; and whether it is possible for evidence-based medicine to truly be value free. The final chapter argues that the most important question we can ask is not, “How can we separate values from science?” but, “In a democratic society, how can we decide in a politically and morally acceptable way what values should drive science?”

Philosophical Issues in Pharmaceutics: Development, Dispensing, and Use

Springer, 2017

This anthology provides a collection of new essays on ethical and philosophical issues that conce... more This anthology provides a collection of new essays on ethical and philosophical issues that concern the development, dispensing, and use of pharmaceuticals. It brings together critical ethical issues in pharmaceutics that have not been included in any collection (e.g., the ethics of patients as researchers). In addition, it includes philosophical issues that are not within the traditional domain of applied ethics. For example, a game-theoretic approach to combating the emergence of antibiotic-resistent pathogens by spreading altruism. A tripartite distinction provides an organized series of discussions that shows the interrelatedness of philosophical issues from the creation of pharmaceuticals, the creation of demand for them, through their delivery to their ultimate consumption.

Papers by Dien Ho

New theory of placebos reframes mind-body problem

Institute of Arts and Ideas, 2024

The placebo effect has puzzled scientists for centuries. Philosopher Dien Ho argues that we now k... more The placebo effect has puzzled scientists for centuries. Philosopher Dien Ho argues that we now know how it works, and that this should transform our understanding of the relationship between mind and body. We must stop thinking of improvements in health due to placebo as somehow less real than those due to other medicines: there can no longer be a clean distinction between ill-health that’s “all in the head” and ill-health that involves a malfunctioning body. Ho argues that our improved understanding of placebos means that doctors should now harness their power in treatment, especially since research shows that they can be effective even when patients are told that they’re taking a placebo.

Love in the Time of Antibiotic Resistance: How Altruism Might Be Our Best Hope

Philosophical Issues in Pharmaceutics, 2017

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SPECIAL ISSUE ON THE EMERGENCE OF ANALYTIC PHILOSOPHY IN EAST ASIA FROM THE EDITORS

by Yi Jiang and Dien Ho

the session was organized and chaired by Dien Ho and arranged under the auspices of the APA Commi... more the session was organized and chaired by Dien Ho and arranged under the auspices of the APA Committee on Asian and Asian American Philosophers and Philosophies. This special issue contains four essays in the history of philosophy that describe the development of analytic philosophy in China, Korea, Taiwan, and Hong Kong. This list unfortunately does not include Japan or Macau. 1 And while there is some discussion in the essays of supranational influence (especially from mainland China to Taiwan and Hong Kong and of course British and North American influence), there is room for more historical work tracing the regional connections in the history of analytic philosophy both more broadly within East Asia and across Asia more widely (in this vein, Ting-an Lin's paper points to the establishment, in the 1990s, of regional collaborations in the philosophy of science between Taiwan, Japan, and Korea, and of their role in fostering analytic philosophy in the region).

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A Call to Revise the Declaration of Helsinki’s Placebo Guidelines

Cambridge Quarterly of Healthcare Ethics

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Recommendations for the development, implementation, and reporting of control interventions in efficacy and mechanistic trials of physical, psychological, and self-management therapies: the CoPPS Statement

BMJ

The design, conduct, and reporting of control interventions are fundamental for interpreting effi... more The design, conduct, and reporting of control interventions are fundamental for interpreting efficacy and mechanistic clinical trials of physical, psychological, and self-management interventions We developed this guideline using a three-round Delphi study with 64 experts in placebo research and/or clinical trials. This panel was presented with a systematic review of control and blinding methods and a meta-analysis that linked design features to trial endpoints. Consensus items informed interviews with eight patient partners. Finally, 44 Delphi participants and two patient representatives discussed the draft manuscript and results from stakeholder interviews at online consensus meetings For clinical trials of treatment efficacy or mechanisms, we recommend designing control interventions that are as similar as possible to the tested intervention, apart from the components examined by the study Structured planning, early stakeholder engagement, feasibility work, and piloting will improve the quality and acceptability of control interventions When participant blinding is an objective, blinding effectiveness should be routinely assessed and reported Detailed and transparent reporting will improve the interpretation and repeatability of clinical trials on 25 May 2023 by guest. Protected by copyright.

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Disability and uncertainty: How to proceed when we do not know

Surgery, 2022

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The Pandemic Dilemma: When Philosophy Conflicts with Public Health

cambridge quarterly of healthcare ethics, 2022

One of the most heartbreaking aspects of the COVID-19 pandemic is how we ignored the warnings epi... more One of the most heartbreaking aspects of the COVID-19 pandemic is how we ignored the warnings epidemiologists and infectious disease experts had been sounding for decades. The question had always been a matter of when and not if a global infectious crisis would occur. Yet, when COVID-19 began to spread around the world, country after county was caught flatfooted, woefully unprepared both materially and strategically. The cause of our collective failure stems less from skepticism toward what scientists and epidemiologists have been telling us; instead, a number of social and political institutions provide strong disincentives to proper preparation, as I will argue. Three examples stand out: representational democracy, a state's obligation to its citizens, and unfettered dissemination and consumption of information. These institutions and practices are deeply entrenched and highly valued in the United States. If they are indeed barriers to effective responses to a pandemic, then we must consider if and to what extent we are willing to sacrifice them in combating the next global threat. Consider the political leadership and foresight needed to prepare for a pandemic. The early days of COVID-19 painfully revealed our lack of critical resources such as personal protective equipment (PPE) ventilators, logistical networks to mobilize personnel, and clinical space. It took the Center for Disease Control over a year from the start of the outbreak to acknowledge that COVID-19 spreads largely through airborne particles; the usefulness of masks in mitigating the contagion might have been uncertain in the early months. But the possibility, if not likelihood, of an airborne pathogen was surely well-known to public health officials, especially given the warnings coming from Asia. The lack of PPE was not the result of SARS-CoV-2 catching us off guard with a novel vector of infection; rather, it was our political failure to prepare for a likely scenario. This failure can be partly attributed to political systems that reward short-term achievements over long-term catastrophic preparations. In the United States, federal election cycles range from 2 years (House of Representatives) to 4 years (President) to 6 years (Senate). Elected officials need to deliver tangible political results if they are to make a convincing case for their reelection. Spending tax dollars stockpiling PPE that might or might not prove visionary is a risky reelection strategy. If a pandemic hits, voters see the preparation as par for the course. If a pandemic does not hit, a politician has little to show except a warehouse filled with soon-to-expire supplies. Preparing for a pandemic constitutes a kind of "invisible project" that, if done right, is invisible to the average voter. It is akin to infrastructure maintenance. So long as water comes out of the tap, the badly corroded water main remains hidden and out of the mind of voters. A shiny new school makes for a great photo-op; a newly installed sewer line hardly garners the same enthusiasm. Without the buy-in from voters to spend their tax dollars on public health preparation, a political leader has little to no incentive to do what is necessary. Representational democracy with relatively short election cycles might be particularly vulnerable to unpreparedness. As COVID-19 vaccines became available, it was apparent that as much as many wealthy countries were committed to ensuring that poorer ones had access to the vaccines, several states including the United States, Russia, and China initially opted out of collaborative efforts such as World Health Organization-sponsored COVAX. Even among those who participate in it, there have been reports of "side deals" between wealthier countries and pharmaceutical companies to guarantee these countries'

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Pharmacist Ethics

International Encyclopedia of Ethics, 2013

Commentary: Harm, Truth, and the Nocebo Effect

Cambridge Quarterly of Healthcare Ethics

Nocebo effects occur when an individual experiences undesirable physiological reactions caused by... more Nocebo effects occur when an individual experiences undesirable physiological reactions caused by doxastic states that are not a treatment’s core or characteristic features.1 As Scott Gelfand2 points out, there are numerous studies that have shown that the disclosure of a treatment’s side effects to a patient increases the risk of the side effects. From an ethical point of view, nocebo effects caused by the disclosures of side effects present a challenging problem. On the one hand, clinicians’ duty to inform patients of the consequences (including possible side effects) of their treatments is critical in ensuring that patients’ autonomy is respected. Patients cannot act autonomously if relevant information is withheld from them (without their consent, perhaps). On the other hand, clinicians also ought to minimize harm to patients.

Do medical schools teach medical humanities? Review of curricula in the United States, Canada and the United Kingdom

Journal of Evaluation in Clinical Practice, 2021

Rationale and objectives: Medical humanities are becoming increasingly recognized as positively i... more Rationale and objectives: Medical humanities are becoming increasingly recognized as positively impacting medical education and medical practice. However, the extent of medical humanities teaching in medical schools is largely unknown. We reviewed medical school curricula in Canada, the UK and the US. We also explored the relationship between medical school ranking and the inclusion of medical humanities in the curricula. Methods: We searched the curriculum websites of all accredited medical schools in Canada, the UK and the US to check which medical humanities topics were taught, and whether they were mandatory or optional. We then noted rankings both by Times Higher Education and U.S. News and World Report and calculated the average rank. We formally explored whether there was an association between average medical school ranking and medical humanities offerings using Spearman's correlation and inverse variance weighting meta-analysis. Results: We identified 18 accredited medical school programmes in Canada, 41 in the UK, and 154 in the US. Of these, nine (56%) in Canada, 34 (73%) in the UK and 124 (80%) in the US offered at least one medical humanity that was not ethics. The most common medical humanities were medical humanities (unspecified), history, and literature (Canada); sociology and social medicine, medical humanities (unspecified), and art (UK); and medical humanities (unspecified), literature and history (US). Higher ranked medical schools appeared less likely to offer medical humanities. Conclusions: The extent and content of medical humanities offerings at accredited medical schools in Canada, the UK and the US varies, and there appears to be an inverse relationship between medical school quality and medical humanities offerings. Our analysis was limited by the data provided on the Universities' websites. Given the potential for medical humanities to improve medical education and medical practice, opportunities to reduce this variation should be exploited.

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Harm, Truth, and the Nocebo Effect

Cambridge Quarterly of Healthcare Ethics, 2020

Narratives, Values, and Medicine

December 2, 2019

Why Construing Theories of Depression as Lakatos' Research Programs Might Spell Trouble for their Proponents

Love in the Time of Antibiotic Resistance: How Altruism Might Be Our Best Hope

Antibiotic-resistant bacteria pose a serious threat to our health. Our ability to destroy deadly ... more Antibiotic-resistant bacteria pose a serious threat to our health. Our ability to destroy deadly bacteria by using antibiotics have not only improved our lives by curing infections, it also allows us to undertake otherwise dangerous treatments from chemotherapies to invasive surgeries. The emergence of antibiotic resistance, I argue, is a consequence of various iterations of prisoner’s dilemmas. To wit, each participant (from patients to nations) has rational self-interest to pursue a course of action that is suboptimal for all of us. The standard solutions to prisoner’s dilemma look to realign cost-benefit such that individuals’ interests match those of the collective. However, the lack of a global organization to enforce an effective carrot-and-stick system makes it unlikely that we can solve the antibiotic resistance problem this way. I argue that our best chance might be an attempt to teach altruism and convince individuals to act not out of their self-interests.

Keeping it Ethically Real

Many clinical ethicists have argued that ethics expertise is impossible. Their skeptical argument... more Many clinical ethicists have argued that ethics expertise is impossible. Their skeptical argument usually rests on the assumptions that to be an ethics expert is to know the correct moral conclusions, which can only be arrived at by having the correct ethical theories. In this paper, I argue that this skeptical argument is unsound. To wit, ordinary ethical deliberations do not require the appeal to ethical or meta-ethical theories. Instead, by agreeing to resolve moral differences by appealing to reasons, the participants agree to the Default Principle—a substantive rule that tells us how to adjudicate an ethical disagreement. The Default Principle also entails a commitment to arguments by parity, and together these two methodological approaches allow us to make genuine moral progress without assuming any deep ethical principles. Ethical expertise, in one sense, is thus the ability and knowledge to deploy the Default Principle and arguments by parity.

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Making Ethical Progress without Ethical Theories

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The Gen-Ethics Bowl – An In-Class Activity Combining Genetics and Bioethics

by Dien Ho and Janet De Souza-Hart

Recent advances in genetics have transformed the mere possibilities of genetic testing and pre-im... more Recent advances in genetics have transformed the mere possibilities of genetic testing and pre-implantation genetic diagnosis into clinical realities. Although undergraduate science professors are able to explicate the science behind these new technologies, they are not always ready to discuss the ethical and social impacts of these new practices. In order to introduce to our students the complex ethical and social issues raised by these genetic procedures, we created a week-long interactive and interdisciplinary “Gen-Ethics Bowl.” The aim is to provide the conceptual tools necessary for our students to identify ethical and social issues that often go unnoticed in a genetics course that covers only the scientific aspects. Our hope is that the Gen-Ethics Bowl will be one of many steps in training our students to become socially responsible and morally sensitive scientists.

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