Diethylstilbestrol standard

Stephen John has recently suggested that the ethics of communication yields important insights as to how values should be incorporated into science. In particular, he examines cases of "wishful speaking" in which a scientific actor (e.g. a tobacco company) endorses unreliable conclusions in order to obtain the consequences of the listener treating the results as credible. He concludes that what is wrong in these cases is that the speaker surreptitiously relies on values not accepted by the hearer, violating what he terms "the value-apt ideal". I expand on this view by integrating into it Miranda Fricker's account of testimonial injustice. I find testimonial injustice can arise in a manner unanticipated by Fricker, specifically that a credibility excess given to a speaker typically reduces the ability of others in the epistemic community to transmit knowledge, a phenomenon I term "collateral epistemic injustice". I argue that this possibility entails that receivers have an ethical obligation to assign credibility judiciously. A further consequence of this view is that the value-apt ideal is insufficient. Because audience members have an obligation to assign credibility judiciously, a speaker cannot merely rely on shared values, they must also be open about the extent to which their conclusions depend on those values. Thus, both wishful speaking and obscuring the value-dependent nature of a conclusion makes one an unreliable source of information. Accordingly, other community members have an ethical obligation to ignore a speaker that frequently engages in either.

Use of exogenous estrogens in manipulating the androgenestrogen equilibrium was one of the earliest therapeutic strategies developed to treat prostate cancer which followed close on heels the discovery of hormone dependence of this tumor. Despite its well-documented benefit, estrogen therapy fell out of favor with the advent of other forms of androgen deprivation therapy (ADT) as the former registered a higher incidence of cardiovascular complications and poorer overall survival. Clearer understanding of the mechanism of action of estrogen coupled with the adoption of alternative routes of administration has triggered a renewed interest in estrogen therapy. Since then, many studies have not only proved the therapeutic benefit of estrogens but also explored the ways and means of minimizing the dreaded side effects deterring its use. Further, the fact that estrogen therapy offered a clear advantage of reduced cost of treatment over other treatments has led many countries to readopt it in the treatment of advanced prostatic cancer. We reviewed the published data on the use of estrogens in CRPC, which may affect its revival as an efficacious treatment option having minimal side effects, with modified dosage and route of administration. Estrogen therapy would be a less expensive option having equivalent or even better therapeutic effect than ADT in advanced carcinoma of prostate.