One of the most common contemporary approaches for developing an ethics of artificial intelligence (AI) involves elaborating guiding principles. This essay explores the limitations of this approach, using the history of bioethics as a comparative case. The examples of bioethics and recent AI ethics suggest that principles are difficult to implement in everyday practice, fail to direct individual action, and can frequently result in a pure proceduralism. The essay encourages an additional attention to virtue, which forms the dispositions of actors, (...) directs them to valued ends, and encourages right action in particular situation to complement principles. Practices and professions like medicine or warfighting that already have rich traditions of reflection on virtue ethics will be especially fruitful fields for developing an AI ethics of virtue. (shrink)

This essay introduces this special issue on virtue ethics in relation to military AI. It describes the current situation of military AI ethics as following that of AI ethics in general, caught between consequentialism and deontology. Virtue ethics serves as an alternative that can address some of the weaknesses of these dominant forms of ethics. The essay describes how the articles in the issue exemplify the value of virtue-related approaches for these questions, before ending with thoughts for further research.

Ground Representationism is the position that for each phenomenal feature there is a representational feature that accounts for it. Against this thesis, Ned Block (The Puzzle of Phenomenal Precision, 2015) has provided an intricate argument that rests on the notion of “phenomenal precision”: the phenomenal precision of a percept may change at a different rate from its representational counterpart. If so, there is then no representational feature that accounts for a specific change of this phenomenal feature. Therefore, (...) Ground Representationism cannot be generally true. -/- Although the notion of phenomenal precision is intuitive, it is admittedly in need of clarification. Here I reconstruct Block’s argument by suggesting a way of estimating phenomenal precision that is based on the assumption that parts of perceptual wholes can share phenomenal features independently of their place in the whole. Understood like this, the overall argument shows what it is supposed to show. -/- A more thorough look at the notion of phenomenal precision suggests tension with Block’s other work: in order to be non-trivial, we have to accept that some of our phenomenality is not concrete, but only generic. Such “solely generic phenomenology”, however, is a position mainly held by opponents to Block’s Access- vs. Phenomenal Consciousness-distinction. Interpreting phenomenal imprecision as constituted by introspective imprecision does not suffice as a way out. It seems that phenomenal precision is either trivial, self-contradictory, or incompatible with Block’s position elsewhere. So some additional elucidation on this crucial notion is needed. (shrink)

Precision medicine is an emerging approach to treatment and disease prevention that relies on linkages between very large datasets of health information that is shared amongst researchers and health professionals. While studies suggest broad support for sharing precision medicine data with researchers at publicly funded institutions, there is reluctance to share health information with private industry for research and development. As the private sector is likely to play an important role in generating public benefits from precision medicine (...) initiatives, it is important to understand what the concerns are and how they might be mitigated. This study reports outcomes of a deliberative method of citizen engagement in Singapore that asked whether sharing precision medicine data with private industry would be permissible, and if so, under what circumstances. Findings from this citizens’ jury suggest sharing with industry would be permissible under certain conditions that are set out in nine recommendations. Implications of the recommendations and their underlying assumptions for policy decision makers are discussed. This study aligns with prior international studies which found conditional acceptance for data sharing with private industry, a public benefit requirement, specific reluctance to share with insurance companies and an emphasis on accountability and transparency to demonstrate trustworthiness. However, our results differ from prior studies in that opt-in consent did not dominate the deliberations as jurors were able to set it aside as an assumed prerequisite for participation in a precision medicine programme. (shrink)

Marine chronometers, often considered precision instruments, proliferated in navigational practices during the nineteenth century. This paper examines their use in the hands of naval officers in the early-nineteenth century. It argues that both the instruments and their operators required careful management and regulation. In addition, officers learnt and adapted observatory practices relating to the process of data collection and management. Through these means, chronometric data was collected, organized, and reduced to negotiate accurate results.

Although continued investments in nanotechnology are made, atomically precise manufacturing (APM) to date is still regarded as speculative technology. APM, also known as molecular manufacturing, is a token example of a converging technology, has great potential to impact and be affected by other emerging technologies, such as artificial intelligence, biotechnology, and ICT. The development of APM thus can have drastic global impacts depending on how it is designed and used. This paper argues that the ethical issues that arise from APM (...) - as both a standalone technology or as a converging one - affects the roles of stakeholders in such a way as to warrant an alternate means furthering responsible innovation in APM research. This paper introduces a value-based design methodology called Value Sensitive Design (VSD) that may serve as a suitable framework to adequately cater to the values of stakeholders. Ultimately, it is concluded that VSD is a strong candidate framework for addressing the moral concerns of stakeholders during the preliminary stages of technological development. (shrink)

The United States’ ambitious Precision Medicine Initiative proposes to accelerate exponentially the adoption of precision medicine, an approach to health care that tailors disease diagnosis, treatment, and prevention to individual variability in genes, environment, and lifestyle. It aims to achieve this by creating a cohort of volunteers for precision medicine research, accelerating biomedical research innovation, and adopting policies geared toward patients’ empowerment. As strategies to implement the PMI are formulated, critical consideration of the initiative's ethical and sociopolitical (...) dimensions is needed. Drawing on scholarship of nationalism and democracy, we discuss the PMI's construction of what we term “genomic citizenship”; the possible normative obligations arising therefrom; and the ethical, legal, and social challenges that will ensue. Although the PMI is a work in progress, discussion of the existing and emerging issues can facilitate the development of policies, structures, and procedures that can maximize the initiative's ability to produce equitable and socially sensitive outcomes. Our analysis can also be applied to other population-based, precision medicine research programs. (shrink)

We construct four models containing one supercompact cardinal in which level by level equivalence between strong compactness and supercompactness and level by level inequivalence between strong compactness and supercompactness are precisely controlled at each non‐supercompact measurable cardinal. In these models, no cardinal κ is ‐supercompact, where is the least inaccessible cardinal greater than κ.

BackgroundIn precision medicine biomarkers stratify patients into groups that are offered different treatments, but this may conflict with the principle of equal treatment. While some patient characteristics are seen as relevant for unequal treatment and others not, it is known that they all may influence treatment decisions. How biomarkers influence these decisions is not known, nor is their ethical relevance well discussed.MethodsWe distributed an email survey designed to elicit treatment preferences from Norwegian doctors working with cancer patients. In a (...) forced-choice conjoint analysis pairs of hypothetical patients were presented, and we calculated the average marginal component effect of seven individual patient characteristics, to estimate how each of them influence doctors’ priority-setting decisions.ResultsA positive biomarker status increased the probability of being allocated the new drug, while older age, severe comorbidity and reduced physical function reduced the probability. Importantly, sex, education level and smoking status had no significant influence on the decision.ConclusionBiomarker status is perceived as relevant for priority setting decisions, alongside more well-known patient characteristics like age, physical function and comorbidity. Based on our results, we discuss a framework that can help clarify whether biomarker status should be seen as an ethically acceptable factor for providing unequal treatment to patients with the same disease. (shrink)

Solidarity is a fundamental social value in many European countries, though its precise practical and theoretical meaning is disputed. In a health care context, I agree with European writers who take solidarity normatively to mean roughly equal access to effective health care for all. That is, solidarity includes a sense of justice. Given that, I will argue that precision medicine represents a potential weakening of solidarity, albeit not a unique weakening. Precision medicine includes 150 targeted cancer therapies (mostly (...) for metastatic cancer), all of which are extraordinarily expensive. Our critical question: Must a commitment to solidarity as defined mean that all these targeted cancer therapies should be guaranteed to all within each country in the European Union, no matter the cost, no matter the degree of effectiveness? Such a commitment would imply that cancer was ethically special, rightfully commandeering unlimited resources. That in itself would undermine solidarity. I offer multiple examples of how current and future dissemination of these targeted cancer drugs threaten a commitment to solidarity. An alternative is to fund more cancer prevention efforts. However, that too proves a threat to solidarity. Solidarity, with or without a sense of justice, is too abstract a notion to address these challenges. Further, we need to accept that we can only hope to achieve “rough justice” and “supple solidarity.” The precise practical meaning of these notions needs to be worked out through a fair and inclusive process of rational democratic deliberation, which is the real and practical foundation of just solidarity. (shrink)

Precision Medicine has become a common label for data-intensive and patient-driven biomedical research. Its intended future is reflected in endeavours such as the Precision Medicine Initiative in the USA. This article addresses the question whether it is possible to discern a new ‘medical cosmology’ in Precision Medicine, a concept that was developed by Nicholas Jewson to describe comprehensive transformations involving various dimensions of biomedical knowledge and practice, such as vocabularies, the roles of patients and physicians and the (...) conceptualisation of disease. Subsequently, I will elaborate my assessment of the features of Precision Medicine with the help of Michel Foucault, by exploring how precision medicine involves a transformation along three axes: the axis of biomedical knowledge, of biomedical power and of the patient as a self. Patients are encouraged to become the managers of their own health status, while the medical domain is reframed as a data-sharing community, characterised by changing power relationships between providers and patients, producers and consumers. While the emerging Precision Medicine cosmology may surpass existing knowledge frameworks; it obscures previous traditions and reduces research-subjects to mere data. This in turn, means that the individual is both subjected to the neoliberal demand to share personal information, and at the same time has acquired the positive ‘right’ to become a member of the data-sharing community. The subject has to constantly negotiate the meaning of his or her data, which can either enable self-expression, or function as a commanding Superego. (shrink)

Both in the case of colloquial language and in the case of specialized scientific language we always have to face the essential issue : what must we do in order not to be misled by an incorrect use of language? When we refer in general to being misled by some use of language we have two cases in mind: primo, when the language in question wrongly performs its communicative function so that the speaker is unable to convey his ideas to (...) the listener, and, secundo, when the language by means of which we think imposes on us, through its structure and forms fixed by tradition (in the case of natural languages), incorrect ideas about reality (cf. the issues of hypostases). The causes of such and similar difficulties are varied. These difficulties, among other things, suggest the idea that language is not only an instrument, but also an object of research, an idea which induced twentieth century philosophers to engage in the study of language in its ontological, gnosiological, and methodological aspects. The method of semantic analysis, understood as a method of analysis of meanings of words, is directed precisely against these shortcomings of language. That method is meant to prevent semantic and logical errors that encumber the process of thinking with difficulties and hamper communication both with others and with oneself. Among other causes, these errors are due to the ambiguity and vagueness of words. (shrink)

Precision medicine functions by grouping patients along genetic, molecular, and related ‘-omics’ factors. This stratification relies on large, growing databases of patient-volunteered information. Both private companies and government bodies incentivize patients to volunteer this genetic information appealing to the creation of collaborative patient partnerships and the concept of empowerment. This paper aims to address two related questions: (1) what is the actual nature of patient participation in precision medicine research? And (2) is this participation in precision medicine (...) research really that empowering for the average patient? I contend that firstly, the nature of this participation is best conceived of as merely contributory. Contributory participation, as it will be shown, falls short of collaboration. The partnership created by participation in precision medicine research is not one of sharing values, equal say in decisions, or shared benefit. Secondly, I contend that there are important caveats to claims that patient participation in precision medicine is empowering. Empowerment is hindered by the type of participation, the practical use or actionability of genetic data, genetic literacy, the cost of precision drugs for patients that qualify for them, and bioethical considerations of informed consent. (shrink)

The success of precision medicine depends on obtaining large amounts of information about at-risk populations. However, getting consent is often difficult. Why? In this commentary I point to the differentials in social status involved. These differentials are inevitable once personal information is surrendered, but are particularly intense when the studied populations are socioeconomically or socioculturally disadvantaged and/or ethnically stigmatized groups. I suggest how the deep distrust of the latter groups can be partially justified as a lack of confidence that (...) their core values or interests will sufficiently be taken into account. Hence, the ethical challenge here lies not in avoiding status differentials, but in dealing with them appropriately. Scientists should not assume trust from others but adopt a norm of “demonstrating trustworthiness”. (shrink)

Autism Spectrum Condition presents a challenge to social and relational accounts of the self, precisely because it is broadly seen as a disorder impacting social relationships. Many influential theories argue that social deficits and impairments of the self are the core problems in ASC. Predictive processing approaches address these based on general purpose neurocognitive mechanisms that are expressed atypically. Here we use the High, Inflexible Precision of Prediction Errors in Autism approach in the context of cultural niche construction to (...) explain atypicalities of the relational self, specifically its minimal, extended, and intersubjective aspects. We contend that the social self in ASC should not be seen as impaired, but rather as an outcome of atypical niche construction. We unpack the scientific, ethical, and practical consequences of this view, and discuss implications for how the challenges that autistic persons face should be approached. (shrink)

1. Sometimes perceptual experience is crystal clear, as when one inspects an object close-up in bright light with corrective lenses. But experience can be less clear. To illustrate how experiences...

Precision medicine and digital phenotyping are two prominent data-based approaches within digital medicine. While precision medicine historically used primarily genetic data to find targeted treatment options, digital phenotyping relies on the usage of big data deriving from digital devices such as smartphones, wearables and other connected devices. This paper first focusses on the aspect of data type to explore differences and similarities between precision medicine and digital phenotyping. It outlines different ways of data collection and production and (...) the consequences thereof. Second, it shows how these sorts of data influence dominant beliefs in the field: The field of precision medicine relying on the dominant understanding of ‘genetic determinism’ imported from genetics, digital phenotyping building on the logic of ‘data fundamentalism’. In the end, the analysis shows how digital data informs potentials as well as challenges of precision medicine and digital phenotyping: a better health care for individuals connected with individualisation and responsibilisation for all, with a prognosed shift from reactive to preventive medicine. Additionally, data-based approaches might facilitate epistemological and ontological redirections for the whole field of medicine that will also affect knowledge production and a reassessment of the value of different types of knowledge with all its consequences. Institutionally, it might lead to shifts in distribution of power to experts in big data related technologies, i.e. private companies. (shrink)

Through the use of culturally appropriate videos on precision medicine research (PMR) that were developed and tailored to five racial and ethnic groups of patients, and subsequent focus-group discu...

St. Thomas Aquinas’ exposition of the Liber de causis, one of the few extended commentaries on this influential work, has received much greater detailed attention during recent decades. Nonetheless, interpretations have diverged concerning how this Neoplatonic source was assimilated and refined by Aquinas. It is not only important to comprehend the originality of procedures and accomplishment of St. Thomas in relation to his work for the sake of historical precision. Equally important is the intention of both the author and (...) his commentator, which is to contribute to our grasp of reality in terms of fundamental metaphysical principles. (shrink)

An intuitive idea concerning degrees of precision is widely accepted, and it is that we increase precision of theories by paying attention to ever decreasing orders of magnitude of measurements which we incorporate in these theories. We increase precision of measuring or of predicting measurement of length, for instance, if we pay attention not only to centimeters but also to millimeters, microns, angstroms, and so on. And our theories are precise to centimeters, then to millimeters, and so (...) on respectively. The idea is that increased precision is the process of capturing a point within nested intervals, and that this is reflected both in experimental and in theoretical progress. An intuitive analogy may be drawn with series of photos made by a camera which approaches the moon's surface. A corollary from this intuitive idea which has been stated by a number of writers is that observation reports and theories are not overthrown even when superseded by more accurate observation because within the limits of their own precision-range they are still valid. When a law in physics is stated, it is stated usually without such qualifications; but this is a mere matter of convenience, we are told. The idea is that a tacit proviso is understood and the law should be understood to be not the statement “such and such is the case” but the statement “within this and that limit of accuracy such and such is the case”; in such a formulation, the law, once verified, remains unshaken regardless of further progress in the field. (shrink)

Background In the wake of mandates for biomedical research to increase participation by members of historically underrepresented populations, community engagement (CE) has emerged as a key intervention to help achieve this goal.Methods Using interviews, observations, and document analysis, we examine how stakeholders in precision medicine research understand and seek to put into practice ideas about who to engage, how engagement should be conducted, and what engagement is for.Results We find that ad hoc, opportunistic, and instrumental approaches to CE exacted (...) significant consequences for the time and resources devoted to engagement and the ultimate impacts it has on research. Critical differences emerged when engagement and research decisionmaking were integrated with each other versus occurring in parallel, separate parts of the study organization, and whether community members had the ability to determine which issues would be brought to them for consideration or to revise or even veto proposals made upstream based on criteria that mattered to them. CE was understood to have a range of purposes, from instrumentally facilitating recruitment and data collection, to advancing community priorities and concerns, to furthering long-term investments in relationships with and changes in communities. These choices about who to engage, what engagement activities to support, how to solicit and integrate community input into the workflow of the study, and what CE was for were often conditioned upon preexisting perceptions and upstream decisions about study goals, competing priorities, and resource availability.Conclusions Upstream choices about CE and constraints of time and resources cascade into tradeoffs that often culminated in “pantomime community engagement.” This approach can create downstream costs when engagement is experienced as improvised and sporadic. Transformations are needed for CE to be seen as a necessary scientific investment and part of the scientific process. (shrink)

This paper problematizes the precision medicine approach embraced by the All of Us Research Program (US) and by Genomics England (UK) in terms of benefits distribution, by arguing that current “diversity and inclusion” efforts do not prevent exclusiveness, unless the framing and scope of the projects are revisited in public health terms. Grounded on document analysis and fieldwork interviews, this paper analyzes efforts to address potential patterns of exclusion upstream (from participating in precision medicine research) and downstream (from (...) benefitting from precision medicine outputs). It argues that efforts for inclusion upstream are not corresponded downstream, and this unbalance jeopardizes the equitable capacities of the projects. It concludes that enhanced focus on socio-environmental determinants of health and aligned public health interventions as precision medicine outputs would be to the benefit of all and especially of those who are most at risk of (upstream as well as downstream) exclusion. (shrink)

Precision livestock farming promises to allow modern, large-scale farms to replicate, at scale, caring farmers who know their animals. PLF refers to a suite of technologies, some only speculative. The goal is to use networked devices to continuously monitor individual animals on large farms, to compare this information to expected norms, and to use algorithms to manage individual animals automatically. Supporters say this could not only create an artificial version of the partially mythologized image of the good steward caring (...) for his or her animals, but to also improve on it. As one paper in favor of PLF has said, “We can not only replace the farmer’s ‘eyes and ears’ to each individual animal as in the past, but several other variables will soon be measurable in practice” Livestock production and society, Wageningen Academic Publishers, Wageningen, pp 287–292, 2006). Yet these methods of monitoring and control raise a host of ethical issues, including alienation of laborers, further consolidation of farms, and further cover for meat consumption. In this paper, I will address these ethical issues, and suggest a different, under-examined concern: namely, that though PLF may indeed improve the lives of livestock, and the sustainability of livestock operations, it is possible that it will do so at the cost of a loss of identity and relationships for farmers, as well as for the animals in their charge. (shrink)

Galasso calls for “the actualization of the public health potential of precision medicine….as the best realistic contribution to health equity” (Galasso 2024, 83). Unfortunately, this is wishful th...

Video surveillance plays a vital role in maintaining the social security although, until now, large uncertainty still exists in danger understanding and recognition, which can be partly attributed to intractable environment changes in the backgrounds. This article presents a brain-inspired computing of attention value of surrounding environment changes with a processes-based cognition model by introducing a ratio valueλof EC-implications within considered periods. Theoretical models for computation of warning level of EC-implications to the universal video recognition efficiency are further established. Imbedding (...) proposed models into the online algorithms is suggested as a future research priority towards precision security for critical applications and, furthermore, schemes for a practical implementation of such integration are also preliminarily discussed. (shrink)

_More Precisely_ is a rigorous and engaging introduction to the mathematics necessary to do philosophy. Eric Steinhart provides lucid explanations of many basic mathematical concepts and sets out the most commonly used notational conventions. He also demonstrates how mathematics applies to fundamental issues in various branches of philosophy, including metaphysics, philosophy of language, epistemology, and ethics. This second edition adds a substantial section on decision and game theory, as well as a chapter on information theory and the efficient coding of (...) information. (shrink)

Various arguments have recently been put forward to support the existence of vague or fuzzy objects. Nevertheless, the only possibly compelling argument would support, not the existence of vague objects, but indeterminately existing objects. I argue for the non‐existence of any vague entities—either particulars or properties ‐ in the mind‐independent world. Even so, many philosophers have claimed that to reduce vagueness to semantics is of no avail, since linguistic vagueness betrays semantic incoherence and this is no less a problem than (...) is ontological incoherence. After spelling out why there are fewer essentially vague concepts than usually thought. I claim that only the linguistic competence of the whole speaking community for each word can draw the sharp boundaries for its concept, even if these are unknowable in practice and still leave a precise range of indetermination. This could explain both the existence of boundaries and our non‐removable ignorance of them, fulfilling the intuitions of the epistemic theory of vagueness with the supervaluationist's indeterminacy. (shrink)

In August of 2018, the results of the largest genomic investigation in human history were published. Scanning the DNA of over one million participants, a genome‐wide association study was conducted to identify genetic variants associated with the number of years of education a person has completed. This measure, called “educational attainment,” is often treated as a proxy for intelligence and cognitive ability. The study raises a host of hard philosophical questions about study design and strength of evidence. It also sets (...) the basis for something far more controversial. Using a new genomic method that generates “polygenic scores,” researchers are now able to use the results of the study to predict a person's educational potential from a blood or saliva sample. Going a step further, some researchers have begun to promote “precision education,” which would tailor students’ school plans to their genetic profiles. The idea of precision education provokes concerns about stigma and self‐fulfilling prophecies. (shrink)

Blended learning has gained increasing popularity in colleges and universities with mixed results. Precision teaching can effectively promote learning performance. The relation between perceived precision teaching and the learning performance of college students in a blended learning environment is investigated in this paper. In the research survey is featuring a structural model, 256 college students who attended blended learning courses featuring precision teaching participated. The model results revealed that PPT is directly and positively related to self-efficacy and (...) learning motivation. Self-efficacy and learning motivation are directly and positively related to cognitive, teaching, and social presence. Additionally, cognitive, teaching, and social presence are directly and positively related to learning performance. Therefore, PPT is remotely and indirectly related to learning performance. These findings provide a new perspective for the theoretical study on blended learning performance and provide a realistic reference for precision teaching practice in the blended learning environment. (shrink)

_More Precisely_ provides a rigorous and engaging introduction to the mathematics necessary to do philosophy. It is impossible to fully understand much of the most important work in contemporary philosophy without a basic grasp of set theory, functions, probability, modality and infinity. Until now, this knowledge was difficult to acquire. Professors had to provide custom handouts to their classes, while students struggled through math texts searching for insight. _More Precisely_ fills this key gap. Eric Steinhart provides lucid explanations of the (...) basic mathematical concepts and sets out most commonly used notational conventions. Furthermore, he demonstrates how mathematics applies to many fundamental issues in branches of philosophy such as metaphysics, philosophy of language, epistemology, and ethics. (shrink)

Tissues are shaped and patterned by mechanical and chemical processes. A key mechanical process is the positioning of the mitotic spindle, which determines the size and location of the daughter cells within the tissue. Recent force and position-fluctuation measurements indicate that pushing forces, mediated by the polymerization of astral microtubules against­ the cell cortex, maintain the mitotic spindle at the cell center in Caenorhabditis elegans embryos. The magnitude of the centering forces suggests that the physical limit on the accuracy and (...) precision of this centering mechanism is determined by the number of pushing microtubules rather than by thermally driven fluctuations. In cells that divide asymmetrically, anti-centering, pulling forces generated by cortically located dyneins, in conjunction with microtubule depolymerization, oppose the pushing forces to drive spindle displacements away from the center. Thus, a balance of centering pushing forces and anti-centering pulling forces localize the mitotic spindles within dividing C. elegans cells. We discuss microtubule-based mechanisms of the mitotic spindle positioning, a key mechanical process that shapes and patterns tissues. The magnitude of the centering forces indicates that the physical limit on the accuracy and precision of centering is set by the number of contributing microtubules rather than by thermally driven fluctuations. (shrink)

Galasso (2024) helpfully puts her finger on what is perhaps the most troubling feature of precision medicine research today: Champions of the science are targeting communities of color and other ma...

Berichte zur Wissenschaftsgeschichte, Volume 45, Issue 3, Page 487-498, September 2022.

The science of metrology characterizes the concept of precision in exceptionally loose and open terms. That is because the details of the concept must be filled in—what I call narrowing of the concept—in ways that are sensitive to the details of a particular measurement or measurement system and its use. Since these details can never be filled in completely, the concept of the actual precision of an instrument system must always retain some of the openness of its general (...) characterization. The idea that there is something that counts as the actual precision of a measurement system must therefore always remain an idealization, a conclusion that would appear to hold very broadly for terms and the concepts they express. (shrink)

There has been a spurt in both fundamental and translational research that examines the underlying mechanisms of the human microbiome in psychiatric disorders. The personalized and dynamic features of the human microbiome suggest the potential of its manipulation for precision psychiatry in ways to improve mental health and avoid disease. However, findings in the field of microbiome also raise philosophical and ethical questions. From a philosophical point of view, they may yet be another attempt at providing a biological cause (...) for phenomena that ultimately cannot be so easily localized. From an ethical point of view, it is relevant that the human gut microbiome comprises data on the individual’s lifestyle, disease history, previous medications, and mental health. Massive datasets of microbiome sequences are collected to facilitate comparative studies to identify specific links between the microbiome and mental health. Although this emerging research domain may show promise for psychiatric patients, it is surrounded by ethical challenges regarding patient privacy, health risks, effects on personal identity, and concerns about responsibility. This narrative overview displays the roles and advances of microbiome research in psychiatry and discusses the philosophical and ethical implications of microbiome big data and microbiome-based interventions for psychiatric patients. We also investigate whether these issues are really “new,” or “old wine in new bottles.”. (shrink)

Evidence-Based Medicine (EBM) and Personalized Medicine (PM) share a common goal: reducing the gap between the results of biomedical research and their clinical application. PM is, however, often presented as a “new paradigm” for medicine, just as EBM was in the 1990s. It covers a wide variety of projects but the core idea that generally unites them is the ambition of better taking account of individual specificities than did EBM with its statistical and population-centred approach. In this article, I concentrate (...) on PM in cancerology, the essence of which is to target treatments based on the molecular profile of the patient. This targeting is made possible by gaining better knowledge about the molecular mechanisms of cancers. The classification of patients as a function of their molecular profile entails the creation of patient sub-groups. This creates a problem for the traditional evaluation of therapeutic treatment promoted by EBM, in particular the use of randomized trials using sizeable cohorts. But a better understanding of the mechanisms and the greater precision of treatments could reduce the need for these trials. Does PM thus represent the revenge of a physio-pathological and mechanistic culture in clinical research against the statistical and empirical one of EBM? My objective is to show how current practices of PM leads to epistemological changes in our estimation of what count as relevant types of information and proof in medicine, in particular in the field of therapeutic evaluation. I defend the idea that PM, far from obviating the need for statistical approaches and the search for correlations, ultimately poses new challenges for EBM. PM drives EBM to strengthen the articulation and the integration of statistical and mechanistic data with a view to providing a better service for each patient. (shrink)

Since the late 1980s, the human genetics and genomics research community has been promising to usher in a “new paradigm for health care”—one that uses molecular profiling to identify human genetic variants implicated in multifactorial health risks. After the completion of the Human Genome Project in 2003, a wide range of stakeholders became committed to this “paradigm shift,” creating a confluence of investment, advocacy, and enthusiasm that bears all the marks of a “scientific/intellectual social movement” within biomedicine. Proponents of this (...) movement usually offer four ways in which their approach to medical diagnosis and health care improves upon current practices, arguing that it is more “personalized,” “predictive,” “preventive,” and “participatory” than the medical status quo. Initially, it was personalization that seemed to best sum up the movement's appeal. By 2012, however, powerful opinion leaders were abandoning “personalized medicine” in favor of a new label: “precision medicine.” The new label received a decisive seal of approval when, in January 2015, President Obama unveiled plans for a national “precision medicine initiative” to promote the development and use of genomic tools in health care. (shrink)

Many countries currently invest in technologies and data infrastructures to foster precision medicine (PM), which is hoped to better tailor disease treatment and prevention to individual patients. But who can expect to benefit from PM? The answer depends not only on scientific developments but also on the willingness to address the problem of structural injustice. One important step is to confront the problem of underrepresentation of certain populations in PM cohorts via improved research inclusivity. Yet, we argue that the (...) perspective needs to be broadened because the (in)equitable effects of PM are also strongly contingent on wider structural factors and prioritization of healthcare strategies and resources. When (and before) implementing PM, it is crucial to attend to how the organisation of healthcare systems influences who will benefit, as well as whether PM may present challenges for a solidaristic sharing of costs and risks. We discuss these issues through a comparative lens of healthcare models and PM-initiatives in the United States, Austria, and Denmark. The analysis draws attention to how PM hinges on—and simultaneously affects—access to healthcare services, public trust in data handling, and prioritization of healthcare resources. Finally, we provide suggestions for how to mitigate foreseeable negative effects. (shrink)

En este ensayo propongo una lectura de los contornos de la primera Meditación. Con ella intento resaltar una dimensión importante del pensamiento de Descartes en torno a la virtud de la precisión. Contrasto la preocupación por la verdad en la vida cotidiana y en la indagación cartesiana, exploro la manera en que Descartes enfrenta algunos riesgos epistémicos en el curso de su meditación, señalo algunos aspectos de su concepción de la agencia epistémica y concluyo con una breve disquisición alrededor de (...) la apuesta de Pascal. (shrink)

Argues for a failure of correspondence between perceptual representation and what it is like to perceive. If what it is like to perceive is grounded in perceptual representation, then, using considerations of veridical representation, we can show that inattentive peripheral perception is less representationally precise than attentive foveal perception. However, there is empirical evidence to the contrary. The conclusion is that perceptual representation cannot ground what it is like to perceive.

Log-file data from computer-based assessments can provide useful collateral information for estimating student abilities. In turn, this can improve traditional approaches that only consider response accuracy. Based on the amounts of time students spent on 10 mathematics items from the PISA 2012, this study evaluated the overall changes in and measurement precision of ability estimates and explored country-level heterogeneity when combining item responses and time-on-task measurements using a joint framework. Our findings suggest a notable increase in precision with (...) the incorporation of response times and indicate differences between countries in how respondents approached items as well as in their response processes. Results also showed that additional information could be captured through differences in the modeling structure when response times were included. However, such information may not reflect the testing objective. (shrink)