The increasing use of cluster randomised trials in low-resource settings raises unique ethical issues. TheOttawa Statement on the Ethical Design and Conduct of Cluster Randomised Trialsis the first international ethical guidance document specific to cluster trials, but it is unknown if it adequately addresses issues in low-resource settings. In this paper, we seek to identify any gaps in theOttawa Statementrelevant to cluster trials conducted in low-resource settings. Our method is (1) to analyse a prototypical cluster trial conducted in a low-resource (...) setting (PURE Malawi trial) with theOttawa Statement; (2) to identify ethical issues in the design or conduct of the trial not captured adequately and (3) to make recommendations for issues needing attention in forthcoming revisions to theOttawa Statement. Our analysis identified six ethical aspects of cluster randomised trials in low-resource settings that require further guidance. The forthcoming revision of theOttawa Statementshould provide additional guidance on these issues: (1) streamlining research ethics committee review for collaborating investigators who are affiliated with other institutions; (2) the classification of lay health workers who deliver study interventions as health providers or research participants; (3) the dilemma experienced by investigators when national standards seem to prohibit waivers of consent; (4) the timing of gatekeeper engagement, particularly when researchers face funding constraints; (5) providing ancillary care in health services or implementation trials when a routine care control arm is known to fall below national standards and (6) defining vulnerable participants needing protection in low-resource settings. (shrink)

Martin E. Rosenberg -/- The Gift of Silence: Towards an Anthropology of Jazz Improvisation as Neuro-Resistance. -/- ABSTRACT: -/- This essay addresses how the complex processes that occur during jazz improvisation enact behaviors that resemble the logic of gift exchange first described by Marcel Mauss. It is possible to bring to bear structural, sociological, political economical, deconstructive or even ethical approaches to what constitutes gift exchange during the performance of jazz. Yet, I would like to shift from focusing this (...) analysis of jazz improvisation with reference to the language of music as symbolic action (which all of these approaches require), to grounding improvisation in embodied and distributed cognition, the performance of which begins with a ritual gift of silence. By silence, I refer to the embodied, yet shared pure duration as felt synchrony within an individual performer, that extends to the members of an ensemble. Thus, I refer to both aesthetic and micro-political implications of embodied, yet also distributed musical cognition in real time. -/- For jazz musicians, embodied silence becomes the initial condition for processes of cognitive bifurcation. For it is bifurcation that attracts us to jazz in the first place. Here I expand my previous work establishing similarities in the behavior of bifurcating systems in physical and cognitive sciences to the unfolding of ambiguity in real time during improvisation with respect to polyphony, polytonality and polyrhythms in the history of jazz from Charlie Parker to Ornette Coleman. We can therefore re-conceptualize jazz improvisation as a subversive antidote for processes of determination identified in a sub-discipline of cultural studies called “cognitive capitalism.” By examining silence from this anthropological perspective, we can conceive of jazz performance as a ritualized resistance to top-down cognitive control immanent with social and digital networks. The ritual enactment that is jazz improvisation points towards an aesthetics of bifurcation that is simultaneously a micro-politics of neuro-resistance. In other words, I argue that freedom of thought requires freedom from thought as an initial condition. -/- Yet, I emphasize the empirical rather than mystical grounds to this gift of silence. The valorization of silence by jazz musicians is not simply etiquette, an ethics of reciprocity for performers exchanging “riffs,” but an initial condition that jazz performers (and, I would argue, listeners) experience in their bodies, thus linking embodied cognition to a collective field of cultural production that emerges from each embodied individual, and yet also pervades the ensemble in ways reminiscent of feedback loops in complex systems. The recent and remarkable research on music and the brain has demonstrated that it is now possible to describe jazz improvisation as possessing both embodied and distributed cognitive properties. The emergent neuronal ensemble behavior within the individual that is visible in jazz improvisors, discovered by the neuroscientists at Johns Hopkins led by Charles Limb, bears striking resemblance to the interactive behaviors of the jazz ensemble itself. Thus, it is by recourse to recent research by myself and others into the cognitive neuroscience of music generally, and jazz improvisation specifically, that the empirical grounds for an anthropology of neuro-resistance become visible. (shrink)

Charles Rosenberg’s latest book is a collection of ten essays spanning twelve years’ work on the history of American medicine, and seeks to provide both the historian and the practicing physician with an understanding of the framework that lies beneath our modern medical system. He states his cause explicitly in the opening chapter: “Insofar as I have a personal agenda, it is a desire to underline the need...for physicians to think and act on an understanding of [their] unique (...) social and moral identity. It means thinking critically about...the world that informs and constrains clinical choices” (p. 11). (shrink)

This paper explores the notions of hope and how individual patient autonomy can trump carefully reasoned ethical concerns and policies intended to regulate stem cell transplants. We argue that the same limits of knowledge that inform arguments to restrain and regulate unproven treatments might also undermine our ability to comprehensively dismiss or condemn them. Incautiously or indiscriminately reasoned policies and attitudes may drive critical information and data underground, impel patients away from working with clinical researchers, and tread needlessly on hope, (...) the essential motivator of patients, advocates and researchers alike. We offer recommendations to clinicians and health care providers to help balance the discourse with individuals seeking treatment while guarding against fraud, misconception, and patient harm. (shrink)

The focus of this paper is the dispute between the Academic Arcesilaus of Pitane (ca. 316–240 BC) and the philosophy of Zeno of Citium. Scholars typically claim that Arcesilaus set out to attack Zeno’s epistemology or theory of knowledge. The framework of epistemology prevails in the modern reconstruction of Arcesilaus’s arguments. Proponents of this framework usually contend that the epistemic possibility of Stoic “cognition” or “apprehension” (κατάληψις) is the principal aim of Arcesilaus’s attack. The aim of this article is to (...) contest the limited scope of the framework of epistemology in the interpretation of Arcesilaus’s attack, and reposition his critical arguments, in view of the fragmentary evidence, within the framework of an ontology of knowledge. (shrink)

Les grands exploits de la pensée moderne ne sont pas tous derrière nous : la modernité constitue l'horizon inéluctable de notre réflexion morale. Mais il nous faut aussi reconnaître qu'il reste bien des problèmes moraux fondamentaux, ayant trait à notre modernité, que nous n'avons pas encore résolus, et où même nous ne voyons pas encore clair.

BackgroundDespite five decades of increasingly elegant studies aimed at advancing the pathophysiology and treatment of mental illness, the results have not met expectations. Diagnoses are still based on observation, the clinical history, and an outmoded diagnostic system that stresses the historic goal of disease specificity. Psychotropic drugs are still based on molecular targets developed decades ago, with no increase in efficacy. Numerous biomarkers have been proposed, but none have the requisite degree of sensitivity and specificity, and therefore have no usefulness (...) in the clinic. The obvious lack of progress in psychiatry needs exploration.MethodsThe historical goals of psychiatry are reviewed, including parity with medicine, a focus on diagnostic reliability rather than validity, and an emphasis on reductionism at the expense of socioeconomic issues. Data are used from Thomas Picketty and others to argue that our failure to advance clinical care may rest in part on the rise in social and economic inequality that began in the 1970s, and in part on our inability to move beyond the medical model of specificity of disease and treatment.ResultsIt is demonstrated herein that the historical goal of specificity of disease and treatment has not only impeded the advance of diagnosis and treatment of mental illness, but, in combination with a rapid increase in socioeconomic inequality, has led to poorer outcomes and rising mortality rates in a number of disorders, including schizophrenia, anxiety, and depression.ConclusionsIt is proposed that Psychiatry should recognize the fact of socioeconomic inequality and its effects on mental disorders. The medical model, with its emphasis on diagnostic and treatment specificity, may not be appropriate for investigation of the brain, given its complexity. The rise of scientific inequality, with billions allocated to connectomics and genetics, may shift attention away from the need for improvements in clinical care. Unfortunately, the future prospects of those suffering from mental illness appear dim. (shrink)

The author discusses the argument between alan r white and gilbert ryle concerning whether or not one can talk of the use of a sentence. His contention is that they did not notice that there are two types of 'what for' questions, And therefore white's argument against ryle does not hold. (staff).

In the piece, “What Should ChatGPT Mean for Bioethics?” Professor Cohen proposes that the introduction of AI generally, and generative AI specifically, requires that patients be informed of, and co...

We applaud Sedlakova and Trachsel’s work and their description of conversational artificial intelligence (CAI) as possessing a hybrid nature with features of both a tool and an agent (Sedlakova and...