Why do corporations and wealthy philanthropists fund the human sciences? Examining the history of the Santa Fe Institute (SFI), a private research institute founded in the early 1980s, this article shows that funders can find as much value in the social worlds of the sciences they sponsor as in their ideas. SFI became increasingly dependent on funding from corporations and libertarian business leaders in the 1990s and 2000s. At the same time, its intellectual work came to focus on the underlying (...) principles of adaptation, innovation, and decentralized coordination supposedly at work in ‘complex systems’ from biological ecosystems to markets and firms. This research cast the ideas of the libertarian economist Friedrich Hayek into a new scientific idiom. SFI also became a space where figures in business, media, academia, and politics could come to learn to see the world in a particular way—to acquire the subjectivity of what I call ‘the Santa Fe Institute libertarian’. At SFI, visitors did not simply learn the principles of neo-Hayekian complex system science. They came to see themselves as agents of social evolution, providing the spark that the free-market system needed to produce new technologies and new solutions to social problems without top-down political direction. For the Institute's corporate and libertarian financiers, SFI was not just a space where intellectuals described the world in favored ideological terms, but a space where elite actors became committed to the project of making a new political-economic order. (shrink)

The prevalence and negative impact of brain disorders are increasing. Clinical Neuropsychology is a specialty dedicated to understanding brain-behavior relationships, applying such knowledge to the assessment of cognitive, affective, and behavioral functioning associated with brain disorders, and designing and implementing effective treatments. The need for services goes beyond neurological diseases and has increased in areas of neurodevelopmental and psychiatric conditions, among others. In Europe, a great deal of variability exists in the education and training of Clinical Neuropsychologists. Training models include (...) master’s programs, continuing education courses, doctoral programs, and/or post-doctoral specialization depending on the country, with no common framework of requirements, although patients’ needs demand equal competencies across Europe. In the past five years, the Standing Committee on Clinical Neuropsychology of the European Federation of Psychologists’ Association has conducted a series of surveys and interviews with experts in the field representing 30 European countries. The information, along with information from the existing literature, is used in presenting an overview of current and relevant topics related to policy and guidelines in the training and competencies in Clinical Neuropsychology. An option for the way forward is the EuroPsy Specialist Certificate which is currently offered in Work- and Organizational psychology and Psychotherapy. It builds upon the Basic Certificate and complements national standards without overriding them. General principles can be found that can set the basis for a common, solid, and comprehensive specialty education/training, sharpening the Neuropsychologists’ competencies across Europe. The requirements in Clinical Neuropsychology should be comparable to those for the existing specialty areas in the EuroPsy model. Despite the perceived challenges, developing a Specialist Certificate appears a step forward for the development of Clinical Neuropsychology. Recommendations are proposed towards a shared framework of competencies by the means of a common level of education/training for the professionals in Europe. Benchmarking training standards and competencies across Europe has the potential of providing protection against unqualified and ethically questionable practice, creating transparency, raising the general European standard, and promoting mobility of both Clinical Neuropsychologists and patients in Europe, for the benefit of the professional field and the population. (shrink)

The multitude of training models and curricula for the specialty of clinical neuropsychology around the world has led to organized activities to develop a framework of core competencies to ensure sufficient expertise among entry-level professionals in the field. The Standing Committee on Clinical Neuropsychology of the European Federation of Psychologists’ Associations is currently working toward developing a specialty certification in clinical neuropsychology to establish a cross-national standard against which to measure levels of equivalency and uniformity in competence and service provision (...) among professionals in the field. Through structured interviews with experts from 28 European countries, we explored potential areas of core competency. Specifically, questions pertained to the perceived importance of a series of foundational, functional, and other competencies, as well as current training standards and practices, and optimal standards. Our findings revealed considerable agreement on academic and clinical training, despite varied actual training requirements currently, with fewer respondents relegating importance to training in teaching, supervision, and research, and even fewer to skills related to management, administration, and advocacy. European expert clinical neuropsychologists were in agreement with previous studies regarding the importance of sound theoretical and clinical training but management, administrative, and advocacy skills were not central to their perspective of a competent specialist in clinical neuropsychology. Establishing a specialty certificate in clinical neuropsychology based on core competencies may enable mobility of clinical neuropsychologists across Europe, and, perhaps, provide an impetus for countries with limited criteria to reconsider their training requirements and harmonize their standards with others. (shrink)

The standard way of representing an epistemic state in formal philosophy is in terms of a set of sentences, corresponding to the agent’s beliefs, and an ordering of those sentences, reflecting how well entrenched they are in the agent’s epistemic state. We argue that this wide-spread representational view – a view that we identify as a “Quinean dogma” – is incapable of making certain crucial distinctions. We propose, as a remedy, that any adequate representation of epistemic states must also include (...) the agent’s research agenda, i.e., the list of question that are open or closed at any given point in time. If the argument of the paper is sound, a person’s questions and practical interests, on the one hand, and her beliefs and theoretical values, on the other, are more tightly interwoven than has previously been assumed to be the case in formal epistemology. (shrink)

We give a direct mathematical proof of the Mathias-Silver theorem that every analytic set is Ramsey.

In a seminal book, Alvin I. Goldman outlines a theory for how to evaluate social practices with respect to their “veritistic value”, i.e., their tendency to promote the acquisition of true beliefs in society. In the same work, Goldman raises a number of serious worries for his account. Two of them concern the possibility of determining the veritistic value of a practice in a concrete case because we often don't know what beliefs are actually true, and even if we did, (...) the task of determining the veritistic value would be computationally extremely difficult. Neither problem is specific to Goldman's theory and both can be expected to arise for just about any account of veritistic value. It is argued here that the first problem does not pose a serious threat to large classes of interesting practices. The bulk of the paper is devoted to the computational problem, which, it is submitted, can be addressed in promising terms by means of computer simulation. In an attempt to add vividness to this proposal, an up-and-running simulation environment is presented and put to some preliminary tests. (shrink)

I draw on the literature on skeptical theism to develop an argument against Christian theism based on the widespread existence of suffering that appears to its sufferer to be gratuitous and is combined with the sense that God has abandoned one or never existed in the first place. While the core idea of the argument is hardly novel, key elements of the argument are importantly different from other influential arguments against Christian theism. After explaining that argument, I make the case (...) that the argument is untouched by traditional skeptical theism. I then consider positive skeptical theism, arguing that while DePoe’s view might provide a response to my argument, it entangles the theist in worries about divine deception. Because traditional skeptical theism and DePoe’s positive skeptical theism constitute the most promising extant strategies for answering my argument, the argument constitutes a serious challenge for the Christian theist. My overall aim, then, is to draw on various strands of the skeptical theism literature to present a challenge for all Christian theists, not just those in the skeptical theist camp, while at the same time revealing some important limitations of skeptical theism. (shrink)

Standard bioethics textbooks present the field to students and non-experts as a form of "applied ethics." This ahistoric and rationalistic presentation is similar to that used in philosophy of science textbooks until three decades ago. Thomas Kuhn famously critiqued this self-conception of the philosophy of science, persuading the field that it would become deeper, richer, and more philosophical, if it integrated the history of science, especially the history of scientific change, into its self-conception. This essay urges a similar reconceptualization for (...) bioethics, arguing that the analysis of moral change ought to be integral to bioethics (and to ethics generally). It proceeds by suggesting the sterility of the ahistoric, rationalist applied ethics model of bioethics embraced by standard bioethics textbooks. It also suggests the fecundity of alternative conceptions of the bioethics that focus on the history of successful and failed attempts to negotiate moral change, and the history of multifaceted relations between moral philosophy and practical ethics. (shrink)

This paper examines a struggle over the future use of Nordic forests, which took place from 2009 to 2012 within a major research program, Future Forests—Sustainable Strategies under Uncertainty and Risk, organized and funded by Mistra, The Swedish Foundation for Strategic Environmental Research. We explore the role of strategic environmental research in societal constructions of long-term challenges and future risks. Specifically, we draw attention to the role played by environmental research in the creation of future images that become dominant for (...) how societies structure action for the long term. We also show that this process is on several accounts problematic. Research labeled “strategic” or “relevant” is intended to manage long-term risks and challenges in a sustainable way, by taking into account the “open” and “plural” nature of the future. The case of Future Forests suggests, rather, that by contributing to the emergence of dominant future images, environmental research is entangled with a process of gradual consensus creation around what may be highly selective or biased narratives of the long term, which may conceal or postpone key forms of future conflict. (shrink)

Theories of the human person differ greatly in their ability to underwrite a metaphysics of resurrection. This paper compares and contrasts a number of such views in light of the Christian doctrine of resurrection. In a Christian framework, resurrection requires that the same person who exists on earth also exists in an afterlife, that a postmortem person be embodied, and that the existence of a postmortem person is brought about by a miracle. According to my view of persons (the Constitution (...) View), a human person is constituted by—but not identical to—a human organism. A person has a first-person perspective essentially, and an organism has interrelated biological functions essentially. I shall argue for the superiority the Constitution View as a metaphysical basis for resurrection. (shrink)

Subjective measures of well-being—measures based on answers to questions such as ‘Taking things all together, how would you say things are these days—would you say you're very happy, pretty happy, or not too happy these days?’—are often presented as superior to more traditional economic welfare measures, e.g., for public policy purposes. This paper aims to spell out and assess what I will call the argument from directness: the notion that subjective measures of well-being better represent well-being than economic measures do (...) because subjective measures (and subjective measures alone) are direct measures of well-being. My main thesis is that the argument begs the question against proponents of economic measures: it is based on a premise that they reject and that is no less in need of justification than the conclusion of the argument, namely, the proposition that well-being is constituted by subjectively experienced mental states. If subjective measures can be defended as valid measures of well-being at all, I will maintain, it is because they are (imperfect) indirect measures of well-being. (shrink)

For Merleau-Ponty,consciousness in skillful coping is a matter of prereflective ‘I can’ and not explicit ‘I think that.’ The body unifies many domain-specific capacities. There exists a direct link between the perceived possibilities for action in the situation (‘affordances’) and the organism’s capacities. From Merleau-Ponty’s descriptions it is clear that in a flow of skillful actions, the leading ‘I can’ may change from moment to moment without explicit deliberation. How these transitions occur, however, is less clear. Given that Merleau-Ponty suggested (...) that a better understanding of the self-organization of brain and behavior is important, I will re-read his descriptions of skillful coping in the light of recent ideas on neurodynamics. Affective processes play a crucial role in evaluating the motivational significance of objects and contribute to the individual’s prereflective responsiveness to relevant affordances. (shrink)

A principal aim of the branch of ethics called ‘population theory’ or ‘population ethics’ is to find a plausible welfarist axiology, capable of comparing total outcomes with respect to value. This has proved an exceedingly difficult task. In this paper I shall state and discuss two ‘trilemmas’, or choices between three unappealing alternatives, which the population ethicist must face. The first trilemma is not new. It originates with Derek Parfit's well-known ‘Mere Addition Paradox’, and was first explicitly stated by Yew-Kwang (...) Ng. I shall argue that one horn of this trilemma is less unattractive than Parfit and others have claimed. The second trilemma, which is a kind of mirror image of the first, appears hitherto to have gone unnoticed. Apart from attempting to resolve the two trilemmas, I shall suggest certain features which I believe a plausible welfarist axiology should possess. The details of this projected axiology will, however, be left open. (shrink)

Whether or not intrinsic value is additively measurable is often thought to depend on the truth or falsity of G. E. Moore's principle of organic unities. I argue that the truth of this principle is, contrary to received opinion, compatible with additive measurement. However, there are other very plausible evaluative claims that are more difficult to combine with the additivity of intrinsic value. A plausible theory of the good should allow that there are certain kinds of states of affairs whose (...) intrinsic value cannot be outweighed by any number of states of certain other, less valuable, kinds. Such``non-trade-off'' cannot reasonably be explained in terms of organic unities, and it can be reconciled with the additivity thesis only if we are prepared to give up some traditional claims about the nature of intrinsic value. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Evaluation, Standards, Normalization: Historico-philosophical Formations and the Conditions of Possibility for Checklist Thought Bernadette Baker University of Wisconsin-Madison In education today a new vocabulary has emerged that is far more than just words. In the context of educational policy the setting of goals or objectives is now being subsumed under terms such as statewidestandards, child development is now being adjectivized by descriptors such as learning disability or emotionally (...) disturbed, and the evaluation ofclassroom-based performance is now being collated in aportfolio. These are more than just buzz words-at one level they are new ways of governing children and teachers, of organizing action, and of perceiving the world. What, for instance, does it tell us about ourselves when first-grade students Mikey, Enrique, Waldo, orDonal are introduced to visitors to the school by labels such as LD, ED, ADD, ADHD, and so forth, rather thanby their name? What does it tell us about ourselves when we say a curriculum or program of study is in line with the standards established somewhere else? And what story do we think is being narratedin the documentation of a child's performance in portfolio form across a semester or year? In consideringwhyterms suchasstandards, child development, or even evaluation have such contemporary currency I am necessarily drawn into a study of the timespaces in which they did not have such currency at all. This paper maps four moves into a moment that I think of as a rather long present-day-a present that is not simply this morning, yesterday, or the daybefore, but one that links the subjectivities ofthose now living in educational workto those made available about one hundred years ago. The four moves that I analyze here can be thought of as conditions of possibility for the operation of contemporary educational mies of reasoning, especially those that have formed around the resurgent popularity of"checklist thought" in reform efforts. The four moves collectively historicize how notions of standards, child development, and evaluation can pop up as commonsensical tropes through which to gather and degather action in the educational field. The first ofthese moves is that which flows from the operation ofan ideal to the operation of a norm. The second move is that which flows between the advent of statistics and the advent of eugenics. The third move is that which flows between the appearance ofnovels and fiction and the novel ficticityoffacts. And the fourth move is that which flows from the fictions of child development narratives to the stories that standards tell us. Collectively, these historico-philosophical moves will enable reconsideration of what we think evaluation, standards, and norms for child development actually narrate, lending food for thought to the specificityoftheir uptake in music education. From Ideal to Norm One way inwhichto examinethe shift from a seventeenth-century concept of the ideal to the nineteenth-century concept of the norm is by telling a story that was told in the early twentieth century. At this time when the educational field was formalizing, there was great care taken to record discussions held at conferences. When conferenceproceedings werepublished, theywere usually structured so that the presenter's paper©Philosophy ofMusic Education ReviewlO, no. 1 (Fall, 2002): 92-101. Bernadette Baker 93 was followed by a transcript of the conversation held after it. Like today, in the discussion time, audience members asked questions or made comments. Unlike today, the names of such participating audience members were typed into the proceedings and their specific questions or comments were written up as part ofreporting on the paper presented. In a discussion held at a conference in 1 905 on the topic of methods for training children labeledas feebleminded, apresenterhadspokenof the positive uses of a vegetable garden in the disciplining of feebleminded girls. The audience members relayed their own versions of experimenting with gardening and gathering, some complaining oftoo little space and others indicating the effects of having too many fields from which to gather. Dr. Dunlap was one such participant, indicatingimplicitlytheeffectsofhavingtoo many choices. In the spirit ofthe hunter/gatherer dichotomy, thegirlslabeledas feeblemindedatthe institutionwhereDr. Dunlap worked weresentout to pick com. The following story emerged. Dr. Dunlap: Our girls go out under an attendant and gather vegetables... (shrink)

In this paper I examine a strategy which aims to bypass the technicalities of the indispensability debate and to offer a direct route to nominalism. The starting-point for this alternative nominalist strategy is the claim that--according to the platonist picture--the existence of mathematical objects makes no difference to the concrete, physical world. My principal goal is to show that the 'Makes No Difference' (MND) Argument does not succeed in undermining platonism. The basic reason why not is that the makes-no-difference claim (...) which the argument is based on is problematic. Arguments both for and against this claim can be found in the literature; I examine three such arguments, uncovering flaws in each one. In the second half of the paper, I take a more direct approach and present an analysis of the counterfactual which underpins the makes-no-difference claim. What this analysis reveals is that indispensability considerations are in fact crucial to the proper evaluation of the MND Argument, contrary to the claims of its supporters. (shrink)

Throughout his illustrious career, Roderick Chisholm was concerned with the nature of persons. On his view, persons are what he called ‘entia per se.’ They exist per se, in their own right. I too have developed an account of persons—I call it the ‘Constitution View’—an account that is different in important ways from Chisholm’s. Here, however, I want to focus on a thesis that Chisholm and I agree on: that persons have ontological significance in virtue of being persons. Although I’ll (...) make the notion of ontological significance more precise later, the rough idea is that Fs (persons, or whatever) have ontological significance just in case a new F is a new thing and not just a change in some already-existing thing. (shrink)

A framework is introduced consisting of five baselines of ethical justification for professional persuasive communications. The models provide a conceptual structure by which to identify and analyze the ethical reasoning, underlying justifications, motivations, and decision making in professional persuasive practices. Although the emphasis of this article is on defining the constructs, their ethical soundness as justification for persuasive practices and their usefulness in establishing direction and methodologies for research in persuasive also are addressed.

This book is a comprehensive account of what it means to try to quantify health in distributing resources for health care. It examines the concept of QALYs which supposedly makes it more accurate to talk about life in terms of both quality and quantity of years lived when referring to health care policy. It offers an elegant new approach to comparing the costs and benefits of medical interventions. Cost-Utility Analysis is a method designed by economists to aid decision makers distribute (...) scarce resources to areas of health care where they will yield the greatest benefits. Erik Nord questions the feasibility of measuring patients' quality of life meaningfully in numerical terms, as CUA presupposes. He presents an alternative approach called cost-value analysis in which representative samples of the general public express preferences between different health-care programs. In this approach, subjects are allowed to include concerns for fairness that go beyond concerns for efficiency of conventional health economics. (shrink)

The present paper revisits the issue of rational decision making in John Rawls' original position. Drawing on Isaac Levi's theory of decision, I discuss how we can defend Rawls against John C. Harsanyi's charge that maximin reasoning in the original position is irrational. The discussion suggests that systematic application of Levi's theory is likely to have important consequences for ethics and political theory as well as for public policy.

I argue that, contrary to the recent claims of physicists and philosophers of physics, general relativity requires no interpretation in any substantive sense of the term. I canvass the common reasons given in favor of the alleged need for an interpretation, including the difficulty in coming to grips with the physical significance of diffeomorphism invariance and of singular structure, and the problems faced in the search for a theory of quantum gravity. I find that none of them shows any defect (...) in our comprehension of general relativity as a physical theory. I conclude by comparing general relativity with quantum mechanics, a theory that manifestly does stand in need of an interpretation in an important sense. Although many aspects of the conceptual structure of general relativity remain poorly understood, it suffers no incoherence in its formulation as a physical theory that only an ‘interpretation’ could resolve. *Received November 2007; revised February 2009. †To contact the author, please write to: Center for Philosophy of Science, University of Pittsburgh, 817 Cathedral of Learning, Pittsburgh, PA 15260; e‐mail: erik@strangebeautiful.com . When science starts to be interpretive it is more unscientific even than mysticism. (D. H. Lawrence, “Self‐Protection”). (shrink)

In this paper we explore the relation between health-care needs and patients’ desires within shared decision-making in a context of priority setting in health care. We begin by outlining some general characteristics of the concept of health-care need as well as the notions of SDM and desire. Secondly we will discuss how to distinguish between needs and desires for health care. Thirdly we present three cases which all aim to bring out and discuss a number of queries which seem to (...) arise due to the double focus on a patient’s need and what that patient desires. These queries regard the following themes: the objectivity and moral force of needs, the prediction about what kind of patients which will appear on a micro level, implications for ranking in priority setting, difficulties regarding assessing and comparing benefits, and implications for evidence-based medicine. (shrink)

ABSTRACT I argue that this examination and appreciation for the shift to abductive reasoning should be extended to the intersection of neuroscience and novel brain-computer interfaces too. This paper highlights the implications of applying abductive reasoning to personalized implantable neurotechnologies. Then, it explores whether abductive reasoning is sufficient to justify insurance coverage for devices absent widespread clinical trials, which are better applied to one-size-fits-all treatments. INTRODUCTION In contrast to the classic model of randomized-control trials, often with a large number of (...) subjects enrolled, precision medicine attempts to optimize therapeutic outcomes by focusing on the individual.[i] A recent publication highlights the strengths and weakness of both traditional evidence-based medicine and precision medicine.[ii] Plus, it outlines a tension in the shift from evidence-based medicine’s inductive reasoning style (the collection of data to postulate general theories) to precision medicine’s abductive reasoning style (the generation of an idea from the limited data available).[iii] The paper’s main example is the application of precision medicine for the treatment of cancer.[iv] I argue that this examination and appreciation for the shift to abductive reasoning should be extended to the intersection of neuroscience and novel brain-computer interfaces too. As the name suggests, brain-computer interfaces are a significant advancement in neurotechnology that directly connects someone’s brain to external or implanted devices.[v] Among the various kinds of brain-computer interfaces, adaptive deep brain stimulation devices require numerous personalized adjustments to their settings during the implantation and computation stages in order to provide adequate relief to patients with treatment-resistant disorders. What makes these devices unique is how adaptive deep brain stimulation integrates a sensory component to initiate the stimulation. While not commonly at the level of sophistication as self-supervising or generative large language models,[vi] they currently allow for a semi-autonomous form of neuromodulation. This paper highlights the implications of applying abductive reasoning to personalized implantable neurotechnologies. Then, it explores whether abductive reasoning is sufficient to justify insurance coverage for devices absent widespread clinical trials, which are better applied to one-size-fits-all treatments.[vii] ANALYSIS I. The State of Precision Medicine in Oncology and the Epistemological Shift While a thorough overview of precision medicine for the treatment of cancer is beyond the scope of this article, its practice can be roughly summarized as identifying clinically significant characteristics a patient possesses (e.g., genetic traits) to land on a specialized treatment option that, theoretically, should benefit the patient the most.[viii] However, in such a practice of stratification patients fall into smaller and smaller populations and the quality of evidence that can be applied to anyone outside these decreases in turn.[ix] As inductive logic helps to articulate, the greater the number of patients that respond to a particular therapy the higher the probability of its efficacy. By straying from this logical framework, precision medicine opens the treatment of cancer to more uncertainty about the validity of these approaches to the resulting disease subcategories.[x] Thus, while contemporary medical practices explicitly describe some treatments as “personalized”, they ought not be viewed as inherently better founded than other therapies.[xi] A relevant contemporary case of precision medicine out of Norway focuses on the care of a patient with cancer between the ventricles of the heart and esophagus, which had failed to respond to the standard regimen of therapies over four years.[xii] In a last-ditch effort, the patient elected to pay out-of-pocket for an experimental immunotherapy (nivolumab) at a private hospital. He experienced marked improvements and a reduction in the size of the tumor. Understandably, the patient tried to pursue further rounds of nivolumab at a public hospital. However, the hospital initially declined to pay for it given the “lack of evidence from randomised clinical trials for this drug relating to this [patient’s] condition.”[xiii] In rebuttal to this claim, the patient countered that he was actually similar to a subpopulation of patients who responded in “open‐label, single arm, phase 2 studies on another immune therapy drug” (pembrolizumab).[xiv] Given this interpretation of the prior studies and the patient’s response, further rounds of nivolumab were approved. Had the patient not had improvements in the tumor’s size following a round of nivolumab, then pembrolizumab’s prior empirical evidence in isolation would have been insufficient, inductively speaking, to justify his continued use of nivolumab.[xv] The case demonstrates a shift in reasoning from the traditional induction to abduction. The phenomenon of ‘cancer improvement’ is considered causally linked to nivolumab and its underlying physiological mechanisms.[xvi] However, “the weakness of abductions is that there may always be some other better, unknown explanation for an effect. The patient may for example belong to a special subgroup that spontaneously improves, or the change may be a placebo effect. This does not mean, however, that abductive inferences cannot be strong or reasonable, in the sense that they can make a conclusion probable.”[xvii] To demonstrate the limitations of relying on the abductive standard in isolation, commentators have pointed out that side effects in precision medicine are hard to rule out as being related to the initial intervention itself unless trends from a group of patients are taken into consideration.[xviii] As artificial intelligence (AI) assists the development of precision medicine for oncology, this uncertainty ought to be taken into consideration. The implementation of AI has been crucial to the development of precision medicine by providing a way to combine large patient datasets or a single patient with a large number of unique variables with machine learning to recommend matches based on statistics and probability of success upon which practitioners can base medical recommendations.[xix] The AI is usually not establishing a causal relationship[xx] – it is predicting. So, as AI bleeds into medical devices, like brain-computer interfaces, the same cautions about using abductive reasoning alone should be carried over. II. Responsive Neurostimulation, AI, and Personalized Medicine Like precision medicine in cancer treatment, computer-brain interface technology similarly focuses on the individual patient through personalized settings. In order to properly expose the intersection of AI, precision medicine, abductive reasoning, and implantable neurotechnologies, the descriptions of adaptive deep brain stimulation systems need to deepen.[xxi] As a broad summary of adaptive deep brain stimulation, to provide a patient with the therapeutic stimulation, a neural signal, typically referred to as a local field potential,[xxii] must first be detected and then interpreted by the device. The main adaptive deep brain stimulation device with premarket approval, the NeuroPace Responsive Neurostimulation system, is used to treat epilepsy by detecting and storing “programmer-defined phenomena.”[xxiii] Providers can optimize the detection settings of the device to align with the patient’s unique electrographic seizures as well as personalize the reacting stimulation’s parameters.[xxiv] The provider adjusts the technology based on trial and error. One day machine learning algorithms will be able to regularly aid this process in myriad ways, such as by identifying the specific stimulation settings a patient may respond to ahead of time based on their electrophysiological signatures.[xxv] Either way, with AI or programmers, adaptive neurostimulation technologies are individualized and therefore operate in line with precision medicine rather than standard treatments based on large clinical trials. Contemporary neurostimulation devices are not usually sophisticated enough to be prominent in AI discussions where the topics of neural networks, deep learning, generative models, and self-attention dominate the conversation. However, implantable high-density electrocorticography arrays (a much more sensitive version than adaptive deep brain stimulation systems use) have been used in combination with neural networks to help patients with neurologic deficits from a prior stroke “speak” through a virtual avatar.[xxvi] In some experimental situations, algorithms are optimizing stimulation parameters with increasing levels of independence.[xxvii] An example of neurostimulation that is analogous to the use of nivolumab in Norway surrounds a patient in the United States who was experiencing both treatment-resistant OCD and temporal lobe epilepsy.[xxviii]Given the refractory nature of her epilepsy, implantation of an adaptive deep brain stimulation system was indicated. As a form of experimental therapy, her treatment-resistant OCD was also indicated for the off-label use of an adaptive deep brain stimulation set-up. Another deep brain stimulation lead, other than the one implanted for epilepsy, was placed in the patient’s right nucleus accumbens and ventral pallidum region given the correlation these nuclei had with OCD symptoms in prior research. Following this, the patient underwent “1) ambulatory, patient-initiated magnet-swipe storage of data during moments of obsessive thoughts; (2) lab-based, naturalistic provocation of OCD-related distress (naturalistic provocation task); and (3) lab-based, VR [virtual reality] provocation of OCD-related distress (VR provocation task).”[xxix] Such signals were used to identify when to deliver the therapeutic stimulation in order to counter the OCD symptoms. Thankfully, following the procedure and calibration the patient exhibited marked improvements in their OCD symptoms and recently shared her results publicly.[xxx] In both cases, there is a similar level of abductive justification for the efficacy of the delivered therapy. In the case study in which the patient was treated with adaptive deep brain stimulation, they at least had their neural activity tested in various settings to determine the optimum parameters for treatment to avoid them being based on guesswork. Additionally, the adaptive deep brain stimulation lead was already placed before the calibration trials were conducted, meaning that the patient had already taken on the bulk of the procedural risk before the efficacy could be determined. Such an efficacy test could have been replicated in the first patient’s cancer treatment, had it been biopsied and tested against the remaining immunotherapies in vitro. Yet, in the case of cancer with few options, one previous dose of a drug that appeared to work on the patient may justify further doses. However, as the Norwegian case presents, corroboration with known responses to a similar drug (from a clinical trial) could be helpful to validate the treatment strategy. (It should be noted that both patients were resigned to these last resort options regardless of the efficacy of treatment.) There are some elements of inductive logic seen with adaptive deep brain stimulation research in general. For example, abductively the focus could be that patient X’s stimulation parameters are different from patient Y’s and patient Z’s. In contrast, when grouped as subjects who obtained personalized stimulation, patients X, Y, and Z demonstrate an inductive aspect to this approach’s safety and/or efficacy. The OCD case holds plenty of abductive characteristics in line with precision medicine’s approach to treating cancer and as more individuals try the method, there will be additional data. With the gradual integration of AI into brain-computer interfaces in the name of efficacy, this reliance on abduction will continue, if not grow, over time. Moving forward, if a responsive deep brain stimulation treatment is novel and individualized (like the dose of nivolumab) and there is some other suggestion of efficacy (like clinical similarities to other patients in the literature), then it may justify insurance coverage for the investigative intervention, absent other unrelated reasons to deny it. III. Ethical Implications and Next Steps While AI’s use in oncology and neurology is not yet as prominent as its use in other fields (e.g., radiology), it appears to be on the horizon for both.[xxxi] AI can be found in both the functioning of the neurotechnologies as well as the implementation of precision medicine. The increasing use of AI may serve to further individualize both oncologic and neurological therapies. Given these implications and the handful of publications cited in this article, it is important to have a nuanced evaluation of how these treatments, which heavily rely on abductive justification, ought to be managed. The just use an abductive approach may be difficult as AI infused precision medicine is further pursued. At baseline, such technology relies on a level of advanced technology literacy among the general public and could exclude populations who lack access to basic technological infrastructure or know-how from participation.[xxxii] Even among nations with adequate infrastructure, as more patients seek out implantable neurotechnologies, which require robust healthcare resources, the market will favor patient populations that can afford this complex care.[xxxiii] If patients already have the means to pay for an initial dose/use of a precision medicine product out of pocket, should insurance providers be required to cover subsequent treatments?[xxxiv] That is, if a first dose of a cancer drug or a deep brain stimulator over its initial battery life is successful, patients may feel justified in having the costs of further treatments covered. The Norwegian patient’s experience implies there is a precedent for the idea that some public insurance companies ought to cover successful cancer therapies, however, insurance companies may not all see themselves as obligated to cover neurotechnologies that rely on personalized settings or that are based on precision/abductive research more than on clinical trials. CONCLUSION The fact that the cases outlined above rely on abductive style of reasoning implies that there may not be as strong a justification for coverage by insurance, as they are both experimental and individualized, when compared to the more traditional large clinical trials in which groups have the same or a standardized protocol (settings/doses). If a study is examining the efficacy of a treatment with a large cohort of patients or with different experimental groups/phases, insurance companies may conclude that the resulting symptom improvements are more likely to be coming from the devices themselves. A preference for inductive justification may take priority when ruling in favor of funding someone’s continued use of an implantable neurostimulator. There are further nuances to this discussion surrounding the classifications of these interventions as research versus clinical care that warrant future exploration, since such a distinction is more of a scale[xxxv] than binary and could have significant impacts on the “right-to-try” approach to experimental therapies in the United States.[xxxvi] Namely, given the inherent limitations of conducting large cohort trials for deep brain stimulation interventions on patients with neuropsychiatric disorders, surgically innovative frameworks that blend abductive and inductive methodologies, like with sham stimulation phases, have traditionally been used.[xxxvii] Similarly, for adaptive brain-computer interface systems, if there are no large clinical trials and instead only publications that demonstrate that something similar worked for someone else, then, in addition to the evidence that the first treatment/dose worked for the patient in question, the balance of reasoning would be valid and arguably justify insurance coverage. As precision approaches to neurotechnology become more common, frameworks for evaluating efficacy will be crucial both for insurance coverage and for clinical decision making. ACKNOWLEDGEMENT This article was originally written as an assignment for Dr. Francis Shen’s “Bioethics & AI” course at Harvard’s Center for Bioethics. I would like to thank Dr. Shen for his comments as well as my colleagues in the Lázaro-Muñoz Lab for their feedback. - [i] Jonathan Kimmelman and Ian Tannock, “The Paradox of Precision Medicine,” Nature Reviews. Clinical Oncology 15, no. 6 (June 2018): 341–42, https://doi.org/10.1038/s41571-018-0016-0. [ii] Henrik Vogt and Bjørn Hofmann, “How Precision Medicine Changes Medical Epistemology: A Formative Case from Norway,” Journal of Evaluation in Clinical Practice 28, no. 6 (December 2022): 1205–12, https://doi.org/10.1111/jep.13649. [iii] David Barrett and Ahtisham Younas, “Induction, Deduction and Abduction,” Evidence-Based Nursing 27, no. 1 (January 1, 2024): 6–7, https://doi.org/10.1136/ebnurs-2023-103873. [iv] Vogt and Hofmann, “How Precision Medicine Changes Medical Epistemology,” 1208. [v] Wireko Andrew Awuah et al., “Bridging Minds and Machines: The Recent Advances of Brain-Computer Interfaces in Neurological and Neurosurgical Applications,” World Neurosurgery, May 22, 2024, S1878-8750(24)00867-2, https://doi.org/10.1016/j.wneu.2024.05.104. [vi] Mark Riedl, “A Very Gentle Introduction to Large Language Models without the Hype,” Medium (blog), May 25, 2023, https://mark-riedl.medium.com/a-very-gentle-introduction-to-large-language-models-without-the-hype-5 f67941fa59e. [vii] David E. Burdette and Barbara E. Swartz, “Chapter 4 - Responsive Neurostimulation,” in Neurostimulation for Epilepsy, ed. Vikram R. Rao (Academic Press, 2023), 97–132, https://doi.org/10.1016/B978-0-323-91702-5.00002-5. [viii] Kimmelman and Tannock, 2018. [ix] Kimmelman and Tannock, 2018. [x] Simon Lohse, “Mapping Uncertainty in Precision Medicine: A Systematic Scoping Review,” Journal of Evaluation in Clinical Practice 29, no. 3 (April 2023): 554–64, https://doi.org/10.1111/jep.13789. [xi] Kimmelman and Tannock, “The Paradox of Precision Medicine.” [xii] Vogt and Hofmann, 1206. [xiii] Vogt and Hofmann, 1206. [xiv] Vogt and Hofmann, 1206. [xv] Vogt and Hofmann, 1207. [xvi] Vogt and Hofmann, 1207. [xvii] Vogt and Hofmann, 1207. [xviii] Vogt and Hofmann, 1210. [xix] Mehar Sahu et al., “Chapter Three - Artificial Intelligence and Machine Learning in Precision Medicine: A Paradigm Shift in Big Data Analysis,” in Progress in Molecular Biology and Translational Science, ed. David B. Teplow, vol. 190, 1 vols., Precision Medicine (Academic Press, 2022), 57–100, https://doi.org/10.1016/bs.pmbts.2022.03.002. [xx] Stefan Feuerriegel et al., “Causal Machine Learning for Predicting Treatment Outcomes,” Nature Medicine 30, no. 4 (April 2024): 958–68, https://doi.org/10.1038/s41591-024-02902-1. [xxi] Sunderland Baker et al., “Ethical Considerations in Closed Loop Deep Brain Stimulation,” Deep Brain Stimulation 3 (October 1, 2023): 8–15, https://doi.org/10.1016/j.jdbs.2023.11.001. [xxii] David Haslacher et al., “AI for Brain-Computer Interfaces,” 2024, 7, https://doi.org/10.1016/bs.dnb.2024.02.003. [xxiii] Burdette and Swartz, “Chapter 4 - Responsive Neurostimulation,” 103–4; “Premarket Approval (PMA),” https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P100026. [xxiv] Burdette and Swartz, “Chapter 4 - Responsive Neurostimulation,” 104. [xxv] Burdette and Swartz, 126. [xxvi] Sean L. Metzger et al., “A High-Performance Neuroprosthesis for Speech Decoding and Avatar Control,” Nature 620, no. 7976 (August 2023): 1037–46, https://doi.org/10.1038/s41586-023-06443-4. [xxvii] Hao Fang and Yuxiao Yang, “Predictive Neuromodulation of Cingulo-Frontal Neural Dynamics in Major Depressive Disorder Using a Brain-Computer Interface System: A Simulation Study,” Frontiers in Computational Neuroscience 17 (March 6, 2023), https://doi.org/10.3389/fncom.2023.1119685; Mahsa Malekmohammadi et al., “Kinematic Adaptive Deep Brain Stimulation for Resting Tremor in Parkinson’s Disease,” Movement Disorders 31, no. 3 (2016): 426–28, https://doi.org/10.1002/mds.26482. [xxviii] Young-Hoon Nho et al., “Responsive Deep Brain Stimulation Guided by Ventral Striatal Electrophysiology of Obsession Durably Ameliorates Compulsion,” Neuron 0, no. 0 (October 20, 2023), https://doi.org/10.1016/j.neuron.2023.09.034. [xxix] Nho et al. [xxx] Nho et al.; Erik Robinson, “Brain Implant at OHSU Successfully Controls Both Seizures and OCD,” OHSU News, accessed March 3, 2024, https://news.ohsu.edu/2023/10/25/brain-implant-at-ohsu-successfully-controls-both-seizures-and-ocd. [xxxi] Awuah et al., “Bridging Minds and Machines”; Haslacher et al., “AI for Brain-Computer Interfaces.” [xxxii] Awuah et al., “Bridging Minds and Machines.” [xxxiii] Sara Green, Barbara Prainsack, and Maya Sabatello, “The Roots of (in)Equity in Precision Medicine: Gaps in the Discourse,” Personalized Medicine 21, no. 1 (January 2024): 5–9, https://doi.org/10.2217/pme-2023-0097. [xxxiv] Green, Prainsack, and Sabatello, 7. [xxxv] Robyn Bluhm and Kirstin Borgerson, “An Epistemic Argument for Research-Practice Integration in Medicine,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 43, no. 4 (July 9, 2018): 469–84, https://doi.org/10.1093/jmp/jhy009. [xxxvi] Vijay Mahant, “‘Right-to-Try’ Experimental Drugs: An Overview,” Journal of Translational Medicine 18 (June 23, 2020): 253, https://doi.org/10.1186/s12967-020-02427-4. [xxxvii] Michael S. Okun et al., “Deep Brain Stimulation in the Internal Capsule and Nucleus Accumbens Region: Responses Observed during Active and Sham Programming,” Journal of Neurology, Neurosurgery & Psychiatry 78, no. 3 (March 1, 2007): 310–14, https://doi.org/10.1136/jnnp.2006.095315. (shrink)

Metaphysics has enjoyed a vigorous revival in the last few decades. Even so, there has been little ontological interest in the things that we interact with everyday—trees, tables, other people.1 It is not that metaphysicians ignore ordinary things altogether. Indeed, they are happy to say that sentences like ‘The daffodils are out early this year’ or ‘My computer crashed again’ are true. But they take the truth of such sentences not to require that a full description of reality mention daffodils (...) or computers. Many metaphysicians now interpret the apparent variety of things in the world as variety only of concepts applied to things that are basically of the same sort—for example, sums of particles or of temporal parts of particles. (shrink)

If T is an isol let D(T) be the least set of isols which contains T and is closed under predecessors and the application of almost recursive combinatorial functions. We find an infinite regressive isol T such that the universal theory (with respect to recursive relations and almost recursive combinatorial functions) of D(T) is the same as that of the nonnegative integers.

In the literature on scientific explanation, there is a classical distinction between explanations of facts and explanations of laws. This paper is about explanations of laws, more specifically mechanistic explanations of laws. We investigate whether providing unificatory information in mechanistic explanations of laws has a surplus value. Unificatory information is information about how the mechanism that explains the law which is our target relates to other mechanisms. We argue that providing unificatory information can lead to explanations with more explanatory power (...) and that it may lead to more strongly supported explanations. (shrink)

The Cambridge World History of Medical Ethics is the first comprehensive scholarly account of the global history of medical ethics. Offering original interpretations of the field by leading bioethicists and historians of medicine, it will serve as the essential point of departure for future scholarship in the field. The volumes reconceptualize the history of medical ethics through the creation of new categories, including the life cycle; discourses of religion, philosophy, and bioethics; and the relationship between medical ethics and the state, (...) which includes a historical reexamination of the ethics of apartheid, colonialism, communism, health policy, imperialism, militarism, Nazi medicine, Nazi "medical ethics," and research ethics. Also included are the first global chronology of persons and texts; the first concise biographies of major figures in medical ethics; and the first comprehensive bibliography of the history of medical ethics. An extensive index guides readers to topics, texts, and proper names. (shrink)

When Ron Giere introduced perspectivism into philosophy of science, he provided a perspectivist analysis of both scientific instruments and scientific theorizing. Today, there is a burgeoning literature that extends Giere’s analysis of theorizing, with many philosophers examining the perspectivist approach to aspects of theorizing such as models, laws, explanations, and so on. However, relatively little attention has been paid to Giere’s analysis of instruments. In this article, I hope to fill this gap. I argue that the perspectivist analysis of instruments (...) should be rejected. First, I give a general account of the kind of instrumentation relevant to instrumental perspectivism, drawing on Cartwright’s notion of nomological machines, which forms the basis of my criticism of Giere’s argument for instrumental perspectivism. Next, I present the case against instrumental perspectivism. I argue that instrumental perspectivism is dependent on theoretical perspectivism in a way that robs it of philosophical significance, and that it introduces new puzzles while adding little to our understanding of instruments. (shrink)