An essential motif of the Western is the frontier in which people of European descent encounter American Indians as other. Indians were viewed as bloodthirsty savages, despite the fact that Europeans were the primary aggressors. The bloodthirsty savage stereotype finds intellectual support in the political philosophy of Thomas Hobbes. Governance in most traditional North American Indian communities isn't about ruling over subordinates, but about forging consent among equals. Indigenous government was often based on equal respect for the values and sovereignty (...) of each member of the community. The Federation embodies Star Trek's vision of multicultural liberalism. The history of Western philosophy has placed masculinity in dominance and control over femininity. This breeds a culture of violence and disharmony and people in need of healing. People of European descent are infected by this history in need of the thawing warmth of the South and a vision that harmonizes masculinity with femininity. (shrink)

The author reflects on the ABC news documentary series Boston Med­—both what it achieved, and what it could have achieved.

Bullying often results in negative coping in victims, including an increased consumption of alcohol. Recently, however, an increase in alcohol use has also been reported among perpetrators of bullying. The factors triggering this pattern are still unclear. We investigated the role of empathy in the interaction between bullying and alcohol use in an adolescent sample (IMAGEN) at age 13.97 (±0.53) years (baseline (BL), N = 2165, 50.9% female) and age 16.51 (±0.61) years (follow-up 1 (FU1), N = 1185, 54.9% female). (...) General empathic distress served as a significant moderator of alcohol use in perpetrators (F9, 493 = 17.978, p < 0.01), which was specific for males and FU1. Male perpetrators, who are generally less sensitive to distress, might thus be more vulnerable to alcohol abuse. (shrink)

The Paradox of the Knower was originally presented by Kaplan and Montague [26] as a puzzle about the everyday notion of knowledge in the face of self-reference. The paradox shows that any theory extending Robinson arithmetic with a predicate K satisfying the factivity axiom K → A as well as a few other epistemically plausible principles is inconsistent. After surveying the background of the paradox, we will focus on a recent debate about the role of epistemic closure principles in (...) the Knower. We will suggest this debate sheds new light on the concept of knowledge which is at issue in the paradox – i.e. is it a “thin” notion divorced from concepts such as evidence or justification, or is it a “thick” notion more closely resembling mathematical provability? We will argue that a number of features of the paradox suggest that the latter option is more plausible. Along the way, we will provide a reconstruction of the paradox using a quantified extension of Artemovʼs [2] Logic of Proofs, as well as a series of results linking the original formulation of the paradox to reflection principles for formal arithmetic. On this basis, we will argue that while the Knower can be understood to motivate a distinction between levels of knowledge, it does not provide a rationale for recognizing a uniform hierarchy of knowledge predicates in the manner suggested by Anderson. (shrink)

This dataset documents results and code for the paper "Interdisciplinarity in the 17th Century? A Co-Occurrence Analysis of Early Modern German Dissertation Titles" by Stefan Heßbrüggen-Walter, forthcoming in *Synthese*. The data to be processed are contained in four files, derived from a larger dataset related to German dissertations and sourced from the national bibliography of 17th century German prints *VD 17* that will be released at a later date. More information can be found in the file `README.md`.

The “standard position” on organ donation is that the donor must be dead in order for vital organs to be removed, a position with which we agree. Recently, Robert Truog and Walter Robinson have argued that brain death is not death, and even though “brain dead” patients are not dead, it is morally acceptable to remove vital organs from those patients. We accept and defend their claim that brain death is not death, and we argue against both the (...) US “whole brain” criterion and the UK “brain stem” criterion. Then we answer their arguments in favour of removing vital organs from “brain dead” and other classes of comatose patients. We dispute their claim that the removal of vital organs is morally equivalent to “letting nature take its course”, arguing that, unlike “allowing to die”, it is the removal of vital organs that kills the patient, not his or her disease or injury. Then, we argue that removing vital organs from living patients is immoral and contrary to the nature of medical practice. Finally, we offer practical suggestions for changing public policy on organ transplantation. (shrink)

I would like to start by thanking Jan Narveson for his time and for the attention that he has shown to my book, The Efficient Society. As someone with broadly left-wing sympathies, I am acutely aware of the lamentable tendency that leftists have of spending their time arguing exclusively with the people who are closest to them on the political spectrum. I have always hoped to avoid that trap. Thus it has been extremely gratifying to see my book provoke unsolicited (...) critical response from, among others, Terrence Corcoran, Walter Robinson, and now Jan Narveson. (shrink)

Prior to August Weismann’s 1889 germ-plasm theory, social reformers believed that humans could inherit the effects of a salubrious environment and, by passing environmentally-induced modifications to their offspring, achieve continuous progress. Weismann’s theory disrupted this logic and caused many to fear that they had little control over human development. As numerous historians have observed, this contributed to the birth of the eugenics movement. However, through an examination of the work of social scientists Lester Frank Ward, Richard T. Ely, Amos Griswold (...) Warner, James Mark Baldwin, Simon Nelson Patten, Alfred Kroeber, Walter Robinson Smith, and Luther Lee Bernard, I demonstrate that Weismann’s ideas also prompted scholars to create of theories of human progress in which the social environment had a central role and biological heredity had a diminished one. Furthermore, in creating a new theory of social progress based on a concept called “social heredity,” the thinkers surveyed in this article separated biological and social thought and asserted the independence of the American social sciences. I argue that this represents an important moment in the maturation of the human sciences, and I suggest that the germ-plasm theory of heredity deserves a larger place in histories of the development of the American social scientific disciplines. (shrink)

In Robinson in Ruins, the third of Patrick Keiller’s trilogy of fictionalised documentaries concerning the wanderings and speculations of an unseen protagonist, the narrator informs us that Robinson had been reading Karl Polanyi’s The Great Transformation, which ‘locates the origin of twentieth century catastrophe in the development of market society in England’. Polanyi identifies how the self-regulating market is not a naturally emergent social form, but was the product of the active interventions of the state. For Robinson (...) (and for Keiller) the contradictions between displacement and dwelling generated by laissez-faire can be revealed and challenged by an exploration of the relationships between landscape, space and politics. The melancholy tone of this trilogy can also be sensed in one of Henri Lefebvre’s final essays, in which he laments the dissolution of the utopian promise of the urban that he once dramatised through his thesis of the ‘urban revolution’. This article explores the themes that drive Keiller’s approach in the Robinson trilogy and draws out the associations in these works to Lefebvre’s writings on the politics of space, Polanyi’s critique of laissez-faire capitalism, and Walter Benjamin’s response to the historical catastrophe we understand as ‘progress’. I will argue that Keiller’s engagement with the idea of catastrophe, through spatial, social and historical registers, is an attempt to link the material ruins of our present with utopian imaginings of alternative forms of sociality—beyond the conceptual limits of capitalist realism and the catastrophic futures of neoliberal space. (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)

Air temperature prediction can play a significant role in studies related to climate change, radiation and heat flux estimation, and weather forecasting. This study applied and compared the outcomes of three advanced fuzzy inference models, i.e., dynamic evolving neural-fuzzy inference system, hybrid neural-fuzzy inference system, and adaptive neurofuzzy inference system for AT prediction. Modelling was done for three stations in North Dakota, USA, i.e., Robinson, Ada, and Hillsboro. The results reveal that FIS type models are well suited when handling (...) highly variable data, such as AT, which shows a high positive correlation with average daily dew point, total solar radiation, and negative correlation with average wind speed. At the Robinson station, DENFIS performed the best with a coefficient of determination of 0.96 and a modified index of agreement of 0.92, followed by ANFIS with R2 of 0.94 and md of 0.89, and HyFIS with R2 of 0.90 and md of 0.84. A similar result was observed for the other two stations, i.e., Ada and Hillsboro stations where DENFIS performed the best with R2: 0.953/0.960, md: 0.903/0.912, then ANFIS with R2: 0.943/0.942, md: 0.888/0.890, and HyFIS with R2: 0.908/0.905, md: 0.845/0.821, respectively. It can be concluded that all three models are capable of predicting AT with high efficiency by only using DP, TSR, and WS as input variables. This makes the application of these models more reliable for a meteorological variable with the need for the least number of input variables. The study can be valuable for the areas where the climatological and seasonal variations are studied and will allow providing excellent prediction results with the least error margin and without a huge expenditure. (shrink)

This guide accompanies the following article(s): ‘Full Disclosure of the “Raw Data” of Research on Humans: Citizens’ Rights, Product Manufacturer’s Obligations and the Quality of the Scientific Database.’Philosophy Compass 6/2 (2011): 90–99. doi: 10.1111/j.1747‐9991.2010.00376.x Author’s Introduction Securing consent (and informed consent) from patients and research study participants is a key concern in patient care and research on humans. Yet, the legal doctrines of consent and informed consent differ in their applications. In patient care, the judicial doctrines of consent and informed (...) consent are disclosure doctrines based on the obligation of physicians to inform their patients of the following types of information: the nature of the procedure the physician is recommending in the patent’s care (P), the alternatives to the physician‐recommendation (A), and the risks of procedure and its alternatives (R). In addition, the physician must provide truthful answers to the patient’s questions (Q) to the best of the physician’s abilities. In research on humans, the onus of disclosure by study sponsors and principal investigators is much greater than in patient care precisely because the purpose of research is not patient care. The purpose of research is the identification and development of new generalizable knowledge. Thus, participation in a research study or trial may not benefit the study volunteer at all. In addition, the participant may carry a heavy risk burden in relationship to any testing of a newly designed drug or device as part of their experiences in the research study. Presently, despite the risks borne by the research study participant, the raw data collected from volunteers in research trials are treated by courts as if they were the private property of the study sponsor rather than generally owed to the public as would be expected by an effort like research participation aimed at contributing to the development of generalizable knowledge. This paper reviews the obligations that study sponsors owe to their study participants based on the very definition of research as a systematic activity whose purpose is to develop generalizable knowledge to help all humans. Author Recommends Court cases Canterbury v. Spence, United States Court of Appeals, District of Columbia Circuit 464 F.2d 772 (1972). (Federal appellate decision heard in the District of Columbia, USA) Reibl v. Hughes, 2 S.C.R. 880 (1980). (Supreme Court of Canada) Rogers v. Whitaker, 175 C.L. R. 479 (1992). (High Court of Australia) Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985) (House of Lords) Canterbury v. Spence is the landmark Federal informed consent case in the United States heard in the District of Columbia. In this case, Judge Spottswood Robinson articulated the reasonable person standard of informed consent. This standard was subsequently adopted by the Supreme Court of Canada (Reibl v. Hughes, 2 S.C.R. 880 (1980)) and the High Court of Australia (Rogers v. Whitaker, 175 C.L. R. 479 (1992)). The House of Lords rejected the reasonable person standard in England in Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985). Book Mazur, Dennis J. The Science and Ethics of Research on Humans. Baltimore, MD: Johns Hopkins University Press, 2007. This book is a detailed guide for the review of scientific and ethical aspects of research on humans contained in the research study protocols and research informed consent forms which need to be submitted by study sponsors and principal investigators to institutional review boards (IRBs) for IRB review before a research study can receive approval to be conducted within a human study population in those institutions over which the IRB has authority. It also presents basic definitions in the area of research on humans and basic approaches to help conduct a deep review of the underlying scientific and ethical issues that are present within a research study protocol and its accompanying research informed consent form. Report National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical Guidelines for the Protection of Human Subjects of Research. Washington, DC: DHEW Publications, 1978 (78‐0012). This U.S. National Commission in the Belmont Report argued for the necessity of a reasonable volunteer standard in research on humans in the United States. Arguing that the professional standard and the reasonable person standard of consent and informed consent were insufficient to base a disclosure standard in research on humans, this National Commission developed the reasonable volunteer standard where a study participant is to be approached in research informed consent with that information that a reasonable volunteer would want to know. Online Materials Belmont Report: Syllabus Topics for Lecture and Discussion Week I: Introduction and Overview Readings: Rogers v. Whitaker, 175 C.L.R. 479 (1992). (High Court of Australia) Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985) (House of Lords) Week II: The Different Standards of Consent and Informed Consent Readings: Canterbury v. Spence, 464 F.2d 772 (1972). (Federal appellate opinion heard in the District of Columbia) Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985) (House of Lords) Week III: Definition of Research Reading: Mazur, Dennis J. The Science and Ethics of Research on Humans. Baltimore, MD: Johns Hopkins University Press, 2007. (Especially Chapters 2 and 3) Week IV: How to Review a Research Study Protocol and Research Informed Consent Form Reading: Mazur, Dennis J. The Science and Ethics of Research on Humans. Baltimore, MD: Johns Hopkins University Press, 2007. (Especially Chapters 4–6, 10, and 12–14) Week V: Obligations in Research of Humans Versus Patient Care Reading: National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical Guidelines for the Protection of Human Subjects of Research. Washington, DC: DHEW Publications, 1978 (78‐0012). Focus Questions • How do the judicial doctrines of consent in England and Australia compare to the judicial doctrines of informed consent in the United States and Canada? • How does a professional standard of disclosure differ from a reasonable person standard of disclosure? • What is the definition of research? • How is a research study (study proposal and research informed consent form) reviewed from scientific and ethical bases for considerations of approval by an IRB? • How do the obligations of a study sponsor, a principal investigator, and a research team conducting a research trial on human study participants differ from the obligations of a physician caring for a patient? • Should all raw data of research derived from humans be made available to the public for use in developing generalizable knowledge to help others, or should raw data be considered the private property of the study sponsors (for example, prescription drug manufacturers), who fund the research trials? Seminar/project Idea Draw a timeline of the development of the basic concepts of consent and informed consent in patient care and in patient research. On this timeline, first place the dates of the key court cases in England, the United States, Canada, and Australia on consent and informed consent. Then place the date of the development of the Belmont Report. Why do differences exist between these four countries in terms of the legal requirements of informedness of a patient (in medical care) and a study participant (in medical research)? What roles if any do the concepts of self‐determination and self‐decision have in consent and informed consent in patient care and in informed consent in research on humans among the four countries of interest? What are the realities of research on human participants that require a new standard of informed consent, the reasonable volunteer standard, to be developed beyond the two standards in patient care, the professional standard, and the reasonable person standard? Counterpoint Arguments The following are counterpoint arguments that need to be appreciated to more fully understand the concepts that impact the thesis that ‘raw data’ should be open to the public to allow the opportunity of checking of the results of its associated scientific paper and for further analysis. De‐Identified (Anonymized) Raw Data A current approach to identifying (anonymizinig) raw data is based on the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (P.L.104‐191). HIPAA was enacted by the U.S. Congress in 1996 to keep a person’s medical information private. In a research study, a person’s private medical information can become research data. HIPAA’s Privacy Rule allows a covered entity to de‐identify data by removing all 18 elements that could be used to identify the individual or the individual’s relatives, employers, or household members; these elements are enumerated in the Privacy Rule. The covered entity must also have no actual knowledge that the remaining information could be used alone or in combination with other information to identify the individual who is the subject of the information. Under this method, the identifiers that must be removed are the following: 1 Names. 2 All geographic subdivisions smaller than a state, including street address, city, county, precinct, ZIP Code, and their equivalent geographical codes, except for the initial three digits of a ZIP Code if, according to the current publicly available data from the Bureau of the Census: 2a. The geographic unit formed by combining all ZIP Codes with the same three initial digits contains more than 20,000 people. 2b. The initial three digits of a ZIP Code for all such geographic units containing 20,000 or fewer people are changed to 000. 3 All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, and date of death, and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older. 4 Telephone numbers. 5 Facsimile numbers. 6 Electronic mail addresses. 7 Social security numbers. 8 Medical record numbers. 9 Health plan beneficiary numbers. 10 Account numbers. 11 Certificate/license numbers. 12 Vehicle identifiers and serial numbers, including license plate numbers. 13 Device identifiers and serial numbers. 14 Web universal resource locators (URLs). 15 Internet protocol (IP) address numbers. 16 Biometric identifiers, including fingerprints and voiceprints. 17 Full‐face photographic images and any comparable images. 18 Any other unique identifying number, characteristic, or code, unless otherwise permitted by the Privacy Rule for re‐identification. Even though ‘raw data’ can be de‐identified (anonymized) so that there is no way to trace back the data to the study participant from which it was drawn, there are still questions whether the ‘de‐identified raw data’ can be given to other researchers or made public without the original study participant’s approval. It may be the case that this approval could be done at the start of any research study where the individual considering study participation would be counseled on what the process of de‐identification consists of and would be asked whether the participant would allow use of the data by other researchers or made available to the public in a de‐identified state. However, there may be questions of the study participants as to whether the data are truly de‐identified and untraceable back to the study participant since the participant would not be able to see the process actually being carried out in detail in all relevant circumstances. Using Raw Data in Context Simply being in possession of raw data is never enough to build on that data from a research perspective. Researchers need to understand the context of the scientific research study in which the data were collected. This research context includes (but is not limited to): (i) the scientific hypothesis of the research study, (ii) the inclusion and exclusion criteria selected by the research designers of the study to determine which study participants were included and which were excluded from the study, (iii) the methods used to collect the data and possibilities of errors in the data collection processes, and (iv) answers to questions regarding whether any data were excluded from the study data and why these data were excluded. Ownership Rights Over Data There are ownership rights over data. Ownership rights include court decision making related to the question which parties are to be considered as the owners of the data. Possible owners here include (but are not limited to) (i) the study sponsor whose only role was to fund that study, (ii) the principal investigator(s) who developed the scientific hypothesis, and (iii) individual study participants through special contracts made by individual participants who negotiate such contracts with study sponsors and principal investigators to share in the ownership of data. Examples of such data are participant sources of unique gene lines or unique cell lines to be used in future research. Objections to Data Sharing Finally, individual researchers may simply object to sharing data. A researcher’s arguments here may be simply stating that he or she has a right to fully analyze the data since the collection of the data was the researchers’ idea in the first place. These researchers may argue that they have the right to mine the data as fully as they can before deciding to make the data open to the public for others to analyze. Works Cited 1 Kaiser, J. ‘Making Clinical Data Widely Available.’Science 322.5899 (10 Oct. 2008): 217–8. 2 de Lusignan, S., J.F. Metsemakers, P. Houwink, V. Gunnarsdottir, and J. van der Lei. ‘Routinely Collected General Practice Data: Goldmines for Research? A Report of the European Federation for Medical Informatics Primary Care Informatics Working Group (EFMI PCIWG) from MIE2006, Maastricht, The Netherlands.’Informatics in Primary Care 14.3 (2006): 203–9. 3 Sim, I. ‘Human Studies Database Project’, CTSA Data Repositories Symposium (17 Oct. 2008). 23 Nov. 2010. 4 Sim, I., C.G. Chute, H. Lehmann, R. Nagarajan, M. Nahm, and R.H. Scheuermann. ‘Keeping Raw Data in Context.’Science 323.5915 (6 Feb. 2009): 713. 5 U.S. Department of Health and Human Services, National Institutes of Health, HIPAA Privacy Rule, Information for Researchers. 13 Nov. 2010. 6 Wilczynski, N.L., R.B. Haynes, and Hedges Team. ‘EMBASE Search Strategies for Identifying Methodologically Sound Diagnostic Studies for Use by Clinicians and Researchers.’BMC Medicine 29.3 (March 2005): 7. (shrink)

This entry concerns dualism in the philosophy of mind. The term ‘dualism’ has a variety of uses in the history of thought. In general, the idea is that, for some particular domain, there are two fundamental kinds or categories of things or principles. In theology, for example a ‘dualist’ is someone who believes that Good and Evil — or God and the Devil — are independent and more or less equal forces in the world. Dualism contrasts with monism, which is (...) the theory that there is only one fundamental kind, category of thing or principle; and, rather less commonly, with pluralism, which is the view that there are many kinds or categories. In the philosophy of mind, dualism is the theory that the mental and the physical — or mind and body or mind and brain — are, in some sense, radically different kinds of thing. Because common sense tells us that there are physical bodies, and because there is intellectual pressure towards producing a unified view of the world, one could say that materialist monism is the ‘default option’. Discussion about dualism, therefore, tends to start from the assumption of the reality of the physical world, and then to consider arguments for why the mind cannot be treated as simply part of that world. (shrink)

Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a (...) set of clearly defined procedures for these decisions. The procedures are based on the principle of nonmaleficence and typically include consultation with hospital ethics committees, reflecting the guidelines of relevant professional associations. Ethical debates about when CPR can and should be limited tend to rely more on discussions of theory, principles, and case studies than systematic empirical study of the situations in which such limitations are applied. Sociologists of bioethics call for empirical study, arguing that what ethicists and health professionals believe they are doing when they draft policies or invoke principles does not always mirror what is happening on the ground. In this article, we begin the task of modeling the empirical analyses sociologists call for, focusing on a cohort at Massachusetts General Hospital. We inductively analyzed ethics committee notes and medical records of nineteen patients whose surrogates did not accept the decision to withhold CPR. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Psychiatric Practice and the Living Force of the Social in the BiopsychosocialGeorge Ikkos, BSc, FRCPsych (bio) and Giovanni Stanghellini, MD, DPhil (HC) (bio)One of the handful of universally acknowledged founders of his discipline, sociologist Emile Durkheim (1857–1917; see Fournier, 2013) is best known to psychiatrists for his seminal “Suicide: A Study in Sociology” (1897/2002). Arguably, he should have been at least as well known for his last completed work (...) “The Elementary Forms of Religious Life” (1912/1995), the best book of sociology ever written according to some (Bellah, 1995). In this magisterial work, through a comprehensive survey of the anthropological evidence available at the time and fine conceptual analysis, Durkheim came to define from a strictly secular perspective phenomena such as the sacred and the profane, soul and magic, but also “mana” (a penetrating and connecting force) and collective “effervescence” (wild gesticulating, copulating, or aggressing when aboriginal family groups came together). The last two concepts can help us to understand the origin and persistence of the living force of the social in our daily experience, that is, what it is, what it feels like and how it plays itself out in relationships (Ikkos & McQueen, 2019). Although he makes no reference to Durkheim, nor to mana nor effervescence, social anthropologist Ongaro’s welcome ambition is to lift the social out of the shadow of the dominating bio- and psychological in the use of the biopsychosocial model and, thus, bring it to bear as an immediately experienced and enacted living force akin to mana and effervescence in contemporary psychiatric practice.In this commentary, we first review issues relating to the biopsychosocial model, Ongaro’s externalist foundations, and predictive processing and functional neurological, somatic and mental symptoms. We then discuss our formulation of contemporary anorexia nervosa and hysteria as examples of our attempts at enhanced engagement with the social. We conclude by suggesting the work of social historian and cultural critic Walter Benjamin (1892–1940) as a vital resource for better engagement with the social in biopsychosocial practice in the future. [End Page 325]The Biopsychosocial ModelMany find that in current practice the biopsycho-social model is simply the biomedical cloaked in another name (Mohtashemi et al., 2016). Those most expert in it acknowledge doubts about what it is exactly (Bolton, 2022). Most would agree with Ongaro and Williamson that though not yet dead, if it is to survive as a clinical force in practice, it needs clarification and revival (Williamson, 2022). Bolton suggests that “we can make use of the term ‘biopsychosocial model’ as a shorthand for methodological assumptions that causes and/or cures of specific conditions at specific stages, including matters of adjustment and quality of life, will generally—across a wide range of conditions—include biological, psychological and social factors, and interactions between them. The contrast here is with the ‘biomedical model’, which deals with biological factors only” (Bolton, 2022). Bolton then discusses the utility and advantages of his definition of the model specifically in relation to research on the social determinants of disease and on pain. That is fine, as far as it goes, that is, research methodology and clinical theory. Ongaro, however, wants to ensure that the social is understood as a more immediately experienced and directly enacted force in clinical encounters. To achieve his aim, he argues, we need a more balanced and persuasive integration of all three components of the model: bio-psycho-social. In effect what he proposes is to vitalize psychiatry with something related to Durkheim’s ideas of mana and effervescence.Externalist FoundationsIn his first paper, Ongaro argues that he can partly achieve his aims by using the tools provided by our contemporary neuroscience research on “predictive processing” and philosophical theories of “enactivism” (Ongaro, 2024a). In his second paper he reports on his anthropological experience of living for 19 months with the Akha, a group of swidden farmers in highland Laos. Here he investigated how they respond to functional neurological disorders (FNDs), functional somatic symptoms (FSS) (Burton et al., 2020), also to what Western medicine defines as (functional) mental disorders (FMDs) and what the Akha and he sometimes conceive as spiritual... (shrink)

Nosso objetivo neste artigo é apresentar o capitalismo como religião contemporânea, tendo o dinheiro como Deus e o marxismo e o liberalismo como correntes proféticas. O texto se divide em três momentos. Na primeira parte, buscamos definir “religião” a partir do conceito fundamental de Pulsão, tal como definido pelo psicanalista MD Magno. Na segunda parte, com base no texto clássico de Walter Benjamin e no recém-lançado “The enchantments of Mammon” de Eugene McCarragher, buscamos caracterizar o capitalismo como religião do (...) nosso tempo. E por fim, analisando passagens das obras de Marx, Smith, Mises e Hayek, procuramos demonstrar que marxismo e liberalismo são vertentes proféticas da religião capitalista. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.3 (2002) 261-264 [Access article in PDF] Mind, Meaning, and the Brain Thomas Fuchs, MD, PhD Keywords: Mind, brain, meaning, translation, depression. A Systemic View of the Mind Progress in brain research over the past two decades demonstrates the power of the neurobiological paradigm. However, this progress is connected with a restricted field of vision typical of any scientific paradigm. The psychiatrist should be aware (...) of this restriction, because, unlike the brain scientist, he deals with patients, not with brains. The restricted view may be described by the terms of (1) reductionism, (2) reification, and (3) isolation.Reductionism: Neurobiology tends to regard subjectivity as a mere by-product of the brain's activity as a symbol-manipulating machine or an information processor. Consciousness becomes an epiphenomon of the neuronal machinery that, operating behind our back, creates the illusion of a continuous self and of an autonomous will (Churchland 1995; Roth 1996).Reification: Mental or subjective states seem to be localizable in the brain; thoughts or feelings, it appears, may be observed in the colored illumination of cortical and subcortical structures. This results in the belief that brain images could also show the cause of a mental illness, or even the illness itself, which then manifests, for instance, in a reduced metabolic activity in certain areas of the cortex.Isolation: As a further consequence, this view isolates the individual patient and considers his illness separated from the interconnections with his environment. However, on these interconnections his personal experiences and dispositions are founded, and it is the actual interpersonal situation that has triggered his present illness.Walter Glannon's paper successfully counters these tendencies toward a neurobiological reductionism with an extended view of the mind: "... the mind is not located in any one place but is distributed among the brain, the body, and the environment." Of course, who observes someone's brain will never see his thoughts, his pain, or his anxiety. For consciousness is not a localizable object or state at all but a process of relating to something: a perceiving of, remembering of, wishing for, aiming at, and so on. Thus on the phenomenological level, there is nothing like a "mental event" that could be isolated from the world and from the stream of conscious experiences. The mind exists only embedded in the world and in the temporal process of life.The same applies to the biological level: Consciousness is based on the continuous interaction of the brain with the organism, and of the organism as a whole with the environment. The role of the brain for mental phenomena is thus comparable to the role of the heart in the circulatory system or of the lung in the respiratory system. Of course, the lung is the central organ of breathing, but respiration may not be restricted to the [End Page 261] lung, nor to the organism as a whole. It means constant exchange with the environment, and there is no sense in asking whether the air taken in still belongs to the surroundings or already to the organism. The same systemic unity is found in the circle of perception and action mediated by the brain: When I am writing a letter, there is no place in the unity of action where my "self" ends and the "world" begins, no border that separates inner and outer worlds.There is another argument to be raised against the reification of the mind if we consider the aspect of a historical biology. From birth on, our mind as well as the correlated brain structures are essentially formed by social and cultural influences. The brain is not inserted into the world as a prefabricated apparatus but through its plastic development in and from the world. Thus it adapts epigenetically to its specific natural and social environment like a key to a lock. This complementarity makes it impossible to restrict one's view to the anatomic organ and requires an interdisciplinary approach to brain-environment investigation, as for example, under the heading of a "social cognitive neuroscience" (Ochsner and Lieberman 2001).As Glannon goes on to argue, to overcome... (shrink)

Gossip is rarely praised. There seems little virtuous that is about talking behind someone’s back. Whether there is anything virtuous about gossip, however, depends on the kind of gossip. Some gossip is idle, but some evaluative gossip promulgates and enforces norms. When properly motivated, such gossip effects positive change in society and counts as gossiping well. The virtue of gossiping well even includes some kinds of false gossip, namely the sort that exaggerates a pre-existing trait, thereby creating a caricature of (...) a person’s character in order to establish a moral exemplar (or anti-exemplar). (shrink)