Scientific authority and physician authority are both challenged by Thomas Kuhn's concept of incommensurability. If competing “paradigms” or “world views” cannot rationally be compared, we have no means to judge the truth of any particular view. However, the notion of local or partial incommensurability might provide a framework for understanding the implications of contemporary philosophy of science for medicine. We distinguish four steps in the process of translating medical science into clinical decisions: the doing of the science, the appropriation of (...) the scientific findings by the clinician, the transfer of the findings from the clinician to the patient, and the choice of a treatment regimen. Incommensurability can play a role in each stage. There is at least some theory- and value-ladenness in science that is dependent on the world view of those who construct the scientific theories. Clinicians who must use the results of scientific research will inevitably interpret the research from the standpoint of their own world view. There may be further incommensurability when these data are communicated to the patient. Finally, clinician and patient values must come into play in any decision about choice of treatment. No stage of medical research or practice is value-free. This position does not imply relativism; some scientific accounts are better than others. However, the challenge of the incommensurabilists shows that further analysis is needed to establish how particular accounts are better or worse. (shrink)

Among bioethicists and members of the public, genetics is often regarded as unique in its ethical challenges. As medical researchers and clinicians increasingly combine genetic information with a range of non-genetic information in the study and clinical management of patients with common diseases, the unique ethical challenges attributed to genetics must be re-examined. A process of genetic routinisation that will have implications for research and clinical ethics, as well as for public conceptions of genetic information, is constituted by the emergence (...) of new forms of genetic medicine, in which genetic information is interpreted in a multifactorial frame of reference. Although the integration of genetics in medical research and treatment may be a helpful corrective to the mistaken assumptions of genetic essentialism or determinism, the routinisation of genetics may have unintended consequences for the protection of genetic information, perceptions of non-genetic information and the loss of genetic research as a laboratory for exploring issues in research and clinical ethics. Consequently, new ethical challenges are presented by the increasing routinisation of genetic information in both biomedical and public spheres. (shrink)

Prenatal screening for foetal abnormalities such as Down's syndrome differs from other forms of population screening in that the usual aim of achieving health gains through treatment or prevention does not seem to apply. This type of screening leads to no other options but the choice between continuing or terminating the pregnancy and can only be morally justified if its aim is to provide meaningful options for reproductive choice to pregnant women and their partners. However, this aim should not be (...) understood as maximizing reproductive choice per se. Only if understood as allowing prospective parents to avoid suffering related to living with serious disorders and handicaps can prenatal screening be a publicly or collectively funded programme. The alternative of moving prenatal testing outside the healthcare system into the private sector is problematic, as it makes these tests accessible only to those who can afford to pay for it. New developments in prenatal screening will have to be assessed in terms of whether and to what extent they either contribute to or undermine the stated aim of providing meaningful options for reproductive choice. In the light of this criterion, this article discusses the introduction of the new non-invasive prenatal test , the tendency to widen the scope of follow-up testing, as well as the possible future scenarios of genome-wide screening and ‘prenatal personalised medicine’. The article ends with recommendations for further debate, research and analysis. (shrink)

Implicit processes almost certainly preceded explicit processes in our evolutionary history, so they are likely to be more resistant to disruption according to the principles of evolutionary biology [Reber, A. S. . The cognitive unconscious: An evolutionary perspective. Consciousness and Cognition, 1, 93–133.]. Previous work . Knowledge, nerves and know-how: The role of explicit versus implicit knowledge in the breakdown of a complex motor skill under pressure. British Journal of Psychology, 83, 343–358.]) has shown that implicitly learned motor skills remain (...) stable under psychological pressure and concurrent cognitive demands, and recently [Poolton, J. M., Masters, R. S. W., & Maxwell, J. P. . Passing thoughts on the evolutionary stability of implicit motor behaviour: Performance retention under physiological fatigue. Consciousness and Cognition, 16, 456–468.] showed that they also remain stable under conditions of anaerobic fatigue that would have significantly challenged the survival skills of our ancestors. Here we examine the stability of an implicitly learned motor skill under fatigue conditions that primarily tax a different physiological system , but which have equally strong evolutionary connotations. Participants acquired a throwing task by means of an errorless learning method or an errorful method. Motor performance in the errorless condition, but not the errorful condition, remained stable following an exhaustive VO2 max. running test. Our findings replicate and extend the work of Poolton et al., providing further support for Reber’s evolutionary distinction between implicit and explicit processes. (shrink)

The formulas-as-types isomorphism tells us that every proof and theorem, in the intuitionistic implicational logic $H_\rightarrow$, corresponds to a lambda term or combinator and its type. The algorithms of Bunder very efficiently find a lambda term inhabitant, if any, of any given type of $H_\rightarrow$ and of many of its subsystems. In most cases the search procedure has a simple bound based roughly on the length of the formula involved. Computer implementations of some of these procedures were done in Dekker. (...) In this paper we extend these methods to full classical propositional logic as well as to its various subsystems. This extension has partly been implemented by Oostdijk. (shrink)

A Hilbert-style version of an implicational logic can be represented by a set of axiom schemes and modus ponens or by the corresponding axioms, modus ponens and substitution. Certain logics, for example the intuitionistic implicational logic, can also be represented by axioms and the rule of condensed detachment, which combines modus ponens with a minimal form of substitution. Such logics, for example intuitionistic implicational logic, are said to be D-complete. For certain weaker logics, the version based on condensed detachment and (...) axioms (the condensed version of the logic) is weaker than the original. In this paper we prove that the relevant logic T→, and any logic of which this is a sublogic, is D-complete. (shrink)

Introduction: Early recognition of prediabetes may prevent progression to diabetes, yet not all adults are aware of their prediabetes risk. To reach all adults unaware of their risk, additional risk assessment strategies are warranted. Objectives: The objective of this study was to evaluate the potential scope of benefit from prediabetes risk assessment in the dental care setting and to identify characteristics of dental patients likely to unknowingly have prediabetes or diabetes. Methods: Data from 10,472 adults in the National Health and (...) Nutrition Examination Survey from 2013 to 2014 and 2015 to 2016 were analyzed for associations among prediabetes/diabetes risk factors, health care use, and hemoglobin A1C levels according to chi-square tests and multivariate logistic regression. Results: A total of 7.73% of US adults had seen a dentist but not a medical provider in the past 12 mo. The composition of this subpopulation was significantly different from that who saw a medical provider, in ways that might affect their diabetes risk. In addition, 31.27% of this subpopulation would be identified as being at high risk for prediabetes according to the CDC Prediabetes Screening Test, and 15.83% had hemoglobin A1C levels indicative of undiagnosed prediabetes or diabetes. Screening in a dental setting would have the highest odds of identifying someone unaware of his or her diabetes risk among those who were non-White, obese, or ≥45 y old. Conclusion: Extrapolation from this analysis indicates that screening for prediabetes at dental visits has the potential to alert an estimated 22.36 million adults of their risk for prediabetes or diabetes. Incorporating prediabetes or diabetes risk assessment into routine dental visits may enable 1) those with prediabetes to take action to decrease their risk of developing diabetes and 2) those with diabetes to engage in treatment to decrease their risk of diabetes-related complications. Knowledge Transfer Statement: Screening for prediabetes and diabetes during dental visits has the potential to raise patients’ awareness of diabetes risk and prevent prediabetes from progressing to diabetes. For some patients, the dental visit may be the only point of contact with the health care system, which heightens the importance of including diabetes risk assessment for patient well-being. (shrink)

During the decades following the publication of Darwin's Origin of species in 1859, religious belief in England and in particular the Church of England experienced some of the most intense criticism in its history. The early 1860s saw the appearance of Lyell's Evidence of the antiquity of man , Tylor's research on the early history of mankind , Renan's Vie de Jésus , Pius IX's encyclical, Quanta cura, and the accompanying Syllabus errarum, John Henry Newman's Apologia , and Swinburne's notorious (...) Atalanta in Calydon ; it was in this period also that Arthur Stanley was appointed Dean of Westminster, and that Bills were introduced in Parliament to amend or repeal the ‘Test Acts’ as they affected universities. They were the years that witnessed Lyell present the case for geology at the British Association at Bath , the first meeting of the X-Club , and the award of the Royal Society's Copley Medal to Charles Darwin. These were the years in which, as Owen Chadwick has put it, ‘the controversy between “science” and “religion” took fire’. (shrink)