This book identifies the physical, emotional, and psychological adjustments many boys have been forced to navigate alone during their most vulnerable, formative years and provides adjustments that adults must make to assist them in these transitions.

The authors argue that an understanding of human agency based on Spinoza's views can resolve the apparent conflict between the demands of happiness and the dictates of morality without damaging the unique values associated with the moral form of life espoused by Kant.

Originating as a proponent of U.S. exceptionalism during the Cold War, American Studies has now reinvented itself, vigorously critiquing various kinds of critical hegemony and launching innovative interdisciplinary endeavors. _The Futures of American Studies_ considers the field today and provides important deliberations on what it might yet become. Essays by both prominent and emerging scholars provide theoretically engaging analyses of the postnational impulse of current scholarship, the field's historical relationship to social movements, the status of theory, the state of higher (...) education in the United States, and the impact of ethnic and gender studies on area studies. They also investigate the influence of poststructuralism, postcolonial studies, sexuality studies, and cultural studies on U.S. nationalist—and antinationalist—discourses. No single overriding paradigm dominates the anthology. Instead, the articles enter into a lively and challenging dialogue with one another. A major assessment of the state of the field, _The Futures of American Studies_ is necessary reading for American Studies scholars. _Contributors._ Lindon Barrett, Nancy Bentley, Gillian Brown, Russ Castronovo, Eric Cheyfitz, Michael Denning, Winfried Fluck, Carl Gutierrez-Jones, Dana Heller, Amy Kaplan, Paul Lauter, Günter H. Lenz, George Lipsitz, Lisa Lowe, Walter Benn Michaels, José Estaban Muñoz, Dana D. Nelson, Ricardo L. Ortiz, Janice Radway, John Carlos Rowe, William V. Spanos. (shrink)

In our commentary we ask whether we should ultimately endeavour to find the deep causes of behaviours? Then we discuss two extensions of the proposed framework: (1) Mendelian randomisation and (2) hypothesis-free gene–environment interaction (leveraging heterogeneity in genetic associations). These complementary methods help move us towards second-generation causal knowledge, ultimately understanding mechanistic pathways and identifying more effective intervention targets.

Editors' introduction to 3rd thematic issue on philosophy of medicine.

Introduction This article is a response to Zagouras, Ellick, and Aulisio who presented a case study justifying the questioning of the capacity and autonomy of a young woman with a physical disability who was pregnant and facing coercive pressure to terminate. Case description Julia is described as a 26-year-old woman with a neurological disability that requires her to receive assistance with activities of daily living. She was described as living with her parents who provided her with personal care assistance. Julia (...) became pregnant and her parents wished her to terminate because they did not want to care for her child in addition to her. In fact, Julia's parents threatened her with institutionalization if she did not elect to terminate the pregnancy. Her health care team questioned her decision-making capacity based on her alleged “mental age” and experiences of being sheltered and excluded. The health care team used directive tactics to convince Julia to terminate the pregnancy, which describe as both an ethical and feminist intervention. Discussion The current authors take issue with the case analysis provided by and argue that they neglected to account for numerous instances of systemic ableism that adversely affected Julia, demonstrated prejudicial and judgmental attitudes toward pregnancy and disability, inappropriately questioned her decision-making capacity by infantilizing her, misconstrued the feminist concept of relational autonomy, and colluded with coercive interference from family members. This is a classic example of discriminatory and culturally incompetent reproductive health care for a disabled woman. (shrink)

Between the Psyche and the Social is the first collection that specifically features the field of psychoanalytic social theory emerging in and between psychoanalysis, feminism, postcolonial studies, and queer theory, and across the disciplines of philosophy, literary, film, and cultural studies. This collection of essays takes the psychoanalytic study of social oppression in some new directions by engaging—indeed, stirring up—unconscious fantasies and ethical tensions at the heart of social subjectivity.

In Free Will and Luck, Mele presents a case of an agent Ernie, whose zygote was intentionally designed so that Ernie A-s in 30 years, bringing about a certain event E. Mele uses this case of original design to outline the zygote argument against compatibilism. In this paper I criticize the zygote argument. Unlike other compatibilists who have responded to the zygote argument, I contend that it is open to the compatibilist to accept premise one, that Ernie does not act (...) freely and is not morally responsible for anything he does. I argue that compatibilists should deny premise two. Diana’s effective intention to create Ernie’s zygote such that Ernie A-s in 30 years and her intervention to bring about his A-ing mark a significant difference between Ernie and normal agents in a deterministic universe with regard to how their zygotes were created that affects whether those agents act freely and are morally responsible for so acting. (shrink)

Viewing the language of modal logic as a language for describing directed graphs, a natural type of directed graph to study modally is one where the nodes are sets and the edge relation is the subset or superset relation. A well-known example from the literature on intuitionistic logic is the class of Medvedev frames $\langle W,R\rangle$ where $W$ is the set of nonempty subsets of some nonempty finite set $S$, and $xRy$ iff $x\supseteq y$, or more liberally, where $\langle W,R\rangle$ (...) is isomorphic as a directed graph to $\langle \wp(S)\setminus\{\emptyset\},\supseteq\rangle$. Prucnal [32] proved that the modal logic of Medvedev frames is not finitely axiomatizable. Here we continue the study of Medvedev frames with extended modal languages. Our results concern definability. We show that the class of Medvedev frames is definable by a formula in the language of tense logic, i.e., with a converse modality for quantifying over supersets in Medvedev frames, extended with any one of the following standard devices: nominals (for naming nodes), a difference modality (for quantifying over those $y$ such that $x\not= y$), or a complement modality (for quantifying over those $y$ such that $x\not\supseteq y$). It follows that either the logic of Medvedev frames in one of these tense languages is finitely axiomatizable---which would answer the open question of whether Medvedev's [31] "logic of finite problems'' is decidable---or else the minimal logics in these languages extended with our defining formulas are the beginnings of infinite sequences of frame-incomplete logics. (shrink)

Jackie Leach Scully, Laurel E. Baldwin-Ragaven, and Petya Fitzpatrick, Feminist Bioethics: At the Center, on the Margins, Baltimore: The Johns Hopkins University Press, 2010, reviewed by Robyn Bluhm.

24 women including E. Feal and B. Sykes describe their alignment with womens movement; Both argue that sexism runs second to racism as oppressive agent of black women, womens movement doesnt address their problems.

RESUMO Em detrimento do acúmulo de 10.000 horas de prática antes do domínio sobre algo - o famoso tipping point de Ericsson - intérpretes médicos podem ganhar considerável experiência ao analisar vídeos de interações médico-paciente, mesmo quando esse par fala a mesma língua. Os hospitais-escola comumente filmam tais interações usando pacientes simulados. Tais filmes têm sido usados em instruções de aula com intérpretes. Aqui, é descrito o uso recente de filmes com PS em um ambiente de aprendizado online, no qual (...) fóruns de discussão e fichas de atividade suplantaram os métodos de trabalho convencionais. Nessa abordagem de aprendizagem baseada em problemas, típica da educação médica, estudantes de pós-graduação em interpretação em serviços de saúde se familiarizam com o discurso típico de diagnóstico e tratamento. Os alunos relataram que essa familiarização os ajudou a liberar seus recursos cognitivos para planejar e monitorar traduções e outras decisões imediatas. Os materiais e métodos de aprendizado usados nessa abordagem online são descritos detalhadamente. O valor do contexto da ABP é descrito em relação às abordagens educacionais de interpretação para o sistema de saúde de modo geral.ABSTRACT Rather than amassing 10,000 hours of practice before mastery is achieved - Ericsson’s famed tipping point - medical interpreters can gain considerable, concomitant experience by analyzing videos of provider-patient interactions, even when the pair speak the same language. Teaching hospitals commonly film such interactions using standardized patients. Such films have been effectively used in classroom-based instruction with interpreters. The novel use of SP films in an on-line learning environment is described herein, where discussion boards and worksheets supplanted traditional instruction methods. In this problem-based learning approach, typical of medical education, graduate-level medical interpreting students became familiar with common diagnostic and treatment discourse. Students reported that this familiarity helped free their cognitive resources for planning and monitoring translations and other decisions on-the-job. The learning materials and methods used in this on-line approach are detailed. The value of the PBL context is described in relation to healthcare interpreting education approaches generally. (shrink)

Non-classical generalizations of classical modal logic have been developed in the contexts of constructive mathematics and natural language semantics. In this paper, we discuss a general approach to the semantics of non-classical modal logics via algebraic representation theorems. We begin with complete lattices L equipped with an antitone operation ¬ sending 1 to 0, a completely multiplicative operation ◻, and a completely additive operation ◊. Such lattice expansions can be represented by means of a set X together with binary relations (...) ⊲, R, and Q, satisfying some first-order conditions, used to represent (L,¬), ◻, and ◊, respectively. Indeed, any lattice L equipped with such a ¬, a multiplicative ◻, and an additive ◊ embeds into the lattice of propositions of a frame (X,⊲,R,Q). Building on our recent study of "fundamental logic", we focus on the case where ¬ is dually self-adjoint (a≤¬b implies b≤¬a) and ◊¬a≤¬◻a. In this case, the representations can be constrained so that R=Q, i.e., we need only add a single relation to (X,⊲) to represent both ◻ and ◊. Using these results, we prove that a system of fundamental modal logic is sound and complete with respect to an elementary class of bi-relational structures (X,⊲,R). (shrink)

Unlike standard modal logics, many dynamic epistemic logics are not closed under uniform substitution. A distinction therefore arises between the logic and its substitution core, the set of formulas all of whose substitution instances are valid. The classic example of a non-uniform dynamic epistemic logic is Public Announcement Logic (PAL), and a well-known open problem is to axiomatize the substitution core of PAL. In this paper we solve this problem for PAL over the class of all relational models with infinitely (...) many agents, PAL-K_omega, as well as standard extensions thereof, e.g., PAL-T_omega, PAL-S4_omega, and PAL-S5_omega. We introduce a new Uniform Public Announcement Logic (UPAL), prove completeness of a deductive system with respect to UPAL semantics, and show that this system axiomatizes the substitution core of PAL. (shrink)

The reasoning abilities of large language models (LLMs) are the topic of a growing body of research in AI and cognitive science. In this paper, we probe the extent to which twenty-nine LLMs are able to distinguish logically correct inferences from logically fallacious ones. We focus on inference patterns involving conditionals (e.g., 'If Ann has a queen, then Bob has a jack') and epistemic modals (e.g., 'Ann might have an ace', 'Bob must have a king'). These inferences have been of (...) special interest to logicians, philosophers, and linguists, since they play a central role in the fundamental human ability to reason about distal possibilities. Assessing LLMs on these inferences is thus highly relevant to the question of how much the reasoning abilities of LLMs match those of humans. All the LLMs we tested make some basic mistakes with conditionals or modals, though zero-shot chain-of-thought prompting helps them make fewer mistakes. Even the best performing LLMs make basic errors in modal reasoning, display logically inconsistent judgments across inference patterns involving epistemic modals and conditionals, and give answers about complex conditional inferences that do not match reported human judgments. These results highlight gaps in basic logical reasoning in today's LLMs. (shrink)

Mirrored-self misidentification is the delusional belief that one's own reflection in the mirror is a stranger. In two experiments, we tested the ability of hypnotic suggestion to model this condition. In Experiment 1, we compared two suggestions based on either the delusion's surface features (seeing a stranger in the mirror) or underlying processes (impaired face processing). Fifty-two high hypnotisable participants received one of these suggestions either with hypnosis or without in a wake control. In Experiment 2, we examined the extent (...) to which social cues and role-playing could account for participants' behaviour by comparing the responses of 14 hypnotised participants to the suggestion for impaired face processing (reals) with those of 14 nonhypnotised participants instructed to fake their responses (simulators). Overall, results from both experiments confirm that we can use hypnotic suggestion to produce a compelling analogue of mirrored-self misidentification that cannot simply be attributed to social cues or role-playing. (shrink)

In "A Problem in Possible-World Semantics," David Kaplan presented a consistent and intelligible modal principle that cannot be validated by any possible world frame (in the terminology of modal logic, any neighborhood frame). However, Kaplan's problem is tempered by the fact that his principle is stated in a language with propositional quantification, so possible world semantics for the basic modal language without propositional quantifiers is not directly affected, and the fact that on careful inspection his principle does not target the (...) world part of possible world semantics—the atomicity of the algebra of propositions—but rather the idea of propositional quantification over a complete Boolean algebra of propositions. By contrast, in this paper we present a simple and intelligible modal principle, without propositional quantifiers, that cannot be validated by any possible world frame precisely because of their assumption of atomicity (i.e., the principle also cannot be validated by any atomic Boolean algebra expansion). It follows from a theorem of David Lewis that our logic is as simple as possible in terms of modal nesting depth (two). We prove the consistency of the logic using a generalization of possible world semantics known as possibility semantics. We also prove the completeness of the logic (and two other relevant logics) with respect to possibility semantics. Finally, we observe that the logic we identify naturally arises in the study of Peano Arithmetic. (shrink)

The problem of inferring probability comparisons between events from an initial set of comparisons arises in several contexts, ranging from decision theory to artificial intelligence to formal semantics. In this paper, we treat the problem as follows: beginning with a binary relation ≥ on events that does not preclude a probabilistic interpretation, in the sense that ≥ has extensions that are probabilistically representable, we characterize the extension ≥+ of ≥ that is exactly the intersection of all probabilistically representable extensions of (...) ≥. This extension ≥+ gives us all the additional comparisons that we are entitled to infer from ≥, based on the assumption that there is some probability measure of which ≥ gives us partial qualitative information. We pay special attention to the problem of extending an order on states to an order on events. In addition to the probabilistic interpretation, this problem has a more general interpretation involving measurement of any additive quantity: e.g., given comparisons between the weights of individual objects, what comparisons between the weights of groups of objects can we infer? (shrink)

TheSatyricahas long been associated with a Neronian courtier named Petronius, mentioned by Tacitus in hisAnnals. As such, the text is usually dated to the mid first centuryc.e.This view is so established that certain scholars have suggested it is ‘little short of perverse not to accept the general consensus and read theSatyricaas a Neronian text of the mid-60sad’. In recent years, however, there has been a groundswell of support for re-evaluating this long-held position. Laird, after comparing the ‘form and content’ of (...) the text to the Greek novel, came to the ‘unattractive’ conclusion that the text may be second century. Similarly, in two recent pieces inCQ, Roth argues that the manumission scene in theCenaestablishes a newterminus post quemfor the text; she suggests that the freedoms granted by Trimalchio closely parallel—and parody—descriptions of awardingciuitasfound in the letters of Pliny the Younger. Indeed, the three slaves manumitted in the novel are associated with a boar (Sat.40.3–41.4), Dionysus (Sat.41.6–7) and a falling star (Sat. 54.1–5); likewise, the three slaves that are the subject of Pliny's letter are C. Valerius Aper (boar), C. Valerius Dionysius (god of wine) and C. Valerius Astraeus (stars). Roth's argument suggests that the author of theSatyricawas not Nero's contemporary but a member of Pliny's intellectual circle, offering strong circumstantial evidence that troubles the accepted tradition on the work's authorship and date. (shrink)

Unlike standard modal logics, many dynamic epistemic logics are not closed under uniform substitution. A distinction therefore arises between the logic and its substitu- tion core, the set of formulas all of whose substitution instances are valid. The classic example of a non-uniform dynamic epistemic logic is Public Announcement Logic (PAL), and a well-known open problem is to axiomatize the substitution core of PAL. In this paper we solve this problem for PAL over the class of all relational models with (...) infinitely many agents, PAL-Kω , as well as standard extensions thereof, e.g., PAL-Tω , PAL-S4ω, and PAL-S5ω. We introduce a new Uniform Public Announcement Logic (UPAL), prove completeness of a deductive system with respect to UPAL semantics, and show that this system axiomatizes the substitution core of PAL. (shrink)

Much attention has been paid recently to the role of anomalous experiences in the aetiology of certain types of psychopathology, e.g. in the formation of delusions. We examine, instead, the top-down influence of pre-existing beliefs and affective factors in shaping an individual’s characterisation of anomalous sensory experiences. Specifically we investigated the effects of paranormal beliefs and alexithymia in determining the intensity and quality of an altered state of consciousness . Fifty five participants took part in a sweat lodge ceremony, a (...) traditional shamanic ritual which was unfamiliar to them. Participants reported significant alterations in their state of consciousness, quantified using the ‘APZ’ questionnaire, a standardized measure of ASC experience. Participants endorsing paranormal beliefs compatible with shamanic mythology, and those showing difficulty identifying feelings scored higher on positive dimensions of ASC experience. Our findings demonstrate that variation in an individual’s characterisation of anomalous experiences is nuanced by pre-existing beliefs and affective factors. (shrink)

Despite the practical knowledge throughout the nineteenth century that citrus fruit cured scurvy, and that rickets and beriberi were diseases caused by poor diet, it was not until 1901 that animal feeding experiments led one investigator to propose the existence of 'accessory food factors,' a lack of which was determined to be the cause of some illnesses (Hopkins, 1949. In Joseph Needham and E. Baldwin (eds.), Hopkins and Biochemistry, 1861-1947: Papers Concerning Sir Frederick Gowland Hopkins, O.M., P.R.S., with a Selection (...) of His Addresses and a Bibliography of His Publications. Cambridge: W. Heifer and Sons Ltd). The discovery of vitamins has long been considered as a delayed discovery. This delay has been attributed to the power of the germ theory in physiology at the time. While the germ theory and theories of autointoxication certainly played a role in delaying the discovery of vitamins, I argue further that it is important to consider the difference made to physiology by understanding the vitamins’ catalytic function. The profound difference made to physiology by the vitamins’ catalytic function suggests that a vitamin concept had previously been systematically inaccessible to researchers working within the conceptual framework of Bernardian physiology. (shrink)

Ecological weed management (EWM) is a scientifically established management approach that uses ecological patterns to reduce weed seedbanks. Such an approach can save organic farmers time and labor costs and reduce the need for repeated cultivation practices that may pose risks to soil and water quality. However, adoption of effective EWM in the organic farm community is perceived to be poor. In addition, communication and collaboration between the scientific community, extension services, and the organic farming community in the US is (...) historically weak. In order to uncover the most persistent obstacles to promoting effective weed management in organic agroecosystems, we use the mental models approach to generate an expert model based on interviews with experts (e.g., weed scientists, weed ecologists, and extension personnel) and theories from the behavioral sciences. The expert model provides two main insights: (1) EWM is a complex strategy that may cause farmers to use heuristics in management decisions and (2) the long-term benefits of EWM, rather than the risks, need to be emphasized in communication with and outreach to organic farmers. The basis for new research topics and outreach material that incorporates these insights from the expert model are discussed. We briefly explain how the expert model is an incomplete picture of on-farm practices, but provides the basis for the second step of our mental models research, the farmer interviews and farmer decision model development. (shrink)

The present study assessed whether dementia worry is associated with adults’ subjective cognitive difficulties, and whether any associations are moderated by age. Participants were 477 adults aged 18–90 years. They completed standard, subjective measures of dementia worry and everyday cognitive difficulties (i.e. attention, language, verbal and visual-spatial memory, and visual-perceptual ability). Moderated regression analyses included dementia worry as a predictor of specific cognitive difficulties, and age as a moderator. Covariates included gender, trait cognitive and somatic anxiety, general aging-related anxiety, depression, (...) stress, mental health treatment status, and health status. Greater overall dementia worry, and specifically more frequent dementia worry, were both associated with greater attentional difficulty in middle-aged and older adults, but not in young adults. Cognitions about developing dementia in reaction to memory lapses were also associated with greater cognitive difficulties across the adult lifespan for multiple cognitive domains. Results highlight a robust relationship between dementia worry and subjective attentional difficulties, especially in middle-aged and older adults. Worry frequency is also more influential with adult aging. A cognitive or meta-cognitive mechanism may underlie subjective cognitive concerns across the adult lifespan. (shrink)

By addressing specific global problems and placing them within an ethical context, "The Environment in Question" provides the reader with both a theoretical and practical understanding of environmental issues. The contributors are internationally known figures drawn from the various disciplines which bear upon these issues, such as geography, psychology, social policy, and philosophy. The contributions range from those tackling individual concrete issues (such as nuclear waste and the threat to the rain forest) to those addressing matters of policy, principle and (...) attitude (such as our obligations to future generations and the nature of technological risk). "The Environment in Question" is designed as a text for students of philosophy, environmental science, environmental education, ecology, and teacher education. It can be used as an inter-disciplinary, self-contained course book or in conjunction with relevant material. In addition, as the essays directly and controversially address current environmental debates in a non-technical manner, it is of great interest both to professionals in those areas and to readers who care about the planet's future. The substantial cross-section of concerns and approaches will enable all readers to develop the necessary level of understanding required to initiate and sustain debate on environmental issues. Contributors: Robert Allsion, David E. Cooper, Barry S. Gower, F. G. T. Holliday, C. A. Hooker, Mary Midgley, Philip Neal, Joy A. Palmer, Robert Prosser, Holmes Rolston III, Mark Sagoff, Vandana Shiva, Stephen Sterling, Rosemary J. Stevenson, Jennifer Trusted. (shrink)

Reviews : Robyn Eckersley, Environmentalism and Political Theory: Toward an Ecocentric Approach ; Robert E. Goodin, Green Political Theory ; Peter Hay and Robyn Eckersley, Ecopolitical Theory: Essaysfrom Australia, ; Peter Hay, Robyn Eckersley and Geoff Holloway Environmental Politics in Australia and New Zealand ; Drew Hutton, Green Politics in Australia ; Michael Muetzelfeldt, Society, State and Politics in Australia.

After the completion of RecA protein‐mediated recombinational repair of daughter‐strand gaps in E. coli, participating chromosomes are held together by Holliday junctions. Until recently, it was not known how the cell disengages the connected chromosomes. Accumulating genetic data suggested that the product of the ruv locus participates in recombinational repair and acts after the formation of Holliday junctions. Molecular characterization of the locus revealed that there are three genes – ruvA, ruvB and ruvC; mutations in any one of (...) the genes confer the same phenotype. Recently, the RuvC protein was found to be a Holliday junction resolvase. At first glance, the resolving activity of RuvC alone would appear to be sufficient for the separation of recombining chromosomes. However, in vitro studies show that the filament of RecA protein is unable to dissociate from the products of the recombination reaction. Thus, in vivo, even if the Holliday junctions are resolved by RuvC, RecA filament must be holding two DNA duplexes together. New findings about enzymatic activities of RuvA and RuvB proteins foster the hope that the machinery for removing the RecA filament from DNA has been found. (shrink)

Robyn Carston and I share a general methodological position which I call ‘Truth-Conditional Pragmatics' (TCP). TCP is the view that the effects of context on truth-conditional content need not be traceable to the linguistic material in the uttered sentence. Some effects of context on truth-conditional content are due to the linguistic material (e.g. to context-sensitive words or morphemes which trigger the search for contextual values), but others result from ‘free' pragmatic processes. Free pragmatic processes take place not because the (...) linguistic material demands it, but because the utterance's content is not faithfully or wholly encoded in the uttered sentence, whose meaning requires adjustment or elaboration in order to determine an admissible content for the speaker's utterance. To make room for these processes, I will argue, we need to distinguish the logical form of an utterance, in the standard sense, and its modified logical form, affected by free pragmatic processes. This distinction will be elaborated and I will show that it can be interpreted in three different ways. (shrink)

In B. Soria and E. Romero, Explicit Communication: Essays on Robyn Carston’s Pragmatics, Palgrave Studies in Pragmatics, Language and Cognition. London.

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. 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