Recently, concerns have been raised about the phenomenon of ‘overdiagnosis’, the diagnosis of a condition that is not causing harm, and will not come to cause harm. Along with practical, ethical, and scientific questions, overdiagnosis raises questions about our concept of disease. In this paper, we analyse overdiagnosis as an epistemic problem and show how it challenges many existing accounts of disease. In particular, it raises ques- tions about conceptual links drawn between disease and dysfunction, harm, and risk. We argue (...) that ‘disease’ should be considered a vague concept with a non-classical structure. On this view, overdiagnosed cases are ‘borderline’ cases of disease, falling in the zone between cases that are clearly disease, and cases that are clearly not disease. We then develop a pre ́cising definition of disease designed to provide practical help in preventing and limiting overdiagnosis. We argue that for this purpose, we can define disease as dysfunction that has a significant risk of causing severe harm to the patient. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 39.1 (2006) 45-71 [Access article in PDF] Presencing "Communion" in Chaïm Perelman's New Rhetoric Richard Graff Wendy Winn Department of RhetoricUniversity of MinnesotaOver the second half of his long and distinguished career, Chaïm Perelman reiterated the central themes of his theory of rhetoric many times. As the audience for his work expanded, Perelman was repeatedly invited to summarize the principles presented in La nouvelle rhétorique, (...) his magnum opus authored in collaboration with Lucie Olbrechts-Tyteca, which appeared in 1958. On these occasions, he would often attempt to clarify or refine the major concepts presented in that treatise. Nevertheless, even today many aspects of Perelman's work remain enigmatic. In outline, The New Rhetoric itself conveys a sense of structural and theoretical clarity, but for many readers this first impression evaporates when they confront the complexity and detail of the work's exposition. In the preface to their new study of Perelman, Alan Gross and Ray Dearin observe:The New Rhetoric is difficult to read, a task made even more difficult for American audiences because virtually all its examples and illustrations are from a literature in a foreign language.... Moreover, Perelman's later attempts to achieve clarity, in The Realm of Rhetoric, and numerous shorter articles, are equally puzzling. Consequently, some of Perelman's best ideas are virtually buried in a very long work, and therefore largely lost even to the most careful readers. In addition, on such central issues as the relationship between rhetoric and philosophy Perelman remains maddeningly obscure. (2003, ix) While Perelman's status as a pioneering figure in the rejuvenation of rhetorical study in Continental Europe is secure, as is his placement among the canonical twentieth-century theorists by American scholars, such difficulties constitute an impediment to contemporary understanding and future appreciation of his achievement; and the sprawling character of The New Rhetoric certainly has not helped to counteract the less [End Page 45] sympathetic reception his work has received in some corners of rhetorical and argumentation studies.1Gross and Dearin's volume joins several other recent studies that have contributed to the untangling of Perelman's thought and to the profitable application of his ideas.2 Still, some of Perelman's "best ideas" remain buried and sorely in need of excavation. Chief among these are considerations prompted by Perelman's use of the evocative yet mysterious term "communion." Although communion appears repeatedly among the panoply of concepts and argumentative techniques described in The New Rhetoric, explicit discussion of it there is brief and scattered, and the subject receives only glancing mention in Perelman's subsequent publications. In turn, communion has been all but ignored in the scholarship responding to or extending Perelman's work.3 This is even the case in studies where one would expect to see more serious engagement with Perelman's ideas on the subject—notably, in those that consider the status of values in argumentation and the role of rhetoric in the constitution and maintenance of community.4In this essay, we offer a detailed analysis of Perelman's conception of communion and, in the course of endowing the concept with greater "presence," aim to show its rich implications for these areas of inquiry. We argue that the idea of communion is a vital, if understated, component of Perelman's proposed "new rhetoric." Like other aspects of Perelman's theory, however, it is an expansive and somewhat slippery notion. In The New Rhetoric, communion is used in a very general sense as the term denoting a community's agreement on questions of value, but also, more narrowly, as an objective sought in certain forms of discourse and as an effect of specific linguistic-stylistic devices. The exegesis needed to indicate the subtle links between these senses will enable us to describe the manner in which Perelman endeavored to integrate the technical lore inherited from the classical tradition of rhetoric with a broadly social and determinedly pluralisticconception of argumentation.We begin by examining communion in relation to Perelman and Olbrechts-Tyteca's ideas... (shrink)

An increasing number of patients receive diagnoses of disease without having any symptoms. These include diseases detected through screening programs, as incidental findings from unrelated investigations, or via routine checks of various biological variables like blood pressure or cholesterol. In this article, we draw on narrative identity theory to examine how the process of making sense of being diagnosed with asymptomatic disease can trigger certain overlooked forms of harm for patients. We show that the experience of asymptomatic disease can involve (...) ‘mismatches’ between one’s beliefs about one’s health status on the one hand, and bodily sensations or past experience on the other. Patients’ attempts to integrate these diagnoses into their self-narratives often involve either forming inaccurate beliefs about bodily sensations and/or past experience, or coming to believe that feelings and experience do not necessarily track or predict health status, leading to an ongoing sense of vulnerability to ill health. These resulting alterations in self-understanding can sometimes be considered harmful, in view of their implications for ascriptions of responsibility and ongoing anxiety. (shrink)

The debate about whether misoprostol should be distributed to low resource communities to prevent post-partum haemorrhage, recognised as a major cause of maternal mortality, is deeply polarised. This is in spite of stakeholders having access to the same evidence about the risks and benefits of misoprostol. To understand the disagreement, we conducted a qualitative analysis of the values underpinning debates surrounding community distribution of misoprostol. We found that different moral priorities, epistemic values, and attitudes towards uncertainty were the main factors (...) sustaining the debate. With this understanding, we present a model for ethical discourse that might overcome the current impasse. (shrink)

Positive claims about narrative approaches to healthcare suggest they could have many benefits, including supporting person-centred healthcare (PCH). Narrative approaches have also been criticised, however, on both theoretical and practical grounds. In this paper we draw on epistemological work on narrative and knowledge to develop a conception of narrative that responds to these concerns. We make a case for understanding narratives as accounts of events in which the way each event is described as influenced by the ways other events in (...) the narrative are described. This view of narratives recognises that they can contribute knowledge of different kinds of connections between events: not just causal, and not just of patient’s perspectives. Additionally, narratives can add further epistemic value by suggesting potentially useful lines of inquiry. We take narrative approaches to healthcare to include clinicians considering both patients’ informational offerings and their own professional understandings as narratives. On this understanding, our account is able to overcome the major theoretical and practical criticisms that have been levelled against the use of narrative approaches in healthcare, and can help to explain why and how narrative approaches are consistent with PCH. (shrink)

Surgery is an important part of contemporary health care, but currently much of surgery lacks a strong evidence base. Uptake of evidence-based medicine (EBM) methods within surgical research and among practitioners has been slow compared with other areas of medicine. Although this is often viewed as arising from practical and cultural barriers, it also reflects a lack of epistemic fit between EBM research methods and surgical practice. In this paper we discuss some epistemic challenges in surgery relating to this lack (...) of fit, and investigate how resources from feminist epistemology can help to characterize them. We point to ways in which these epistemic challenges may be addressed by gathering and disseminating evidence about what works in surgery using methods that are contextual, pluralistic, and sensitive to hierarchies. (shrink)

Evidence in medicine can come from more or less trustworthy sources and be produced by more or less reliable methods, and its interpretation can be disputed. As such, it can be unclear when disagreements in medicine result from different, but reasonable, interpretations of the available evidence and when they result from unreasonable refusals to consider legitimate evidence. In this article, we seek to show how assessments of the relevance and implications of evidence are typically affected by factors beyond that evidence (...) itself, such as our beliefs about the credibility of the speaker or source of the evidence. In evaluating evidence, there is thus a need for reflective awareness about why we accept or dismiss particular claims. (shrink)

In the paper “An archeology of corruption in medicine”, Miles Little, Wendy Lipworth, and Ian Kerridge present an account of corruption and describe its prevalent forms in medicine. In presenting an individual-focused account of corruption found within “social entities”, Little et al. argue that these entities are corruptible by nature and that certain individuals are prone to take advantage of the corruptibility of social entities to pursue their own ends. The authors state that this is not preventable, so the (...) way to remedy corruption is via management and, where necessary, punishment. This commentary will briefly lay out the key features and functions of corruption as presented by Little et al., before providing a critical discussion that will focus on whether corruptibility is a necessary feature of social entities. I will propose that it is not a necessary feature, though it may frequently arise where individualistic values are unchecked. Corruption can be prevented within social entities by enhancing structures that direct toward virtue and which promote and reward cooperation instead of competition. (shrink)

Research leadership in Australian universities takes place against a backdrop of policy reforms concerned with measurement and comparison of institutional research performance. In particular, the Excellence in Research in Australian initiative undertaken by the Australian Research Council sets out to evaluate research quality in Australian universities, using a combination of expert review process, and assessment of performance against ?quality indicators?. Benchmarking exercises of this sort continue to shape institutional policy and practice, with inevitable effects on the ways in which research (...) leadership, mentoring and practice are played out within university faculties and departments. In an exploratory study that interviewed 32 Australian academics in universities in four Australian states, we asked participants, occupying formal or informal research leadership roles, to comment on their perceptions of research leadership as envisioned and enacted in their particular workplaces. We found a pervasive concern amongst participants that coalesced around binaries characterized in metaphoric terms of ?carrots and whips?. Research leadership was seen by many as managerial in nature, and as such, largely tethered to instrumentalist notions of productivity and performativity, while research cultures were seen as languishing under the demoralizing weight of reward and punishment systems. Here, we consider what is at stake for the future of the academic workforce under such conditions, arguing that new models of visionary research leadership are urgently needed in the ?troubled times? of techno-bureaucratic university reforms. (shrink)

I present Lockean considerations that count in favor of a global basic income program. This paper articulates a conception of equal-share left-libertarianism that is supported by the moral rights of full self-ownership and world-ownership. It is argued that, according to this view, an appropriately constructed global basic income program would be a key institution for promoting the rights of full self-ownership and world-ownership.

Increasingly there are calls for climate services to be “co-produced” with users, taking into account not only the basic information needs of users but also their value systems and decision contexts. What does this mean in practice? One way that user values can be incorporated into climate services is in the management of inductive risk. This involves understanding which errors in climate service products would have particularly negative consequences from the users’ perspective (e.g., underestimating rather than overestimating the change in (...) an impact variable) and then prioritizing the avoidance of those errors. This essay shows how inductive risk could be managed in climate services in ways that serve user values and argues that there are both ethical and practical reasons in favor of doing so. (shrink)

To study Earth’s climate, scientists now use a variety of computer simulation models. These models disagree in some of their assumptions about the climate system, yet they are used together as complementary resources for investigating future climatic change. This paper examines and defends this use of incompatible models. I argue that climate model pluralism results both from uncertainty concerning how to best represent the climate system and from difficulties faced in evaluating the relative merits of complex models. I describe how (...) incompatible climate models are used together in ‘multi-model ensembles’ and explain why this practice is reasonable, given scientists’ inability to identify a ‘best’ model for predicting future climate. Finally, I characterize climate model pluralism as involving both an ontic competitive pluralism and a pragmatic integrative pluralism. (shrink)

Rowan Williams's theological-moral reasoning regarding the formation of personal identities in relation to gender, familial and communal ties is analysed in an article review of his book Lost Icons. This is his most sustained essay in theological social criticism, and was intended for the general public beyond academic theology. Williams exposes Christian moral reasoning on these issues to forms of secular critique whilst simultaneously using theological and historical strategies from liberal Anglo-Catholicism. His argumentation is subjected to theological and social-scientific scrutiny. (...) The article calls for closer attention to debates within secular feminism and social research concerning the formation of adult men and women in relation to the wider post-Christian society. Links are made from Williams's thought in Lost Icons to underlying patterns in his academic theological output. (shrink)

Wendy Brown's work commands widespread attention and respect, and there has been considerable interest as to how it would develop after "States of Injury." This book will not disappoint.

In Sleeping with Extra-Terrestrials , Wendy Kaminer argues that we are a society intoxicated by the irrational: religion, spirituality, and popular therapies threaten to replace rational thought with supernaturalism and impassioned but unexamined personal testimony. Ranging from our fascination with angels, aliens, and near- death experiences to the rise of junk science, the recovery movement, and the digital culture, Kaminer points out the amusing and ominous effects of our deference to spiritual authorities and resistance to critical thinking. She questions (...) conventional wisdom about the association of religious belief with virtue, identifying the sectarianism of efforts to establish religion in the public square. With both wit and empathy, Kaminer takes on what many people hold sacred. Kaminer is an eloquent and incisive critic and rationalist living in a superstitious, evangelical age. In Sleeping with Extra-Terrestrials she challenges us to exercise skepticism, reason, and irreverence and to appreciate the pleasures of free inquiry. (shrink)

I introduce a distinction between general and local model-data symbiosis and offer three examples of local symbiosis in the fields of meteorology and climate science. Local model-data symbiosis ref...

Recent calls for retraction of a large body of Chinese transplant research and of Dr Jiankui He’s gene editing research has led to renewed interest in the question of publication, retraction and use of unethical biomedical research. In Part 1 of this paper, we briefly review the now well-established consequentialist and deontological arguments for and against the use of unethical research. We argue that, while there are potentially compelling justifications for use under some circumstances, these justifications fail when unethical practices (...) are ongoing—as in the case of research involving transplantations in which organs have been procured unethically from executed prisoners. Use of such research displays a lack of respect and concern for the victims and undermines efforts to deter unethical practices. Such use also creates moral taint and renders those who use the research complicit in continuing harm. In Part 2, we distinguish three dimensions of ‘non-use’ of unethical research: non-use of published unethical research, non-publication, and retraction and argue that all three types of non-use should be upheld in the case of Chinese transplant research. Publishers have responsibilities to not publish contemporary unethical biomedical research, and where this has occurred, to retract publications. Failure to retract the papers implicitly condones the research, while uptake of the research through citations rewards researchers and ongoing circulation of the data in the literature facilitates subsequent use by researchers, policymakers and clinicians. (shrink)

This pedagogical essay explores the tendency of undergraduate media ethics students to do what Bernard Gert calls “morality by slogans” and their tendency to misuse Aristotle's golden mean slogan. While not solving the dilemma of morality by slogans, the essay suggests some ways of rectifying the misuse of the golden mean and encouraging its more authentic application.

This target article presents a plausible evolutionary scenario for the emergence of the neural preconditions for language in the hominid lineage. In pleistocene primate lineages there was a paired evolutionary expansion of frontal and parietal neocortex (through certain well-documented adaptive changes associated with manipulative behaviors) resulting, in ancestral hominids, in an incipient Broca's region and in a configurationally unique junction of the parietal, occipital, and temporal lobes of the brain (the POT). On our view, the development of the POT in (...) our ancestors resulted in the neuroanatomical substrate consistent with the ability for representations in modality-neutral association cortex and, as a result of structure-imposing interaction with Broca's area, the hierarchically structured Evidence from paleoneurology and comparative primate neuroanatomy is used to argue that Homo habilis (2.5–2 million years ago) was the first hominid to have the appropriate gross neuroanatomical configuration to support conceptual structure. We thus suggest that the neural preconditions for language are met in H. habilis. Finally, we advocate a theory of language acquisition that uses conceptual structure as input to the learning procedures, thus bridging the gap between it and language. (shrink)

'Is politics gendered? Wendy Brown things so, and argues for this point with elegance, imagination and pungent phrases. Brown's book is challenging, provocative and...original; it does force us to question the degree to which gender controls our politics.'-THE REVIEW OF POLITICS.

Current conceptions of human language include a gestural component in the communicative event. However, determining how the linguistic and gestural signals are distinguished, how each is structured, and how they interact still poses a challenge for the construction of a comprehensive model of language. This study attempts to advance our understanding of these issues with evidence from sign language. The study adopts McNeill's criteria for distinguishing gestures from the linguistically organized signal, and provides a brief description of the linguistic organization (...) of sign languages. Focusing on the subcategory of iconic gestures, the paper shows that signers create iconic gestures with the mouth, an articulator that acts symbiotically with the hands to complement the linguistic description of objects and events. A new distinction between the mimetic replica and the iconic symbol accounts for the nature and distribution of iconic mouth gestures and distinguishes them from mimetic uses of the mouth. Symbiotic symbolization by hand and mouth is a salient feature of human language, regardless of whether the primary linguistic modality is oral or manual. Speakers gesture with their hands, and signers gesture with their mouths. (shrink)

Across the Euro-Atlantic world, political leaders have been mobilizing their bases with nativism, racism, xenophobia, and paeans to “traditional values,” in brazen bids for electoral support. How are we to understand this move to the mainstream of political policies and platforms that lurked only on the far fringes through most of the postwar era? Does it herald a new wave of authoritarianism? Is liberal democracy itself in crisis? In this volume, three distinguished scholars draw on critical theory to address our (...) current predicament. Wendy Brown, Peter E. Gordon, and Max Pensky share a conviction that critical theory retains the power to illuminate the forces producing the current political constellation as well as possible paths away from it. Brown explains how “freedom” has become a rallying cry for manifestly un-emancipatory movements; Gordon dismantles the idea that fascism is rooted in the susceptible psychology of individual citizens and reflects instead on the broader cultural and historical circumstances that lend it force; and Pensky brings together the unlikely pair of Tocqueville and Adorno to explore how democracies can buckle under internal pressure. These incisive essays do not seek to smooth over the irrationality of the contemporary world, and they do not offer the false comforts of an easy return to liberal democratic values. Rather, the three authors draw on their deep engagements with nineteenth–and twentieth–century thought to investigate the historical and political contradictions that have brought about this moment, offering fiery and urgent responses to the demands of the day. (shrink)

Abstract This article outlines Locke's theory of war as found in his political writings and seeks to redress a perceived imbalance in John Locke's morality of war. Locke's strident rejection of any sense of proportionality in warfare against unjust aggression, as read in the Second Treatise of Government, has to be tempered with his general philosophical programme against extremism of any sort. Arguably, Locke's war ethic when read alone is strict, objective, and emphatic, but when compared with his epistemological work, (...) its righteousness is reduced to extreme circumstances. (shrink)

In this paper we explore the nature of the emerging purpose ecosystem and its role in transforming and supporting business to help address the UN Sustainable Development Goals. We argue that interactions among its ‘private actors’, who share efforts and belief in changing and redefining the purpose and nature of business by advocating broader non-financial performance outcomes, have the potential to contribute to a wider sustainability-oriented transformation of the business sector. Through interview data collected in the UK and Australia, we (...) identify six main roles that characterise the activities and interactions among its actors and their stakeholders. Our research contributes to expanding knowledge on the emerging phenomenon of the purpose ecosystem and how its actors support the achievement of the UN SDGs by seeking to change the purpose of business and integrating the goals into their operations and engagements with stakeholders. (shrink)

A political philosopher dissects the duties and dilemmas of the unelected spokesperson, from Martin Luther King, Jr., to Greta Thunberg. -/- Political representation is typically assumed to be the purview of formal institutions and elected officials. But many of the people who represent us are not senators or city councilors—think of Martin Luther King, Jr., or Malala Yousafzai or even a neighbor who speaks up at a school board meeting. Informal political representatives are in fact ubiquitous, often powerful, and some (...) bear enormous responsibility. In Speaking for Others, political philosopher Wendy Salkin develops the first systematic conceptual and moral analysis of informal political representation. -/- Salkin argues that informal representation can be a political lifeline, particularly for oppressed and marginalized groups that are denied representation in formal political institutions. Yet informal political representatives exert outsized influence over the ways these groups’ interests are understood by the public, without the represented having much recourse to hold them accountable. And many informal political representatives are selected not by the groups they represent but by outsiders, sticking these groups with representatives they would not choose but cannot shake. The role of informal political representatives is therefore fraught with moral questions. What exactly are their duties and to whom are they owed? Should they be members of the groups they represent? When is informal representation permissible and when is it best avoided? -/- Informal political representation is taking place all around us. In fact, you yourself may be an informal political representative without knowing it. Speaking for Others explores the tensions central to this pervasive yet underexamined practice, bringing light to both its perils and its promise. (shrink)

In the first thirty years after World War II, the US economy performed very well. The rate of growth averaged 4—5%, the rate of unemployment was seldom above 5%, inflation was almost non-existent, and the living standards of workers improved steadily. These were the ‘good old days'. However, this long period of expansion and prosperity ended in the 1970s. Since then, both the rate of unemployment and the rate of inflation have been much higher than before, and the average real (...) wages of workers have declined some 20%. Productivity growth has also slowed down and the debt burden of both capitalist enterprises and the Federal government has increased dramatically. It is in this sense that we may refer to the ‘economic crisis’ of the US economy over the last two decades. This crisis has certainly not been as severe as the Great Depression of the 1930s, but the economic performance has been significantly worse than in the early post-war period. (shrink)