Unnecessary health care is a tremendous problem that negatively impacts individuals and also increases health care costs across the system. While much scholarly attention has been paid to the role of patients and providers, payors' role in contributing to the problem is underexplored. The article recommends that payors should nudge providers away from unnecessary care by requiring electronic alerts intended to deter unnecessary care.

We live in a world of crowds and corporations, artworks and artifacts, legislatures and languages, money and markets. These are all social objects — they are made, at least in part, by people and by communities. But what exactly are these things? How are they made, and what is the role of people in making them? In The Ant Trap, Brian Epstein rewrites our understanding of the nature of the social world and the foundations of the social sciences. (...) class='Hi'>Epstein explains and challenges the three prevailing traditions about how the social world is made. One tradition takes the social world to be built out of people, much as traffic is built out of cars. A second tradition also takes people to be the building blocks of the social world, but focuses on thoughts and attitudes we have toward one another. And a third tradition takes the social world to be a collective projection onto the physical world. Epstein shows that these share critical flaws. Most fundamentally, all three traditions overestimate the role of people in building the social world: they are overly anthropocentric. Epstein starts from scratch, bringing the resources of contemporary metaphysics to bear. In the place of traditional theories, he introduces a model based on a new distinction between the grounds and the anchors of social facts. Epstein illustrates the model with a study of the nature of law, and shows how to interpret the prevailing traditions about the social world. Then he turns to social groups, and to what it means for a group to take an action or have an intention. Contrary to the overwhelming consensus, these often depend on more than the actions and intentions of group members. (shrink)

'Tis true governments cannot be supported without great charge, and it is fit everyone who enjoys a share of the protection should pay out of his estate his proportion for the maintenance of it. But still it must be with his own consent, i.e., the consent of the majority giving it either by themselves or their representatives chosen by them. For if any one shall claim a power to lay and levy taxes on the people, by his own authority, and (...) without such consent of the people, he thereby invades the fundamental law of property and subverts the end of government. For what property have I in that which another may by right take when he pleases to himself. (shrink)

Lloyd (2009) contends that climate models are confirmed by various instances of fit between their output and observational data. The present paper argues that what these instances of fit might confirm are not climate models themselves, but rather hypotheses about the adequacy of climate models for particular purposes. This required shift in thinking—from confirming climate models to confirming their adequacy-for-purpose—may sound trivial, but it is shown to complicate the evaluation of climate models considerably, both in principle and in practice.

In his insightful and challenging paper, Jonathan Schaffer argues against a distinction I make in The Ant Trap (Epstein 2015) and related articles. I argue that in addition to the widely discussed “grounding” relation, there is a different kind of metaphysical determination I name “anchoring.” Grounding and anchoring are distinct, and both need to be a part of full explanations of how facts are metaphysically determined. Schaffer argues instead that anchoring is a species of grounding. The crux of his (...) argument comes in the last sections of his paper, in his discussion of “exportation,” the relations strategy, and the definitions strategy. I am inclined to agree that Schaffer’s interesting strategies offer the best choices for the philosopher who wants to insist that anchoring is a species of grounding. But both, I will argue, are fatally flawed. I do not take the separation of anchors from grounds lightly, but find the evidence in its favor overwhelming. And once the distinction is made, I find anchoring to be a powerful practical tool in metaphysics. Philosophy and Phenomenological Research, Volume 99, Issue 3, Page 768-781, November 2019. (shrink)

Imitation is said to be the sincerest form of flattery. Socially, the proposition may well be true. But in the world of ideas it is false: to the extent that two incompatible traditions use the same words or symbols to articulate different visions of legal or social organization, imitation begets confusion, not enlightenment. The effects of that confusion, moreover, are not confined to the world of ideas, but spill over into the world of politics and public affairs. Words are more (...) than tools of description: they work also as tools of persuasion and transformation. Let a term have a favorable connotation in one context, and its imitative use can mislead people into thinking that a major departure from established practice is merely the extension or updating of an old principle to deal with new circumstances. (shrink)

In this paper, I want to explore the relationship between the various forms of individual self-interest and the appropriate structures of government. I shall begin with the former, and by degrees extend the analysis to the latter. I do so in order to mount a defense of principles of limited government, private property, and individual liberty. The ordinary analysis of self-interest treats it as though it were not only a given but also a constant of human nature, and thus makes (...) few allowances for differences between persons. Yet common experience tells us that personality and behavior are as unique as fingerprints. The positive inquiry, therefore, is how we find what is constant about self-interest in a world of natural human diversity. The normative inquiry must take into account both the constant and variable features of human nature in order to determine what forms of social arrangements hold the greatest prospect of long-term social advantage. The gulf between ‘is’ and ‘ought’ must be overcome here, as it must be in all normative discourse. Yet we cannot make sensible judgments of what ought to be the case in the domain of rules unless we first have some idea of what is the case in the domain of behavior. The initial inquiry asks why self-interest is regarded as a constant of human behavior. The explanation derives more from the biological and less from the social. The powerful pressures of natural selection weed out any organisms for whom selfinterest is not the paramount consideration. (shrink)

This paper presents a systematic approach for analyzing and explaining the nature of social groups. I argue against prominent views that attempt to unify all social groups or to divide them into simple typologies. Instead I argue that social groups are enormously diverse, but show how we can investigate their natures nonetheless. I analyze social groups from a bottom-up perspective, constructing profiles of the metaphysical features of groups of specific kinds. We can characterize any given kind of social group with (...) four complementary profiles: its “construction” profile, its “extra essentials” profile, its “anchor” profile, and its “accident” profile. Together these provide a framework for understanding the nature of groups, help classify and categorize groups, and shed light on group agency. (shrink)

Social ontology is the study of the nature and properties of the social world. It is concerned with analyzing the various entities in the world that arise from social interaction. -/- A prominent topic in social ontology is the analysis of social groups. Do social groups exist at all? If so, what sorts of entities are they, and how are they created? Is a social group distinct from the collection of people who are its members, and if so, how is (...) it different? What sorts of properties do social groups have? Can they have beliefs or intentions? Can they perform actions? And if so, what does it take for a group to believe, intend, or act? -/- Other entities investigated in social ontology include money, corporations, institutions, property, social classes, races, genders, artifacts, artworks, language, and law. It is difficult to delineate a precise scope for the field (see section 2.1). In general, though, the entities explored in social ontology largely overlap with those that social scientists work on. A good deal of the work in social ontology takes place within the social sciences (see sections 5.1–5.8). -/- Social ontology also addresses more basic questions about the nature of the social world. One set of questions pertains to the constituents, or building blocks, of social things in general. For instance, some theories argue that social entities are built out of the psychological states of individual people, while others argue that they are built out of actions, and yet others that they are built out of practices. Still other theories deny that a distinction can even be made between the social and the non-social. -/- A different set of questions pertains to how social categories are constructed or set up. Are social categories and kinds produced by our attitudes? By our language? Are they produced by causal patterns? And is there just one way social categories are set up, or are there many varieties of social construction? -/- The term ‘social ontology’ has only come into wide currency in recent years, but the nature of the social has been a topic of inquiry since ancient Greece. As a whole, the field can be understood as a branch of metaphysics, the general inquiry into the nature of entities. (shrink)

This book argues that this powerful technique permits the social sciences to meet an explanation, in which one 'grows' the phenomenon of interest in an artificial society of interacting agents: heterogeneous, boundedly rational actors.

This paper sets out an organizing framework for the field of social ontology, the study of the nature of the social world. The subject matter of social ontology is clarified, in particular the difference between it and the study of causal relations and the explanation of social phenomena. Two different inquiries are defined and explained: the study of the grounding of social facts, and the study of how social categories are “anchored” or set up. The distinction between these inquiries is (...) used to clarify prominent programs in social theory, particularly theories of practice and varieties of individualism. (shrink)

The thesis of methodological individualism in social science is commonly divided into two different claims—explanatory individualism and ontological individualism. Ontological individualism is the thesis that facts about individuals exhaustively determine social facts. Initially taken to be a claim about the identity of groups with sets of individuals or their properties, ontological individualism has more recently been understood as a global supervenience claim. While explanatory individualism has remained controversial, ontological individualism thus understood is almost universally accepted. In this paper I argue (...) that ontological individualism is false. Only if the thesis is weakened to the point that it is equivalent to physicalism can it be true, but then it fails to be a thesis about the determination of social facts by facts about individual persons. Even when individualistic facts are expanded to include people’s local environments and practices, I shall argue, those still underdetermine the social facts that obtain. If true, this has implications for explanation as well as ontology. I first consider arguments against the local supervenience of social facts on facts about individuals, correcting some flaws in existing arguments and affirming that local supervenience fails for a broad set of social properties. I subsequently apply a similar approach to defeat a particularly weak form of global supervenience, and consider potential responses. Finally, I explore why it is that people have taken ontological individualism to be true. (shrink)

In an unusual instance of lay participation in biomedical research, U.S. AIDS treatment activists have constituted themselves as credible participants in the process of knowledge construction, thereby bringing about changes in the epistemic practices of biomedical research. This article examines the mechanisms or tactics by which these lay activists have constructed their credibility in the eyes of AIDS researchers and government officials. It considers the inwlications of such interventions for the conduct of medical research; examines some of the ironies, tensions, (...) and limitations in the process; and argues for the importance of studying social movements that engage with expert knowledge. (shrink)

With few exceptions, theorists analyze group attitudes in terms of the attitudes of members. In Epstein 2015, 2019a, 2019b, I argued that this thesis (which I call "MEMBERS ONLY")—and hence any theory that analyzes group attitudes in terms of member attitudes—is mistaken: the attitudes of many groups are ontologically determined by a broader range of factors than member attitudes. My aim in the present paper is to consider new arguments against MEMBERS ONLY. I argue that arguments based on the (...) "hypothesis of the extended mind" are not persuasive for challenging MEMBERS ONLY, but reinforce my earlier arguments, and I also propose new arguments from group content externalism are more promising. (shrink)

According to the Fine-Tuning Argument, the existence of life in our universe confirms the Multiverse Hypothesis. A standard objection to FTA is that it violates the Requirement of Total Evidence. I argue that RTE should be rejected in favor of the Predesignation Requirement, according to which, in assessing the outcome of a probabilistic process, we should only use evidence characterizable in a manner available before observing the outcome. This produces the right verdicts in some simple cases in which RTE leads (...) us astray, and, when applied to FTA, it shows that our evidence does confirm HM. (shrink)

This book presents modern logic as the formalization of reasoning that needs and deserves a semantic foundation. Chapters on propositional logic; parsing propositions; and meaning, truth and reference give the reader a basis for establishing criteria that can be used to judge formalizations of ordinary language arguments. Over 120 worked examples illustrate the scope and limitations of modern logic, as analyzed in chapters on identity, quantifiers, descriptive names, and functions. The chapter on second-order logic shows how different conceptions of predicates (...) and propositions do not lead to a common basis for quantification over predicates, as they do for quantification over things. Notable for its clarity of presentation and supplemented by many exercises, this volume will be invaluable for philosophers, linguists, mathematicians, and computer scientists who wish to better understand the tools they use in formal reasoning. (shrink)

In recent years, theorists have debated how we introduce new social objects and kinds into the world. Searle, for instance, proposes that they are introduced by collective acceptance of a constitutive rule; Millikan and Elder that they are the products of reproduction processes; Thomasson that they result from creator intentions and subsequent intentional reproduction; and so on. In this chapter, I argue against the idea that there is a single generic method or set of requirements for doing so. Instead, there (...) is a variety of what I call “anchoring schemas,” or methods by which new social kinds are generated. Not only are social kinds a diverse lot, but the metaphysical explanation for their being the kinds they are is diverse as well. I explain the idea of anchoring and present examples of social kinds that are similar to one another but that are anchored in different ways. I also respond to Millikan’s argument that there is only one kind of “glue” that is “sticky enough” for holding together kinds. I argue that no anchoring schema will work in all environments. It is a contingent matter which schemas are successful for anchoring new social kinds, and an anchoring schema need only be “sticky enough” for practical purposes in a given environment. (shrink)

COVID-19 has created significant concern surrounding the impact of pandemic lockdown on mental health. While the pandemic lockdown can be distressing, times of crisis can also provide people with the opportunity to think divergently and explore different activities. Novelty seeking, where individuals explore novel and unfamiliarly stimuli and environments, may enhance the creativity of individuals to solve problems in a way that allows them to adjust their emotional responses to stressful situations. This study employs a longitudinal design to investigate changes (...) in novelty seeking and mental health outcomes before, during, and after COVID-19 pandemic lockdown, among a group of students from a university in southeast China. Participants were surveyed at three points: November, 2019 ; between February and March, 2020 ; and between May and June, 2020. Cross-sectionally, correlation analysis indicated that greater novelty seeking was associated with lower levels of stress, anxiety, and depression at all three time points. Univariate latent curve modeling indicated a growth trajectory in which novelty seeking increased over time and then remained high during the post-lockdown period. Stress, anxiety, and depression all showed V-shaped growth trajectories in which these variables decreased during lockdown, before increasing in the post-lockdown period. Multivariate LCM indicated the growth trajectory for novelty seeking was associated with the growth trajectories for stress, anxiety, and depression. This suggests that the observed decreases in stress, anxiety, and depression during the lockdown period may be attributable to the sample’s observed increase in novelty seeking. These findings are valuable in that they challenge the notion that lockdown measures are inherently detrimental to mental health. The findings indicate the important role of novelty seeking in responding to crises. It may be possible for future public health measures to incorporate the promotion of novelty seeking to help individuals’ respond to stressful situations and maintain good mental health in the face of crises. (shrink)

A recurring theme dominates recent philosophical debates about the nature of conscious perception: naïve realism’s opponents claim that the view is directly contradicted by empirical science. I argue that, despite their current popularity, empirical arguments against naïve realism are fundamentally flawed. The non-empirical premises needed to get from empirical scientific findings to substantive philosophical conclusions are ones the naïve realist is known to reject. Even granting the contentious premises, the empirical findings do not undermine the theory, given its overall philosophical (...) commitments. Thus, contemporary empirical research fails to supply any new argumentative force against naïve realism. I conclude that, as philosophers of mind, we would be better served spending a bit less time trying to wield empirical science as a cudgel against our opponents, and a bit more time working through the implications of each other’s views – something we can accomplish perfectly well from the comfort of our armchairs. (shrink)

The country's leading libertarian scholar sets forth the essential principles for a legal system that best balances individual liberty versus the common good.

Background: Healthcare providers who are accountable for patient care safety and quality but who are not empowered to actualize them experience moral distress. Interventions to mitigate moral distress in the healthcare organization are needed. Objective: To evaluate the effect on moral distress and clinician empowerment of an established, health-system-wide intervention, Moral Distress Consultation. Methods: A quasi-experimental, mixed methods study using pre/post surveys, structured interviews, and evaluation of consult themes was used. Consults were requested by staff when moral distress was present. (...) The purpose of consultation is to identify the causes of moral distress, barriers to action, and strategies to improve the situation. Intervention participants were those who attended a moral distress consult. Control participants were staff surveyed prior to the consult. Interviews were conducted after the consult with willing participants and unit managers. Moral distress was measured using the Moral Distress Thermometer. Empowerment was measured using the Global Empowerment Scale. Results: Twenty-one consults were conducted. Analysis included 116 intervention and 30 control surveys, and 11 interviews. A small but significant decrease was found among intervention participants, especially intensive care staff. Empowerment was unchanged. Interview themes support the consult service as an effective mode for open discussion of difficult circumstances and an important aspect of a healthy work environment. Conclusions: Moral distress consultation is an organization-wide mechanism for addressing moral distress. Consultation does not resolve moral distress but helps staff identify strategies to improve the situation. Further studies including follow up may elucidate consultation effectiveness. (shrink)

This article reports the results of a study of confirmational response bias among social work journals. A contrived research paper with positive findings and its negative mirror image were submitted to two different groups of social work journals and to two comparison groups of journals outside social work. The quantitative results, suggesting bias, are tentative; but the qualitative findings based upon an analysis of the referee comments are clear and consistent. Few referees from prestigious or nonprestcgrous social work journals prepared (...) reviews that were knowledgeable, scientifically astute, or objective. The best reviews came from journals outside of soccal work or from journals that are accepted as social work journals but originate with other disciplines. (shrink)

It is often seen as a truism that social objects and facts are the product of human intentions. I argue that the role of intentions in social ontology is commonly overestimated. I introduce a distinction that is implicit in much discussion of social ontology, but is often overlooked: between a social entity’s “grounds” and its “anchors.” For both, I argue that intentions, either individual or collective, are less essential than many theorists have assumed. Instead, I propose a more worldly – (...) and less intellectualist – approach to social ontology. (shrink)

William James described the stream of thought as having two components: (1) a nucleus of highly conscious, often perceptual material; and (2) a fringe of dimly felt contextual information that controls the entry of information into the nucleus and guides the progression of internally directed thought. Here I examine the neural and cognitive correlates of this phenomenology. A survey of the cognitive neuroscience literature suggests that the nucleus corresponds to a dynamic global buffer formed by interactions between different regions of (...) the brain, while the fringe corresponds to a set of mechanisms in the frontal and medial temporal lobes that control the contents of this global buffer. A consequence of this account is that there might be conscious imagistic representations that are not part of the nucleus. I argue that phenomenology can be linked to psychology and neuroscience and a meaningful way that illuminates both. (shrink)

The Gestalt psychologists adopted a set of positions on mind-body issues that seem like an odd mix. They sought to combine a version of naturalism and physiological reductionism with an insistence on the reality of the phenomenal and the attribution of meanings to objects as natural characteristics. After reviewing basic positions in contemporary philosophy of mind, we examine the Gestalt position, characterizing it m terms of phenomenal realism and programmatic reductionism. We then distinguish Gestalt philosophy of mind from instrumentalism and (...) computational functionalism, and examine Gestalt attributions of meaning and value to perceived objects. Finally, we consider a metatheoretical moral from Gestalt theory, which commends the search for commensurate description of mental phenomena and their physiological counterparts. (shrink)

Altered Conditions provides a bold new intervention into existing theories of the human body and its meanings in a variety of cultural contexts. By exploring the history of medical narratives, especially medical case histories, as well as the exciting work that has been done in feminist and lesbian and gay studies, Julia Epstein poses a number of provocative questions about the relations between bodies, selves, and identities. Epstein focuses on a number of diagnoses that shed light on what (...) is at stake when cultures regulate human bodies, including hermaphroditism, birth malformations, and AIDS. She pays special attention to the regulation of sexual minorities and women and looks carefully at the ways in which cultures attempt to define and control behaviors seen as threatening or subversive. (shrink)

Shape and slant judgments of rotated or frontoparallel ellipses were elicited from three groups of 10 subjects. A masking stimulus was introduced to control processing time. Backward masking trials were presented with interstimulus intervals of 0, 25, and 50 msec, Reduction of processing time altered shape judgments in the direction of projective shape and slant judgments in the direction of frontoparallelness. This finding is consistent with the shape-slant invariance hypothesis. In order to study the effects of processing load, one group (...) of subjects was given prior knowledge of the kind of judgment to be made on each trial, one group had no prior knowledge, and a third group made both judgments on each trial. The effects of the processing load manipulation were interpreted in terms of the role of attention in perceptual encoding. Consistent with previous findings, allocation of attention did not affect perceptual encoding. (shrink)

According to Minkoswki, Einstein's special theory of relativity reveals that ‘space by itself, and time by itself are doomed to fade away into mere shadows’. But perceptual experience represents objects as instantiating shapes like squareness — properties of ‘space by itself’. Thus, STR seems to threaten the veridicality of shape experience. In response to this worry, some have argued that we should analyze the contents of our spatial experiences on the model of traditional secondary qualities. On this picture—defended in recent (...) work by Chalmers —an experience of squareness just represents whatever property usually causes such experiences. This view salvages the veridicality of shape experience, but leaves the nature of the properties we perceive outside our ken. I argue that such a move is unwarranted: STR is compatible with the idea that shape experience acquaints us with the spatial character of our world. In defending this claim, I propose a view on which shape experience presents familiar Euclidean spatial properties veridically, while implicitly representing those properties as instantiated in a particular manner — namely, relative to our own frame of reference. (shrink)

During the past decade many individuals have sought to create a connection between their work persona and their religious/spiritual persona. Management education has a legitimate role to play in introducing teachings drawn from our religious traditions into business ethics and other courses. Thereby, we can help prepare students to consider the possibility that business endeavors, spirituality and religious commitment can be inextricable parts of a coherent life.

Twelve subjects provided shape and orientation judgments for a set of projectively equivalent, variously rotated rectangles under three viewing conditions—monoptic, dichoptic, and binocular—with and without the presence of a pattern mask. In the absence of the mask, partial constancy was exhibited under the first two conditions and near perfect constancy under the binocular condition. Orientation was discriminated. Presence of the mask produced projective shape matching and diminished orientation discrimination. It is argued that the site of masking was postchiasmal, and the (...) results are related to previous work with pattern masking of projectively equivalent ellipses. (shrink)

Individualists about social ontology hold that social facts are “built out of” facts about individuals. In this paper, I argue that there are two distinct kinds of individualism about social ontology, two different ways individual people might be the metaphysical “builders” of the social world. The familiar kind is ontological individualism. This is the thesis that social facts supervene on, or are exhaustively grounded by, facts about individual people. What I call anchor individualism is the alternative thesis that facts about (...) individuals put in place the conditions for a social entity to exist, or the conditions for something to have a social property. Examples include conventionalist theories of the social world, such as David Hume’s theories of promises, money, and government, and collective acceptance theories, such as John Searle’s theory of institutional facts. Anchor individualism is often conflated with ontological individualism. But in fact, the two theses are in tension with one another: if one of these kinds of individualism is true, then the other is very unlikely to be. My aim in this paper is to clarify both, and argue that they should be sharply distinguished from one another. (shrink)

This groundbreaking work by one of the world's foremost theoreticians of Russian literature, culture, and thought gives for the first time an extensive and detailed examination of the development of Russian thought during the late Soviet period. Countering the traditional view of an intellectual wilderness under the Soviet regime, Mikhail Epstein offers a systematic account of Russian thought in the second half of the 20th century. In doing so, he provides new insights into previously ignored areas such as Russian (...) liberalism, personalism, structuralism, neo-rationalism, and culturology. Epstein shows how Russian philosophy and culture has long been trapped in an intellectual prison of its own making as it sought to create its own utopia. However, he demonstrates that it is time to reappraise Russian philosophical thought and cultural theory, now freed from the bonds of totalitarianism. We are left with not only a new and exciting interpretation of Russian thought, but also an opportunity to rethink our own intellectual heritage. (shrink)

In their article “A Broader Understanding of Moral Distress,” Campbell, Ulrich, and Grady (2016) correctly assert that moral distress is well established in the nursing literature and is gaining at...

The advent of the cinema radically altered our comprehension of time, space, and reality. With his experience as a pioneering avant-garde filmmaker, Jean Epstein uses the universes created by the cinematograph to deconstruct our understanding of how time and space, reality and unreality, continuity and discontinuity, determinism and randomness function both inside and outside the cinema. Time, he says, should be regarded as the first, not the fourth, dimension—and the cinematograph allows us, for the first time, to manipulate it (...) in directions and speeds of our choosing. The theoretical work of Jean Epstein greatly influenced later generations of cinema philosophers, notably Gilles Deleuze and Jacques Rancière, but the bulk of his work remains unpublished. _The Intelligence of a Machine_, his first major title published in English, is one of the earliest philosophies of cinema. (shrink)

Agent-​​based modeling is showing great promise in the social sciences. However, two misconceptions about the relation between social macroproperties and microproperties afflict agent-based models. These lead current models to systematically ignore factors relevant to the properties they intend to model, and to overlook a wide range of model designs. Correcting for these brings painful trade-​​offs, but has the potential to transform the utility of such models.