The clinical decision is supposed to be based on evidence. In fact, what counts as evidence is far from being established. Some definition of "proof" is needed to distinguish between scientific medicine and charlatanism. My thesis is that unfortunately a clear-cut boundary between evidence and lack of evidence cannot be found, for several reasons that I summarise in the paper. Evidence in medicine very often has fuzzy boundaries, and dichotomising fuzziness and uncertainty can have serious consequences. Physicians and patients should (...) accept the irreducible fuzziness of many of the concepts they use when dealing with health and disease. (shrink)

The objective of the article is to examine the extensions of a clinical measure of efficacy, the Number Needed to Treat (NNT), in different settings including screening, scanning, genetic testing and primary prevention, and the associated ethical implications. We examine several situations in which the use of the NNT or NNS (Number Needed to Screen) has been suggested, such as Prostate-Specific Antigen for prostate cancer, Magnetic Resonance Imaging scans, genetic testing and banning of smoking. For each application, we explore the (...) ethical implications of the relevant measure. We have found that the different measures have different ethical implications. For example, the Number Needed to Prevent is the only measure that can be lower than one, indicating with a numerical example that prevention is better than cure. Conversely, we raise questions about the acceptability of genetic screening. In a realistic example, we show that primary prevention of the effects of arsenic in drinking water, targeted to the most susceptible, would require to genetically screen a large number of subjects, whereas giving rise to ethical concerns. We warn against the abuse of testing, in particular genetic testing, we show that different measures are associated with different ethical issues and that prevention tends to be better than cure. (shrink)

In the last decades, Systems Biology (including cancer research) has been driven by technology, statistical modelling and bioinformatics. In this paper we try to bring biological and philosophical thinking back. We thus aim at making diferent traditions of thought compatible: (a) causality in epidemiology and in philosophical theorizing—notably, the “sufcient-component-cause framework” and the “mark transmission” approach; (b) new acquisitions about disease pathogenesis, e.g. the “branched model” in cancer, and the role of biomarkers in this process; (c) the burgeoning of omics (...) research, with a large number of “signals” and of associations that need to be interpreted. In the paper we summarize frst the current views on carcinogenesis, and then explore the relevance of current philosophical interpretations of “cancer causes”. We try to ofer a unifying framework to incorporate biomarkers and omic data into causal models, referring to a position called “evidential pluralism”. According to this view, causal reasoning is based on both “evidence of diference-making” (e.g. associations) and on “evidence of underlying biological mechanisms”. We conceptualize the way scientists detect and trace signals in terms of information transmission, which is a generalization of the mark transmission theory developed by philosopher Wesley Salmon. Our approach is capable of helping us conceptualize how heterogeneous factors such as micro and macro-biological and psycho-social—are causally linked. This is important not only to understand cancer etiology, but also to design public health policies that target the right causal factors at the macro-level. (shrink)

In this paper we set out to examine thearguments for and against the claim thatEvidence-Based Medicine (EBM) will improve thequality of care. In particular, we examine thefollowing issues.

Reflection Principles are commonly thought to produce only strong axioms of infinity consistent with V = L. It would be desirable to have some notion of strong reflection to remedy this, and we have proposed Global Reflection Principles based on a somewhat Cantorian view of the universe. Such principles justify the kind of cardinals needed for, inter alia , Woodin’s Ω-Logic.

Since the microbiological revolution, most infectious diseases have been defined and classified according to an etiologic criterion, i.e. the identification of single, external necessary causes (for example, Mycobacterium for tuberculosis). This is not the case with cancer. Not only external necessary causes of cancer have not been identified, but also the morphological classification cannot be based on univocal criteria. Although neoplasia and anaplasia appear to be universal attributes of cancer, these events are only quantitative. Neoplastic growth can be fast or (...) slow (development may take weeks or years), and tissue pathologies are difficult to detect from normal tissue in some cancers but are obvious in others. Common special properties of anaplasia appear to be concealed in the wide range of morphologies. In the absence of a coherent morphological definition, and of external necessary causes (such as bacteria for infectious diseases), a mechanistic definition could be adopted. However, unless molecular biology discovers specific mechanistic steps in carcinogenesis, which indicate the existence of necessary events in carcinogenesis, we cannot adopt a univocal (monothetic) definition of cancer. The alternative is to use a polythetic definition, according to Wittgenstein's model of a long rope twisted together out of many shorter fibres. (shrink)

Epidemiology relies upon a broad interpretation of determinism. This paper discusses analogies with the evolution of the concept of cause in physics, and analyzes the classical nine criteria proposed by Sir Austin Bradford Hill for causal assessment. Such criteria fall into the categories of enumerative induction, eliminative induction, deduction and analogy. All of these four categories are necessary for causal assessment and there is no natural hierarchy among them, although a deductive analysis of the study design is preliminary to any (...) assessment. (shrink)

Using the example of air pollution, I criticize a restricted utilitarian view of environmental risks. It is likely that damage to health due to environmental pollution in Western countries is relatively modest in quantitative terms (especially when considering cancer and comparing such damage to the effects of some life-style exposures). However, a strictly quantitative approach, which ranks priorities according to the burden of disease attributable to single causes, is questionable because it does not consider such aspects as inequalities in the (...) distribution of risks. Secondly, the ability of epidemiological research to identify some health effects is limited. Third, the environment has symbolic and aesthetic components that overcome a strict evaluation of damage based on the impairment of human health. It is not acceptable that priorities be set just balancing the burden of disease caused by pollution in the environment against economic constraints. As an example of a computation that inherently includes economic analysis, I refer to the proposal of an estimator of mortality in coal mining, i.e., a rate which puts deaths in the numerator and tons of coal extracted in the denominator. According to this estimator, mortality due to accidents decreased from 1.15 to 0.42 in the period 1950–1970 in the United States, for each million tons of coal extracted. However, considering the steep decline in the workforce in the same period, the traditional mortality rate (deaths over persons-time) actually increased. The proposal of a measure of mortality based on the amount of coal extracted is just one example of the attempts to influence decisions by including an economic element (productivity) in risk assessment. This paper has three purposes: One, to describe empirical research concerning the health effects of environmental pollutants; two, to discuss the scientific principles and methods used in the identification of environmental hazards; and three, to critically discuss some of the ethical principles which are applied in medicine and in the assessment and management of risk. (shrink)

As Dobzhansky wrote, nothing in biology makes sense outside the context of the evolutionary theory, and this truth has not been sufficiently explored yet by medicine. We comment on Shanks and Pyles' recently published paper, Evolution and medicine: the long reach of "Dr. Darwin", and discuss some recent advancements in the application of evolutionary theory to carcinogenesis. However, we disagree with Shanks and Pyles about the usefulness of animal experiments in predicting human hazards. Based on the darwinian observation of inter-species (...) and inter-individual variation in all biological functions, Shanks and Pyles suggest that animal experiments cannot be used to identify hazards to human health. We claim that while the activity of enzymes may vary among individuals and among species, this does not indicate that critical events in disease processes occurring after exposure to hazardous agents differ qualitatively between animal models and humans. In addition, the goal is to avoid human disease whenever possible and with the means that are available at a given point in time. Epidemics of cancer could have been prevented if experimental data had been used to reduce human exposures or ban carcinogenic chemicals. We discuss examples. (shrink)

Inleidend overzicht van de wijsgerige ethiek.

Scientific realists have suggested that changes in our scientific communities over the course of their history have rendered those communities progressively less vulnerable to the problem of unconcieved alternatives over time. I argue in response not only that the most fundamental historical transformations of the scientific enterprise have generated steadily mounting obstacles to revolutionary, transformative, or unorthodox scientific theorizing, but also that we have substantial independent evidence that the institutional apparatus of contemporary scientific inquiry fosters an exceedingly and increasingly theoretically (...) conservative form of that inquiry. I conclude that contemporary scientific communities are actually more vulnerable to the problem of unconceived alternatives than their historical predecessors, and I briefly suggest how we might seek to pursue scientific inquiry in a less theoretically conservative way. (shrink)

인간의 이성적 의식과 법의 관계를 밝히고 법의 해석 과 판단에 인간의 의식이 어떻게 작용하는가를 고찰 한 저술. 제1부에서는 법의 형이상학적인 측면에서 법의 실체, 그리스의 법, 데카르트의 법, 로크와 법, 칸트와 법, 헤겔과 법, 아담스미스의 법의 경제, 중국의 도덕과 법사상을 다루었다. 제2부에서는 심리학적 분석으로 헌법의 심리학적 해석, 법의 판결절차, 증거법, 형법과 죄, 청소년과 가족법, 조세법, 플라톤의 법, 칸트의 도덕론의 경험적 확인, 헤겔의 자아와 노동법, 법의 4차원에 대해 다뤘다.

George Berkeley is one of the greatest and most influential modern philosophers. In defending the immaterialism for which he is most famous, he redirected modern thinking about the nature of objectivity and the mind's capacity to come to terms with it. Along the way, he made striking and influential proposals concerning the psychology of the senses, the workings of language, the aims of science, and the scope of mathematics. In this Companion volume a team of distinguished authors not only examines (...) Berkeley's achievements but also his neglected contributions to moral and political philosophy, his writings on economics and development, and his defense of religious commitment and religious life. The volume places Berkeley's achievements in the context of the many social and intellectual traditions - philosophical, scientific, ethical, and religious - to which he fashioned a distinctive response. (shrink)

One diagnosis of what is wrong with the Knowledge Argument rests on the Ability Hypothesis. This couples an ability analysis of knowing what an experience is like together with a denial that phenomenal propositions exist. I argue against both components. I consider three arguments against the existence of phenomenal propositions and find them wanting. Nevertheless I deny that knowing phenomenal propositions is part of knowing what an experience is like. I provide a hybrid account of knowing what an experience is (...) like which is the coherent expression of a single idea: knowing what an experience is like is knowing what it would be like to have the phenomenal content of the experience as the content of an experience one is currently having. I explain how my conclusions indicate that the focus of discussion should be on the alleged explanatory gap between phenomenal facts and physical facts and not on the Knowledge Argument. The latter is a poor expression of the difficulty Physicalists face. (shrink)

Typical discussions of virtual reality (VR) fixate on technology for providing sensory stimulation of a certain kind. They thus fail to understand reality as the place wherein we live and work, misunderstanding it instead as merely a sort of presentation. The first half of the paper examines popular conceptions of VR. The most common conception is a shallow one according to which VR is a matter of simulating appearances. Yet there is, even in popular depictions, a second, more subtle conception (...) according to which VR is a matter of facilitating new kinds of interaction. The latter half of the paper turns to questions about the contemporary technology of Internet chatrooms. The fact that chatrooms can be used in certain ways suggests something about the prospects for VR. The penultimate section asks whether chatrooms may legitimately be thought of as places. (In a sense, they may.) The final section asks whether cybersex may legitimately be thought of as sex. (Again, yes.) Chatroom technology thus provides an argument for the second conception of VR over its much ballyhooed rival. (shrink)

There has been an increase in recent years in the use of empirical methods in healthcare ethics. Appeals to empirical data cannot answer moral questions, but insights into the knowledge, attitudes, experience, preferences and practice of interested parties can play an important part in the development of healthcare ethics. In particular, while we may establish a general ethical principle to provide explanatory and normative guidance for healthcare professionals, the interpretation and application of such general principles to actual practice still requires (...) interpretation and judgement. And many situations in healthcare practice are complex and may involve a variety of principles, each of which may conflict with the others. Simple surveys or interview studies may not be sufficient if we wish to develop a nuanced approach to ethical practice that can be set out in guidelines, codes or directives. We do not resolve moral questions by plebiscite. In this paper, the authors argue for the use of consensus methods to develop shared understanding of ethical practice, and they argue further for the combination of the Delphi method with the use of vignettes to illustrate the kind of situations that may occur in practice. They develop their argument in part by reference to their experience of using this approach in their recent research. (shrink)

As family physicians, general practitioners play a key role in safeguarding children. Should they suspect child abuse or neglect they may experience a conflict between responding to the needs and interests of the child and those of an adult patient. English law insists on the paramountcy of the interests of the child, but in family practice many other interests may be at stake. The authors argue that uncritical adoption of the paramountcy principle is too simplistic and can lead, paradoxically, to (...) greater harm. They argue for a more subtle and nuanced view of interests and of conflicts of interest in safeguarding children. (shrink)

Prospect Theory: For Risk and Ambiguity, provides a comprehensive and accessible textbook treatment of the way decisions are made both when we have the statistical probabilities associated with uncertain future events and when we lack them. The book presents models, primarily prospect theory, that are both tractable and psychologically realistic. A method of presentation is chosen that makes the empirical meaning of each theoretical model completely transparent. Prospect theory has many applications in a wide variety of disciplines. The material in (...) the book has been carefully organized to allow readers to select pathways through the book relevant to their own interests. With numerous exercises and worked examples, the book is ideally suited to the needs of students taking courses in decision theory in economics, mathematics, finance, psychology, management science, health, computer science, Bayesian statistics, and engineering. (shrink)

On-line, just as off-line, there are ways of assessing the credibility of information sources. The Internet, although it arguably makes for nothing wholly new in this regard, complicates the ordinary task of assessing credibility. In the first section, I consider a specific example and argue that Internet content providers have no clear interest in resolving these comlications. In the second, I consider four general ways that we might assess credibility and explore how they apply to life online. Finally, I argue (...) that even careful information gathering may pose subtle pitfalls but that some of these may be mitigated on-line. (shrink)

Stuart Hameroff opens with an extended and updated exposition of the Penrose/Hameroff Orch-OR model, and subsequently addresses recent criticisms of quantum approaches to the brain. Evan Walker presents his view on consciousness from the perspective of a new approach to the integration of quantum theory and relativity. Friedrich Beck elaborates on the Beck/Eccles quantum approach to consciousness. Karl Pribram puts the holographic view on consciousness in perspective of his life long work. Peter Marcer and Edgar Mitchell explain the relevance of (...) quantum holography for consciousness. Gordon Globus discusses the relation between postmodern philosophical theories and quantum consciousness. Chris Clarke develops a theory in terms of a specific type of formal logic to reconcile the phenomenology of consciousness with the physical world. Ilya Prigogine summarizes his view on complexity, and on the future of quantum theory, which goes beyond the present formalism, and goes on to comment on the problem of consciousness. Matti Pitkanen identifies the place for consciousness in a unifying topological geometro-dynamics theory. Colin McGinn argues against classical materialism. Dick Bierman gives an overview of anomalous phenomena. He identifies a decline effect, and discusses different possible interpretations. Philip Van Loocke closes the volume with a discussion on how deep teleology in cellular systems may relate to consciousness. (shrink)