Testimony about the future dangerousness of a person has become a central staple of many judicial processes. In settings such as bail, sentencing, and parole decisions, in rulings about the civil confinement of the mentally ill, and in custody decisions in a context of domestic violence, the assessment of a person’s propensity towards physical or sexual violence is regarded as a deciding factor. These assessments can be based on two forms of expert testimony: actuarial or clinical. The purpose of (...) this paper is to examine the scientific and epistemological basis of both methods of prediction or risk assessment. My analysis will reveal that this kind of expert testimony is scientifically baseless. The problems I will discuss will generate a dilemma for factfinders: on the one hand, given the weak predictive abilities of the branches of science involved, they should not admit expert clinical or actuarial testimony as evidence; on the other hand, there is a very strong tradition and a vast jurisprudence that supports the continued use of this kind of expert testimony. It is a clear case of the not so uncommon conflict between science and legal tradition. (shrink)

American Academy of Pediatrics (AAP) and American College of Medical Genetics (ACMG) recently provided two recommendations about predictive genetic testing of children. The Clinical Sequencing Exploratory Research Consortium's Pediatrics Working Group compared these recommendations, focusing on operational and ethical issues specific to decision making for children. Content analysis of the statements addresses two issues: (1) how these recommendations characterize and analyze locus of decision making, as well as the risks and benefits of testing, and (2) whether the guidelines conflict (...) or come to different but compatible conclusions because they consider different testing scenarios. These statements differ in ethically significant ways. AAP/ACMG analyzes risks and benefits using best interests of the child and recommends that, absent ameliorative interventions available during childhood, clinicians should generally decline to order testing. Parents authorize focused tests. ACMG analyzes risks and benefits using the interests of the child and other family members and recommends that sequencing results be examined for additional variants that can lead to ameliorative interventions, regardless of age, which laboratories should report to clinicians who should contextualize the results. Parents must accept additional analysis. The ethical arguments in these statements appear to be in tension with each other. (shrink)

Monothematic delusions involve a single theme, and often occur in the absence of a more general delusional belief system. They are cognitively atypical insofar as they are said to be held in the absence of evidence, are resistant to correction, and have bizarre contents. Empiricism about delusions has it that anomalous experience is causally implicated in their formation, whilst rationalism has it that delusions result from top down malfunctions from which anomalous experiences can follow. Within empiricism, two approaches to the (...) nature of the abnormality/abnormalities involved have been touted by philosophers and psychologists. One-factor approaches have it that monothematic delusions are a normal response to anomalous experiences whilst two-factor approaches seek to identify a clinically abnormal pattern of reasoning in addition to anomalous experience to explain the resultant delusion. In this paper we defend a one-factor approach. We begin by making clear what we mean by atypical, abnormal, and factor. We then identify the phenomenon of interest and overview one and two-factor empiricism about its formation. We critically evaluate the cases for various second factors, and find them all wanting. In light of this we turn to our one-factor account, identifying two ways in which ‘normal response’ may be understood, and how this bears on the discussion of one-factor theories up until this point. We then conjecture that what is at stake is a certain view about the epistemic responsibility of subjects with delusions, and the role of experience, in the context of familiar psychodynamic features. After responding to two objections, we conclude that the onus is on two-factor theorists to show that the one-factor account is inadequate. Until then, the one-factor account ought to be understood as the default position for explaining monothematic delusion formation and retention. We don’t rule out the possibility that, for particular subjects with delusions there may be a second factor at work causally implicated in their delusory beliefs but, until the case for the inadequacy of the single factor is made, the second factor is redundant and fails to pick out the minimum necessary for a monothematic delusion to be present. (shrink)

Nanomedicine promises unprecedented innovations for diagnosis and therapy as well as for predicting and preventing diseases. On the other hand it raises fears linked to new and unknown characteristics of nanoscale materials. Both, promises and fears, are closely linked to the realm of uncertainty. To a large extent it is currently not known which expectations could become reality and which suspected adverse events might come true. Medicine is quite familiar with decision-making under uncertainty. Rules and regulations for clinical (...) research have been developed to reduce possible harm for research participants without abandoning necessary investigations. Here we examine whether clinical research trials of nanomedicine need new regulations and conclude that the established rules should suffice. (shrink)

BackgroundThe present study aimed at assessing the diagnostic properties of the Montreal Cognitive Assessment in non-demented ALS patients and at exploring the MoCA administrability according to motor-functional status.MaterialsN = 348 patients were administered the MoCA and Edinburgh Cognitive and Behavioural ALS Screen. Administrability rates and prevalence of defective MoCA scores were compared across King’s and Milano-Torino clinical stages. Regression models were run to test whether the non-administrability of the MoCA and a defective score on it were predicted, net of (...) the ECAS-Total, by disease duration, ALS Functional Rating Scale-Revised and progression rate, computed as /disease duration. Intrinsic and post-test diagnostics were tested against a below-cut-off ECAS-total score.ResultsThe 79.9% of patients successfully underwent the MoCA, whose administrability rates decreased with advanced clinical stages, at variance with its defective score prevalence. The probability of the FAB not being administrable was predicted only by lower ALSFRS-R-bulbar and-upper-limb scores; no motor features, but the ECAS-Total, predicted a defective MoCA performance. The MoCA showed high accuracy and good intrinsic and post-test properties—being slightly more specific than sensitive.DiscussionIn non-demented ALS patients, the MoCA is featured by optimal diagnostics as a screener for cognitive impairment, especially for ruling-out its occurrence, as long as patients are in the early stages of the disease and have sufficiently spared bulbar and upper-limb functions. (shrink)

This article advances two views on the role of evaluative judgment in clinical assessments of decision-making capacity. The first is that it is rationally impossible for such assessments to exclude judgments of the values a patient uses to motivate their decision-making. Predictably, and second, attempting to exclude such judgments sometimes yields outcomes that contain intractable dilemmas that harm patients. These arguments count against the prevailing model of assessment in common law countries—the four abilities model—which is often incorrectly advertised as (...) being value-neutral in respect of patient decision-making both by its proponents and in statute. A straightforward evaluative model of capacity assessment which wears its values on its sleeves and is biased against what are called ‘serious prudential mistakes’ avoids these rational and practical problems. (shrink)

Conscience and conscientious objections are important issues in medical law and ethics. However, discussions tend to focus on a particular type of conscience-based claim. These types of claims are based upon predictable, generalizable rules in which an individual practitioner objects to what is otherwise standard medical treatment. However, not all conscience based claims are of this type. There are other claims which are based not on an objection to a treatment in general but in individual cases. In other words, (...) these cases may involve practices which the doctor does not usually object to but does so in this instance on these facts. This paper will explore these types of conscience-based claims in two ways. First, it will explore whether these types of individualised conscience-based claims are really conscience claims at all. Second, it will explore how these claims interact with the other sorts of judgements we expect doctors to make in these cases. (shrink)

State prescription drug monitoring programs (PDMPs) use proprietary, predictive software platforms that deploy algorithms to determine whether a patient is at risk for drug misuse, drug diversion, doctor shopping, or substance use disorder (SUD). Clinical overreliance on PDMP algorithm‐generated information and risk scores motivates clinicians to refuse to treat—or to inappropriately treat—vulnerable people based on actual, perceived, or past SUDs, chronic pain conditions, or other disabilities. This essay provides a framework for challenging PDMP algorithmic discrimination as disability discrimination under (...) federal antidiscrimination laws, including a new proposed rule interpreting section 1557 of the Affordable Care Act. (shrink)

Pharmaceutical companies fund the bulk of clinical research that is carried out on medications. Poor outcomes from these studies can have negative effects on sales of medicines. Previous research has shown that company funded research is much more likely to yield positive outcomes than research with any other sponsorship. The aim of this article is to investigate the possible ways in which bias can be introduced into research outcomes by drawing on concrete examples from the published literature. Poorer methodology (...) in industry-funded research is not likely to account for the biases seen. Biases are introduced through a variety of measures including the choice of comparator agents, multiple publication of positive trials and non-publication of negative trials, reinterpreting data submitted to regulatory agencies, discordance between results and conclusions, conflict-of-interest leading to more positive conclusions, ghostwriting and the use of seeding trials. Thus far, efforts to contain bias have largely focused on more stringent rules regarding conflict-of-interest (COI) and clinical trial registries. There is no evidence that any measures that have been taken so far have stopped the biasing of clinical research and it’s not clear that they have even slowed down the process. Economic theory predicts that firms will try to bias the evidence base wherever its benefits exceed its costs. The examples given here confirm what theory predicts. What will be needed to curb and ultimately stop the bias that we have seen is a paradigm change in the way that we treat the relationship between pharmaceutical companies and the conduct and reporting of clinical trials. (shrink)

Professionals often believe that they must “exercise judgment” in making decisions critical to other people’s lives. The relative superiority of statistical prediction rules to intuitive judgment for combining incomparable sources of information to predict important human outcomes leads us to question this personal input belief. Some professionals hence use SPR’s to “educate” intuitive judgment, rather than replace it. In psychology in particular, such amalgamation is not justified. If a well‐validated SPR that is superior to professional judgment exists in (...) a relevant decision making context, professionals should use it, totally absenting themselves from the prediction. (shrink)

Professionals often believe that they must “exercise judgment” in making decisions critical to other people's lives. The relative superiority of statistical prediction rules to intuitive judgment for combining incomparable sources of information to predict important human outcomes leads us to question this personal input belief. Some professionals hence use SPR's to “educate” intuitive judgment, rather than replace it. In psychology in particular, such amalgamation is not justified. If a well-validated SPR that is superior to professional judgment exists in (...) a relevant decision making context, professionals should use it, totally absenting themselves from the prediction. (shrink)

The most discussed and mysterious column within the Babylonian astronomy is columnΦ. It is closely connected to the lunar velocity and to the duration of the Saros. This paper presents new ideas for the development and interpretation of columnΦ. It combines the excellent Goal-Year method with old ideas and practices from the “schematic astronomy”. Inspired by the old “TU11” rule for prediction of times of lunar eclipses, it proposes that columnΦ, in a similar way, used the sum of the (...) Lunar Four to predict times of lunar eclipses as well as the duration of one, 6, and 12 months by means of what usually is called “R–S” schemes. It also explains fully the structure and development of such schemes, a fact that strongly supports the new interpretation of columnΦ. (shrink)

Bishop and Trout here present a unique and provocative new approach to epistemology. Their approach aims to liberate epistemology from the scholastic debates of standard analytic epistemology, and treat it as a branch of the philosophy of science. The approach is novel in its use of cost-benefit analysis to guide people facing real reasoning problems and in its framework for resolving normative disputes in psychology. Based on empirical data, Bishop and Trout show how people can improve their reasoning by relying (...) on Statistical Prediction Rules. They then develop and articulate the positive core of the book. Their view, Strategic Reliabilism, claims that epistemic excellence consists in the efficient allocation of cognitive resources to reliable reasoning strategies, applied to significant problems. The last third of the book develops the implications of this view for standard analytic epistemology; for resolving normative disputes in psychology; and for offering practical, concrete advice on how this theory can improve real people's reasoning. This is a truly distinctive and controversial work that spans many disciplines and will speak to an unusually diverse group, including people in epistemology, philosophy of science, decision theory, cognitive and clinical psychology, and ethics and public policy. (shrink)

People often have a strong intuitive sense that we ought to rescue those in serious need, even in cases where we could produce better outcomes by acting in other ways. It has become common in such cases to refer to this as the Rule of Rescue. Within the medical field this rule has predominantly been discussed in relation to decisions about whether to fund particular treatments. Whilst in this setting the arguments in favour of the Rule of Rescue have generally (...) been found to be unconvincing, there are some reasons for thinking that it may have more of a role to play at the clinical level. In this article we examine three lines that such reasoning might take. In each case we argue that the reasons given do not support the adoption of a Rule of Rescue in clinical practice. (shrink)

Human genomics is a translational field spanning research, clinical care, public health, and direct-to-consumer testing. However, law differs across these domains on issues including liability, consent, promoting quality of analysis and interpretation, and safeguarding privacy. Genomic activities crossing domains can thus encounter confusion and conflicts among these approaches. This paper suggests how to resolve these conflicts while protecting the rights and interests of individuals sequenced. Translational genomics requires this more translational approach to law.

Stopping rules — rules dictating when to stop accumulating data and start analyzing it for the purposes of inferring from the experiment — divide Bayesians, Likelihoodists and classical statistical approaches to inference. Although the relationship between Bayesian philosophy of science and stopping rules can be complex (cf. Steel 2003), in general, Bayesians regard stopping rules as irrelevant to what inference should be drawn from the data. This position clashes with classical statistical accounts. For orthodox statistics, stopping (...) rules do matter to what inference should be drawn from the data. "The dispute over stopping rule is far from being a marginal quibble, but is instead a striking illustration of the divergence of fundamental aims and standards separating Bayesians and advocates of orthodox statistical methods" (Steel 2004, 195) ... (shrink)

Abstractabstract:Expectations about future events underlie practically every decision we make, including those in medical research. This paper reviews five studies undertaken to assess how well medical experts could predict the outcomes of clinical trials. It explains why expert trial forecasting was the focus of study and argues that forecasting skill affords insights into the quality of expert judgment and might be harnessed to improve decision-making in care, policy, and research. The paper also addresses potential criticisms of the research agenda (...) and summarizes key findings from the five studies of trial forecasting. Together, the studies suggest that trials frequently deliver surprising results to expert communities and that individual experts are often uninformative when it comes to forecasting trial outcome and recruitment. However, the findings also suggest that expert forecasts often contain a "signal" about whether a trial will be positive, especially when forecasts are aggregated. The paper concludes with needs for further research and tentative policy recommendations. (shrink)

I argue that the dual-process account of human learning rejected by Mitchell et al. in the target article is informative and predictive with respect to human behaviour in a way that the authors' purely propositional account is not. Experiments that reveal different patterns of results under conditions that favour either associative or rule-based performance are the way forward.

There is an ethical dilemma present when considering updating predictive clinical artificial intelligence (AI) models, which should be part of the departmental quality improvement process. One needs to consider whether withdrawing the AI model is necessary to obtain the relevant information from a naive patient population or whether to use causal inference techniques to obtain this information. Withdrawing an AI model from patient care might pose challenges if the AI model is considered standard of care, while use of causal (...) inference will not be reliable if the relevant statistical assumptions do not hold true. Hence, each of these two updating strategies is associated with patient risks, but lack of reliable data might endanger future patients. Similarly, not withdrawing an outdated AI might also expose patients to risk. Here I propose a high level ethical framework – epistemic risk management - that provides guidance for which route of model updating should be taken based on the likelihood of the assumptions used during the creation of the original AI model and the assumptions required for causal inference holding true. This approach balances our uncertainty about the status of the AI as standard of care with the risk of not obtaining the necessary data, so as to increase the probability of benefiting current and future patients for whose care the AI is being used. (shrink)

Scientific reports about clinical research appear objective and straightforward. They describe a study's findings, methods, subject population, number of subjects, and contribution to existing knowledge. The overall picture is pristine: the research team establishes the requirements of study participation and subjects conform to these requirements. Readers are left with the impression that everything was done correctly, by the book.In other places, however, one finds a different and messier picture of clinical research. In this picture, research subjects deviate from (...) the prescribed plan. One author contrasted the “tidy graphics” and “crisp prose” of the New England Journal of Medicine's HIV/AIDS trial publications with reports that subjects shared medications and broke other trial rules. Awareness of this behavior, he wrote, could lead insiders to “conclude that knowledge was resting on something rather less solid than bedrock.”. (shrink)

Research subjects do not always conform to research requirements. When their personal interests conflict with the demands of participation, some subjects surreptitiously break the rules. These subjects are subversive — they undermine the research endeavor. In rejecting the restrictions research imposes, subversive subjects diminish the value of research results. From one vantage point, subversive subjects engage in unethical behavior. They create risks to themselves and others; they also disregard ethical responsibilities to adhere to research agreements and tell the truth. (...) At the same time, subversive subjects expose ethical problems in the design and conduct of clinical trials. Features of the research environment create fertile ground for subject subversion. Intensified policing and guidance are two common strategies for reducing subject subversion, but collaborative reforms are more consistent with the partnership model of clinical research. (shrink)

Psychiatry has witnessed a new wave of approaches to clinical phenotyping and the study of psychopathology, including the National Institute of Mental Health’s Research Domain Criteria, clinical staging, network approaches, the Hierarchical Taxonomy of Psychopathology, and the general psychopathology factor, as well as a revival of interest in phenomenological psychopathology. The question naturally emerges as to what the relationship between these new approaches is – are they mutually exclusive, competing approaches, or can they be integrated in some way (...) and used to enrich each other? In this opinion piece, we propose a possible integration between clinical staging and phenomenological psychopathology. Domains identified in phenomenological psychopathology, such as selfhood, embodiment, affectivity, etc., can be overlaid on clinical stages in order to enrich and deepen the phenotypes captured in clinical staging (‘high resolution’ clinical phenotypes). This approach may be useful both ideographically and nomothetically, in that it could complement diagnosis, enrich clinical formulation, and inform treatment of individual patients, as well as help guide aetiological, prediction, and treatment research. The overlaying of phenomenological domains on clinical stages may require that these domains are reformulated in dimensional rather than categorial terms. This integrative project requires assessment tools, some of which are already available, that are sensitive and thorough enough to pick up on the range of relevant psychopathology. The proposed approach offers opportunities for mutual enrichment: clinical staging may be enriched by introducing greater depth to phenotypes; phenomenological psychopathology may be enriched by introducing stages of severity and disorder progression to phenomenological analysis. (shrink)

We propose a new hybrid data mining method for predicting protein-protein interactions combining Likelihood-Ratio with rule induction algorithms. In essence, the new method consists of using a rule induction algorithm to discover rules representing partitions of the data, and then the discovered rules are interpreted as “bins” which are used to compute likelihood ratios. This new method is applied to the prediction of protein-protein interactions in the Saccharomyces Cerevisiae genome, using predictive genomic features in an integrated scheme. (...) The results show that the new hybrid method outperforms a pure likelihood ratio based approach. (shrink)

ABSTRACTThe present study examined relationships between attention to negative words and daily rumination and daily adjustment in a sample of clinically depressed individuals. We recorded eye movements of 43 individuals diagnosed with major depression while they were freely viewing dysphoric, threat-related, neutral, and positive words. Then, each day for one week, participants provided measures of their daily rumination and psychological adjustment. Multilevel analyses found that attention to dysphoric and threat-related words was positively related to daily rumination and attention to threat-related (...) words was negatively related to daily adjustment. These findings suggest that the impaired ability to disengage from negative words is positively related to rumination in daily life and is negatively related to well-being, as defined in terms of Beck’s Triad. (shrink)

All major research ethics policies assert that the ethical review of clinical trial protocols should include a systematic assessment of risks and benefits. But despite this policy, protocols do not typically contain explicit probability statements about the likely risks or benefits involved in the proposed research. In this essay, I articulate a range of ethical and epistemic advantages that explicit forecasting would offer to the health research enterprise. I then consider how some particular confidence levels may come into conflict (...) with the principles of ethical research. (shrink)

Background Hospital ethical climate has important implications for clinical nurses’ service behavior; however, the relationships are complicated by the fact that five types of ethical climate (caring, law and code, rules, instrumental, and independence) can be combined differently according to their level and shape differences. Recent developments in person-centered methods (e.g., latent profile analysis (LPA)) have helped to address these complexities. Aim From a person-centered perspective, this study explored the distinct profiles of hospital ethical climate and then examined (...) the relationships of the profiles with clinical nurses’ service behavior (both in-role and extra-role service behavior). Research design A quantitative study was conducted using cluster random sampling. Latent profile analysis and binary coded hexadecimal (BCH) analysis were conducted using Mplus 8.2. Participants and research context A total of 871 clinical nurses in China were surveyed using the Ethical Climate Scale and Nurses’ Service Behavior Questionnaire. Ethical considerations Ethical approval was obtained from the IRB of the First Affiliated Hospital of Jinan University (No. KY-2020-090). Results A four-profile hospital ethical climate model provided the best fit for the data. The four different profiles not only varied in level, but also in shape: high normative and low egoism (45.8%), high ethical climate (19.9%), low ethical climate (3.6%), and moderate ethical climate (30.8%). These profiles differentially predicted clinical nurses’ overall, in-role, and extra-role service behaviors. Conclusions The results reveal new insights into the nature of hospital ethical climate and how different clinical nurses in these profiles can be best managed to accomplish different forms of service behavior. (shrink)

Proponents of the rule of law argue about whether that ideal should be conceived formalistically or in terms of substantive values. Formalistically, the rule of law is associated with principles like generality, clarity, prospectivity, consistency, etc. Substantively, it is associated with market values, with constitutional rights, and with freedom and human dignity. In this paper, I argue for a third layer of complexity: the procedural aspect of the rule of law; the aspects of rule-of-law requirements that have to do with (...) "natural Justice" or "procedural due process." These I believe have been neglected in the jurisprudential literature devoted specifically to the idea of the rule of law and they deserve much greater emphasis. Moreover procedural values go beyond elementary principles like the guarantee of an unbiased tribunal or the opportunity to present and confront evidence. They include the right to argue in a court about what the law is and what its bearing should be on one's situation. The provision that law makes for argument is necessarily unsettling, and so this emphasis on the procedural aspect highlights the point predictability should not be regarded as the be-all and end-all of the rule of law. (shrink)

A background assumption of this paper is that the repertoire of inference schemes available to humanity is not fixed, but subject to change as new schemes are invented or refined and as old ones are obsolesced or abandoned. This is particularly visible in areas like health and environmental sciences, where enormous societal investment has been made in finding ways to reach more dependable conclusions. Computational modeling of argumentation, at least for the discourse in expert fields, will require the possibility of (...) modeling change in a stock of schemes that may be applied to generate conclusions from data. We examine Randomized Clinical Trial, an inference scheme established within medical science in the mid-20th Century, and show that its successful defense by means of practical reasoning allowed for its black-boxing as an inference scheme that generates (and warrants belief in) conclusions about the effects of medical treatments. Modeling the use of a scheme is well-understood; here we focus on modeling how the scheme comes to be established so that it is available for use. (shrink)

Predictive processing (PP) accounts of perception are unique not merely in that they postulate a unity between perception and imagination. Rather, they are unique in claiming that perception should be conceptualised in terms of imagination and that the two involve an identity of neural implementation. This paper argues against this postulated unity, on both conceptual and empirical grounds. Conceptually, the manner in which PP theorists link perception and imagination belies an impoverished account of imagery as cloistered from the external world (...) in its intentionality, akin to a virtual reality, as well as endogenously generated. Yet this ignores a whole class of imagery whose intentionality is directed on the actual environment—projected mental imagery—and also ignores the fact that imagery may be triggered crossmodally in a bottom-up, stimulus-driven way. Empirically, claiming that imagery and perception share neural circuitry ignores relevant clinical results in this area. These evidence substantial perception/imagery neural dissociations, most notably in the case of aphantasia. Taken together, the arguments here suggest that PP theorists should substantially temper, if not outright abandon, their claim to a perception/imagination unity. (shrink)

The objective of this work was to construct and validate an instrument for assessing resilience to suicide attempts in a Spanish clinical population that has made a previous attempt, and to verify its efficacy for predicting future suicide reattempts at 6 months. For the construction of a Scale of Resilience to Suicide Attempts the theoretical-rational strategy was used. The constructed SRSA-18 consisted of 18 items and 3 subdimensions, had high internal consistency and a high positive correlation with the Suicide (...) Resilience Inventory-25, SRI-25, and to a lesser extent with general resilience scales such as the Connor-Davidson Resilience Scale, CD-RISC and the Resilience Scale of 14 items, RS-14. Additionally, a specific SRSA-18 score predicted future suicide reattempts 6 months after the first attempt. This new scale assesses in a brief and rapid way, through protective factors rather than risk factors, the level of resilience to the suicide attempt in specific clinical subpopulations in hospital emergency services, being able to prevent suicide reattempts with higher lethality. (shrink)