The underreporting of suspected adverse drug reactions remains a primary issue for contemporary post-market drug surveillance or ‘pharmacovigilance.’ Pharmacovigilance pioneer W.H.W. Inman argued that ‘deadly sins’ committed by clinicians are to blame for underreporting. Of these ‘sins,’ ignorance and lethargy are the most obvious and impactful in causing underreporting. However, recent analyses show that diffidence, insecurity, and indifference additionally play a major role. I aim to augment our understanding of diffidence, insecurity, and indifference by arguing these sins are underwritten by (...) value judgments arising via epistemic risk. I contend that ‘evidence-based’ medicine codifies these sins. (shrink)

Side effects are ubiquitous in medicine and they often play a role in treatment decisions for patients and clinicians alike. Philosophers and health researchers often use side effects to illustrate issues with contemporary medical research and practice. However, technical definitions of ‘side effect’ differ among health authorities. Thus, determining the side effects of an intervention can differ depending on whose definition we assume. Here I review some of the common definitions of side effect and highlight their issues. In response, I (...) offer an account of side effects as jointly (i) unintended and (ii) effects due to the causal capacities or invariances of an intervention. I discuss (i) by examining the intentions or reasons behind therapeutic interventions, and I discuss (ii) by appealing to a manipulationist model of causation. The analysis here highlights that side effects are conceptually distinct from related outcomes like adverse events, adverse drug reactions, and placebo effects. The analysis also allows for reflection on the utility of ‘side effect’ as a technical term in medical research and practice. (shrink)

Exploratory experiments are widely characterized as experiments that do not test hypotheses. Experiments that do test hypotheses are characterized as confirmatory experiments. Philosophers have pointed out that research programmes can be both confirmatory and exploratory. However, these definitions preclude single experiments being characterized as both exploratory and confirmatory; how can an experiment test and not test a hypothesis? Given the intuition that some experiments are exploratory, some are confirmatory, and some are both, a recharacterization of the relationship between exploratory and (...) confirmatory experimentation is needed. I discuss ‘phase IV’ trials to show what this recharacterization could look like. Phase IV trials can be exploratory and confirmatory insofar as they concurrently test hypotheses and explore for unforeseen phenomena. Even if it is uncontroversial that a single experiment can have multiple aims, the recharacterization of the relationship between exploratory and confirmatory experimentation is still required for these aims to be held together coherently. I offer an alternative characterization of the relationship between exploratory and confirmatory experimentation where the former remains a distinct kind of experimentation but is not characterized as non-hypothesis-testing. (shrink)

Trusting and its Tribulations -- Contents -- Illustrations -- Preface -- Introduction -- 1 Unfixed Trust -- 2 Witchcraft -- 3 Trusting the Untrustworthy -- 4 The Puzzle of the Animal Witch -- 5 'Sharing Secrets' -- 6 Eddies of Distrust -- 7 Intimate Documents -- 8 Trustworthy Bodies -- 9 Habitus of Trust -- 10 'You Can Tell the Company We Done Quit' -- Index.

Name der Zeitschrift: Semiotica Jahrgang: 2014 Heft: 202 Seiten: 207-240.

Recent works have suggested an analytical complementarity in mixing big and thick data sources. These works have, however, remained as programmatic suggestions, leaving us with limited methodological inputs on how to archive such complementary integration. This article responds to this limitation by proposing a method for ‘blending’ big and thick analytical insights. The paper first develops a methodological framework based on the cognitivist linguistics terminology of ‘blending’. Two cases are then explored in which blended spaces are crafted from engaging big (...) and thick analytical insights with each other. Through these examples, we learn how blending processes should be conducted as a rapid, iterative and collaborative effort with respect for individual expertise. Further, we demonstrate how the unique, but often overlooked, granularity of big data plays a key role in affording the blending with thick data. We conclude by suggesting four commonly appearing blending strategies that can be applied when relying upon big and thick data sources. (shrink)

This book is about film's encounter with love throughout the medium's history. It is also about the philosophy of love... [it] outlines a new metaphysics and ontology of love as a reciprocal erotic relationship. This study argues that film's special narrative language is particularly well suited to depicting love in this way. It begins with early silent directors, such as Joseph von Sternberg, and concludes with contemporary filmmakers, such as Sophia Coppola; it also compares classical French and American love films (...) of the 1940s with modernist films by Luis Buñuel, François Truffaut, and Wong Kar Wai, amongst many others"--Page [4] of cover. (shrink)

The underreporting of suspected adverse drug reactions hinders pharmacovigilance. Solutions to underreporting are oftentimes directed at clinicians and health care professionals. However, given the recent rise of public inclusion in medical science, solutions may soon begin more actively involving patients. I aim to offer an evaluative framework for future possible proposals that would engage patients with the aim of mitigating underreporting. The framework may also have value in evaluating current reporting practices. The offered framework is composed of three criteria that (...) are bioethical, social-epistemic, and pragmatic: (i) patients should not be exposed to undue harms, e.g., nocebo effects; (ii) data should be collected, analyzed, and communicated prioritizing pharmacovigilance’s aims, i.e., free from industry bias; and (iii) proposals should account for existing and foreseeable pragmatic constraints like clinician ‘buy in’ and existing reporting infrastructure. Proposals to engage patients in pharmacovigilance that fulfil or address these criteria are preferable to those that do not. (shrink)

Face-to-face interaction is a primordial site for human activity and intersubjectivity. Empirical studies have shown how people reflexively exhibit a face orientation and work to establish a formation in which everyone is facing each other in local participation frameworks. The Face has also been described by, e.g., Levinas as the basis for a first ethical philosophy. Humans have established these Face-formations when interacting since time immemorial, but what happens when one of the participants is present through a telepresence robot? Based (...) on ethnomethodology, Peircean/goodwinian semiotics, multimodal conversation analysis and video data from a Danish residential rehabilitation center, the article shows the ways in which participants manage to interactively, cooperatively, and moment by moment achieve an F-formation in situ. The article contributes a detailed analysis and discussion of the kind of participant a telepresence robot is, in and through situated interactions: I propose that we term this participant the RoboDoc, given that it is an assemblage of a doctor who controls a robot. By focusing on the affordances of mobility, the article contributes to a renewed understanding of the importance and relevance of establishing Face-orientations in an increasingly technofied telepresence world. (shrink)

Journal Name: Semiotica Issue: Ahead of print.

This book provides a clear and concise introduction to the philosophy of Gilles Deleuze. It analyses his key theoretical concepts, such as difference and the body without organs, and covers all the different areas of his thought, including metaphysics, the history of philosophy, psychoanalysis, political theory, the philosophy of the social sciences and aesthetics. As the first book to offer a comprehensive analysis of Deleuze's writings, it reveals both the internal coherence of his philosophy and its development through a series (...) of distinct phases. Reidar Due offers an entirely new interpretation of Deleuze's philosophy, centred around the notion of thought as a capacity to form relations. These relations are embodied in nature, in language and in the unconscious; in art, science and social practice. With this concept of embodied thought, Deleuze challenges our most entrenched beliefs about the self and about signs whether linguistic or social. He develops an original theory of power and social systems and presents a method for understanding any signifying practice, from language and ritual to the unconscious, including cinema, literature and painting. Due analyses the different strands in this theoretical edifice and shows its implications for a wide range of human sciences, from history and psychology to political theory and cultural studies. (shrink)

In this paper, we study the interactional organization of an instructed object exploration among sighted and visually impaired people (VIPs) in order to contribute to studies of instructional activities and the observable accomplishment of haptic perception. We do this by showing the situated, interactional, and co-operative organization of achieving object understanding. We focus on the dynamics of haptic perception as being reliant on instructions, while at the same time being an observable production that furnishes further instructions. We show the organization (...) of visual and verbal instructions versus the touching of objects for haptic perception. Based on ethnomethodological conversation analysis of video data, we study a VIP’s haptic actions in interaction with a professional, sighted ICT consultant who provides instructions on what an object is and what it can do. We show how the instructions are sequentially adjusted to make them relevant for a simultaneous, emerging exploration in which the VIP uses their hands and fingers to perceive very specific details of the object. We argue that achieving object understanding is accomplished in and through the fine-tuned coordination of haptic exploration, both as a response to verbal instructions and also as a means of conveying perception-related actions, which the ICT uses to build new actions. The paper thus makes a case for instructed and distributed haptic perception as observable in social interaction and as a resource for building object understanding within phenomenal fields. (shrink)

Gilles Deleuze famously expressed distaste for the philosophy of Ludwig Wittgenstein and his followers. The two thinkers are here seen as irreconcilable. The critique of false problems and the refutation of scepticism found in Wittgenstein have no resonance in Deleuze, who was a systematic metaphysical philosopher in the tradition of pre-Kantian rationalism. Pragmatic-sceptical self-limitation of thought's capabilities on the grounds of existing practice flies in the face of aesthetic experience. Moreover Deleuze explicitly upholds modern literature as a locus of philosophical (...) innovation. The comparison between Deleuze and Wittgenstein is pursued in an examination of the questions of ‘rule following’, literary practice and semiotics. Deleuze was hostile to ‘pragmatism’, whereas Wittgenstein and his followers could often be described as pragmatists. (shrink)

This essay raises some questions concerning the method and conceptual structure of Sartre's Being and Nothingness. Three substantially different types of interpretation of this text have been put forward. One of the main issues separating the three interpretative strategies is the relationship that they each establish between Sartre's three fundamental concepts: consciousness, nothingness and freedom—each of which can be seen to play the fundamental role in the argument. It therefore seems crucial for any interpretation of Being and Nothingness to determine (...) the exact relationship between these terms. However, Being and Nothingness presents a hybrid argument that interweaves metaphysical deduction, phenomenological description and moral-existential argument in a way that makes it almost impossible to decide which of the strands of the argument should be seen to dominate the others. It is therefore perhaps equally difficult to ascertain which of its principal concepts has the most central place in the system. One could therefore argue that a reading of Being and Nothingness should aim to account for (rather than dismiss) the hybridity of the argument and then seek to assign relative functions to its different strands. The following remarks are intended as a step in that direction. (shrink)

L’article propose une analyse de la gestion politique de la pandémie, élaborant un concept de domination nouvelle qui, du côté de l’Etat comme du côté du citoyen, et des attitudes normatives que l’on attend de lui, aurait été caractérisé par un type de réflexion rationnelle à échelle temporelle brève. L’article analyse les implications temporelles et politiques de ce lien de domination nouveau en comparant la raison d’Etat des gouvernements occidentaux durant la pandémie à des conceptions du pouvoir défini en termes (...) d’idéologie ou de “biopolitique”. Ensuite, il cherche à déterminer la nature du citoyen-sujet qui entre dans cette nouvelle forme de domination par comparaison avec trois formes de subjectivité canoniques : le sujet kantien, l’individu sociologique et la subjectivité contingente et éthique théorisée par Hannah Arendt. Par ce biais, il définit la singularité du citoyen-sujet nouveau par sa réactivité. (shrink)

Side effects are a concern in medical decision making and a robust area of biomedical research. However, there is relatively little philosophical investigation into side effects as such, especially given that side effects are appealed to for various applications in philosophy of medicine. In addition, health authorities like the FDA, CDC, and WHO have contrary definitions of ‘side effect.’ Moreover, these definitions have clear counterexamples. This dissertation aims to provide a complete account of what side effects are. I posit that (...) an account of side effects ought to draw clean conceptual lines between side effects and related treatment outcomes. I contend that an account of side effects must address two components: the reasons behind an intervention that produced the side effect, and the causal powers of the intervention that brought about that effect. With this account in mind, I address contemporary philosophical models that distinguish placebo effects from side effects. These arguments, respectively in chapters 2 and 3, yield a more complete, less problematic account of side effects than previous accounts. The dissertation then turns to the process of discovering side effects, specifically in the post-market context. Given the paucity of external validity in pre-market drug trials, chapter 4 argues that post-market ‘phase IV’ trials blur the received distinction of ‘confirmatory’ versus ‘exploratory’ experimentation in philosophy of science. The other component of post-market drug research is spontaneous reporting, or the voluntary reporting of a suspected side effect to a regulatory body. Chapter 5 uses the framework of risks and values in science to examine why clinicians underreport, which hinders our ability to prevent drug-related harms. Chapter 6 looks at how patients could mitigate underreporting and develops a social-epistemic, pragmatic, and ethical framework which can evaluate proposals to engage patients to spontaneously report their suspected side effects. In short, this dissertation aims to firstly address the conceptual problems in how we define ‘side effect’ and relate it to other treatment outcomes, and secondly it addresses issues that hinder the scientific investigation of side effects. (shrink)

This paper seeks to present a kind of skeptical, and, in an indirect way, Wittgensteinian perspective upon purpose and meaning in architecture. The argument presented here revolves around the two notions that, first, there are different categories, which we have available for making architecture seem intelligible to us, and, second, that there are distinct historical discourses in which architecture has been made intelligible in specific ways.

This chapter contains sections titled: Meet the Celebrity Moms How to be a Good Mother Working Mothers How to be a Bad Mother Conclusion: Mothering as Boring Notes.

Fiona Allon writes that “ home, now more than ever, is seen as firmly connected to the world of politics and economics, as actively shaped and defined by the public sphere rather than existing simply as a refuge from it.” 1 From this perspective, claims to home as they are located in a relationship to claims of both national and local belonging are often a contested site within Australia, where notions of who is seen to be at home in Australia (...) are constantly being challenged and reworked. Structured around the desire amongst white people to retain Australia as a “white nation,” claims to home may be seen as operating in complex ways in regards to the rights that arise from the ongoing existence of Indigenous sovereignties, and the politics surrounding levels of immigration from groups of people perceived as belonging to minority racial groups. In this context, the notion of home is frequently drawn upon in relation to both how people perceive the way in which they, and others, belong in a country, and this raises questions surrounding who is legitimately able to call Australia home. Such discourses of home evoke feelings of ownership in people who feel that they have a legitimate claim to a country for reasons primarily of race or location of birth. In Australia, despite the powerful presence and voice of Indigenous peoples, popular perceptions of the country tend to place such homely rights firmly in the laps of white people, who, through images of white nuclear families in front of white picket fences, perceive themselves as already and rightfully at home in Australia. Yet such conceptions of Australia are not accepted without struggle. Notions of home are very much contested, especially in terms of Indigenous sovereignty and non-white immigration, both of which question the legitimacy of a normatively white Australia. Such ideas of home as being a contested space in which issues of national belonging are played out in Australia were seen quite clearly in relation to the 2005 Cronulla riots, in which thousands of white Australians gathered around Cronulla beach, shouting at and threatening those located as “Lebanese Muslim” people. The people involved in the riots made it quite clear that whilst Australia was a home for them, it ought not to be home to people who were identified as Lebanese Muslims. Such racist opinions exemplified the fact that Australia is seen to be a white country, and therefore as a legitimate home to white people rather than to non-white minority groups or even to Indigenous Australians. This is discussed in more detail later in this paper. (shrink)

Whilst feminist commentators have long critiqued surrogacy as a practice of commodification, surrogacy as a mode of family formation continues to grow in popularity. In this paper we explore public representations of surrogacy through a discourse analytic reading of submissions made in Australia to an Inquiry regarding surrogacy legislation. The findings suggest that many submissions relied upon normative understandings of surrogates as either ‘good women’ or ‘bad mothers’. This is of concern given that such public representations may shape the views (...) of those who utilize surrogacy services in ways that limit attention to the ethics of surrogacy. (shrink)

This article proposes a direction—inspired by a reading of Heidegger’s reflections on sculpture— in which thinking enriched by artistic experience can unfold an alternative mode of being-in-the-world. Heidegger points out that, in contrast to a scientific understanding of space as an empty container, the special character of space in sculpture is characterized by a clearing-away (Räumen), which presupposes and points to an open, receptive attitude toward experience that is necessary for dwelling to take place. From Heidegger this article proceeds to (...) reflect on artworks by Eduardo Chillida and Janet Echelman. These offer concrete examples of how a thinking of sculpture can apply to different notions of place. While Chillida’s sculptures present a sense of place as rooted and embedded in the landscape, Echelman’s artworks explore an expanded notion of place through a multisensory sense of immersion. Applying Heidegger’s meditations on Räumen, it turns out that the differences between these artworks are of greatest significance in illustrating the breadth of the experiential space that they share: an openness to dwelling and a receptivity toward being-in-the-world. In this way, Heidegger’s reflections on sculpture are unfolded in a contemporary context and the potential of sculpture for a thinking of experience is established. (shrink)

The paper contributes to previous studies of identity as locally and interactionally produced by pointing to some of the multimodal resources employed by participants to achieving, challenge and manage the professional identity of ‘leader’ in different workplace settings. We examine professional identity work in sequential environments where it provides a resource for handling the resistance to improvement displayed by another participant. We show how leader identity work gets embedded within a four-part structure of: identifying a problem, proposing improvements, misaligning with (...) others’ proposals, and managing the misalignment. The paper is based on video ethnographic fieldwork and recordings of face-to-face institutional interaction at two different institutional settings in Denmark. The study provides insight about the role of identity work in the interactional achievement of institutional procedures. (shrink)

Person‐specific evidence was developed as a grounded theory by analyzing 20 selected case descriptions from interventions using the guided self‐determination method with people with various long‐term health conditions. It explains the mechanisms of mobilizing relational capacity by including person‐specific evidence in shared decision‐making. Person‐specific self‐insight was the first step, achieved as individuals completed reflection sheets enabling them to clarify their personal values and identify actions or omissions related to self‐management challenges. This step paved the way for sharing these insights and (...) challenges in a relationship with a supportive health professional, who could then rely on person‐specific evidence instead of assumptions or a narrow disease perspective for shared decision‐making. Trust in the evidence encouraged the supportive health professional to transfer it to the interdisciplinary team. Person‐specific evidence then enhanced the ability of team members to apply general evidence in a meaningful way. The increased openness achieved by individuals through these steps enabled them to eventually share their new self‐insights in daily life with other people, decreasing loneliness they experienced in self‐management. Relational capacity, the core of the theory, is mobilized in both people with long‐term health conditions and healthcare professionals. Further research on person‐specific evidence and relational capacity in healthcare is recommended. (shrink)

Due process is the means by which ethical constraints are placed on administrative decision-making. I have developed a model of variation in due process and use this model to explore the implementation of “due process” norms by three standard-setting bodies that are created, funded, and overseen by the Canadian Institute of Chartered Accountants – the Accounting Standards Board, the Auditing and Assurance Standards Board, and the Public Sector Accounting Standards Board. I conducted two analyses: a comparative analysis of the implementation (...) of due process norms based on differences among the three cases; and, a critique of the due process norms followed by these boards based on their internal logic and a set of best practices identified in other contexts for due process by standard setters. I have presented evidence that due process norms are more fully developed, where standards are enforced by the state and the heterogeneity of users is greatest. (shrink)

Obesity is one of several targets of public health efforts related to availability of and access to healthy foods. The tension between individual food decisions and social contexts of food production, preparation, and consumption makes targeting individuals deeply problematic and yet tempting. Such individualization of responsibility for obesity and nutrition is unethical and impractical. This article warns public health campaigns against giving into the temptation to individualize responsibility, and presents an argument for why they should proceed with all due caution, (...) advising providers and public health organizations to keep in mind structural factors rather than aiming at individuals. (shrink)

Belgium is one of very few countries where euthanasia on the basis of psychiatric illness is legally possible. Three physicians involved in the euthanasia of a 38-year-old woman suffering from psychiatric illness recently faced a criminal trial for “murder by poisoning”, for allegedly having failed to comply with several requirements of the Belgian Euthanasia Law. Although none of the physicians were convicted, the case generated extensive debate, in the media and the general public as well as in the medical profession (...) and among policy makers. In this chapter, we take this trial as the starting point for a critical analysis of the clinical-psychiatric, ethical, and legal issues involved in evaluating euthanasia requests in cases of complex psychiatric disorders. In these cases, the requirements of the Belgian Euthanasia Law could be improved by mandating the advice of two psychiatrists, who are experts in the treatment of the specific condition of the person requesting euthanasia. Simultaneously with the process of evaluating the euthanasia request, there should be a parallel treatment track in which all therapeutic and recovery-oriented options are explored. These two tracks should not be in the hands of the same physician. (shrink)

There is a robust scientific consensus concerning climate change and evolution. But many people reject these expert views, in favour of beliefs that are strongly at variance with the evidence. It is tempting to try to explain these beliefs by reference to ignorance or irrationality, but those who reject the expert view seem often to be no worse informed or any less rational than the majority of those who accept it. It is also tempting to try to explain these beliefs (...) by reference to epistemic overconfidence. However, this kind of overconfidence is apparently ubiquitous, so by itself it cannot explain the difference between those who accept and those who reject expert views. Instead, I will suggest that the difference is in important part explained by differential patterns of epistemic deference, and these patterns, in turn, are explained by the cues that we use to filter testimony. We rely on cues of benevolence and competence to distinguish reliable from unreliable testifiers, but when debates become deeply politicized, asserting a claim may itself constitute signalling lack of reliability. (shrink)

If scientists can successfully clone sheep, will humans be next? Today's headlines read like a science fiction novel! Due Consideration takes a poignant look at the rapidly changing field of biomedicine and the consequences it will have on our lives. Arthur Caplan, one of this nation's leading bioethicists, explores these issues and analyzes moral questions including: * Will we retain our essential humanity if we modify our biological blueprint? * Would it be irresponsible to procreate without a thorough genetic examination? (...) * Who will decide if physical traits like short stature and baldness are considered diseases? * Can biomedicine make our lives better? You'll also learn about the most current and controversial topics such as: * Cloning, abortion and assisted suicide. * Genetically engineering a human to be immune from infectious diseases. * The ability to "design" our children from head to toe. * Diagnosing and treating illnesses during fetal development. * Programs to prevent the transmission of HIV. No other book on the market today combines this analytic clarity with the latest from medical journals and media headlines. Now, you can decide for yourself what the future ought to hold in store. (shrink)