The Belmont Report’s distinction between research and the practice of accepted therapy has led various authors to suggest that these purportedly distinct activities should be governed by different ethical principles. We consider some of the ethical consequences of attempts to separate the two and conclude that separation fails along ontological, ethical, and epistemological dimensions. Clinical practice and clinical research, as with yin and yang, can be thought of as complementary forces interacting to form a dynamic system in which the whole (...) exceeds the sum of its parts. Just as effective clinical practice cannot exist without clinical research, meaningful clinical research requires the context of clinical practice. We defend this thesis by triangulation, that is, by outlining how multiple investigators have reached this conclusion on the basis of varied theoretical and applied approaches. More confidence can be placed in a result if different methods/viewpoints have led to that result. (shrink)

In this essay, we defend the design of the Salk polio vaccine trial and try to put some limits on the role schemata should play in designing clinical research studies. Our presentation is structured as a response to de Freitas and Pietrobon who identified the CONSORT statement as a schema that would have, had it existed at the time, ruled out the design of the Salk polio vaccine trial of 1954 in favor of a completely randomized controlled clinical trial. We (...) argue that large-scale public health interventions often require evidence beyond simple efficacy, the limit of what an RCT can provide, and that the design actually adopted for the Salk trial represented a reasonable—albeit imperfect—compromise. This is of more than historical interest in that many contemporary studies are of the scale and scope to require a more pragmatic, rather than explanatory, approach to study design. (shrink)

Survival of the fittest in evolutionary biology has a counterpart in the evolution of research paradigms. It’s called survival of the funded, and there is a sense in which paradigms are even more adaptable than species. Whereas species may become extinct if their fitness declines below a critical threshold, paradigms can rise again, perhaps with a new name, following fiscal collapse, provided only that funding is once again made available.A current example is the born-again concept of comparative effectiveness research , (...) which achieved resurrection status with the passage of the Affordable Care Act of 2010. The ACA established a private, nonprofit entity to oversee publicly financed CER. According to .. (shrink)

David Sackett and Jack Wennberg have each introduced and developed ideas and methods that have had major impacts on how we think about and perform clinical research. Sackett is best known for his work in Evidence-Based Medicine (Sackett et al. 1997); Wennberg, upon noting wide geographic (and other) variations in best practices for the same conditions, stressed the importance of comparative effectiveness in clinical decision-making (Wennberg et al. 1993). When these two collaborated in an editorial about the current state of (...) the art and science of clinical research, it comes as no great surprise that they produced some truly memorable guidance. And, as is so often the case for inspired—and inspiring—advice, their .. (shrink)

That dichotomization is, at least under certain circumstances, a bad idea is not news. A well-known, early example is the biblical story of King Solomon, who used the absurdity of the procedure to help adjudicate a dispute between two women who each claimed to be the mother of a contested child. Solomon reasoned that his proposal to split the child into two, giving half to each woman, would be abhorrent to the real mother, and when one of the women objected (...) while the other thought the proposal was "only fair," the choice between the women was made obvious.Things, however, are not always so clear-cut, and it is not difficult to find arguments that point to the advantages that accrue to those that simplify matters.... (shrink)

In a recent paper in this journal, John Worrall (2008) used the example of a series of trials involving extracorporeal membrane oxygenation (ECMO), a technology for the treatment of respiratory failure in newborns, to illustrate the relationship between ethics and epistemology in medical research. One of the issues considered was whether or not it was ethical to perform a particular clinical trial at all, and he showed clearly that the answer was intimately related to epistemological judgments about the weight to (...) be given existing evidence concerning treatment effectiveness. In the case of ECMO, a trial was initiated at the University of Michigan (Bartlett et al. 1985), despite the fact that the researchers had .. (shrink)

It is perhaps most useful to approach the Doctor-Patient relationship (DPR) by admitting that it’s complicated. We review some of the strategies that have been employed to mitigate this complexity, zeroing in on one that promises to capture the main features of the DPR without eliminating some of its more important, existential components; pieces of the puzzle that must be retained if we are to avoid oversimplification and the errors that can arise by ignoring important foundational properties. We believe that (...) a useful way to look at the DPR and to capture essential features that must be balanced in the process is provided by Partnership Theory and its definition in terms of the so-called domination and partnership systems. We apply this theory to the DPR and investigate the implications of this application to health care. We see that in the absence of mitigating circumstances, adoption of the patient-as-partner model serves healthcare well and is flexible enough to accommodate circumstances that dictate modifications. (shrink)

Following Bernheim,1 we examine aspects of 'felicitometrics,'2 the measurement of the 'quality' term in Quality of Life (QOL). Bernheim argued that overall QOL is best captured as the Gestalt3 of a global self-assessment and suggested that the Anamnestic Comparative Self Assessment (ACSA) approach, in which subjects' memories of the best and worst times of their lives are used to anchor a Visual Analog Scale (VAS), provided a serious answer to the serious question, 'How have you been?' Bernheim compares and contrasts (...) the ACSA to multi-item questionnaire QOL instruments, such as the SF-36, concluding that the ACSA has a number of advantages. His discussion assumes that the use of QOL outcomes in clinical trials is both relevant and appropriate. In the present paper, we document the reasonableness of this latter assumption,4 contribute to the characterization of the similarities and differences between multi-item and individualized QOL instruments, and point to some other individualized instruments that may be used in clinical trial contexts. These 'other individualized instruments' differ from the ACSA in fundamental ways; but they are individualized in that the subject defines those areas in his/her life that are most important, and these may vary from subject-to-subject. (shrink)

The use of quality of life (QOL) outcomes in clinical trials is increasing as a number of practical, ethical, methodological, and regulatory reasons for their use have become apparent. It is important, then, that QOL measurements and differences between QOL scores be readily interpretable. We study interpretation in two contexts: when determining QOL and when basing decisions on QOL differences. We consider both clinical situations involving individual patients and research contexts, e.g., randomized clinical trials, involving groups of patients. We note (...) the ethical importance of such understanding: proper interpretation and communication facilitate health care decision making. Communication that facilitates interpretation is of moral significance since better communication can attenuate ethical problems and inform choices. Much of what is communication worthy about QOL assessments is determined by the particular QOL instrument used in the assessment and how it is administered. In practice, these choices will be driven by the purpose of the assessment, but, it is argued, to maximize understanding, we should combine the information garnered from traditional standardized QOL instruments, from individualized QOL assessments, and from a recently proposed dialogic paradigm, where QOL is determined by shared conversation regarding the interpretation of texts. And, while some studies can surely succeed using abbreviated methods of administration (e.g., postal surveys may suffice for certain purposes), we will focus on methods of administration involving interviewer–respondent interaction. We suggest that during the QOL elicitation process, interviewer and respondent should engage in a two-way conversation in order to achieve a shared understanding of the “answers” to QOL “questions” and, finally, to reach a shared interpretation of the individual’s QOL. (shrink)

Data Safety and Monitoring Boards have been referred to as a “growth industry,” and this trend continues to be fueled by recent FDA guidance and the NIH's requirement that DSMBs be employed in virtually all phase III clinical trials. The widening role of DSMBs has been sporadically questioned on ethical grounds, but growth has continued, despite the fact that many of the questions endure, unanswered, save for repeated references to safeguarding the scientific integrity of trials. This may be about to (...) change. The recently appointed director of the Office for Human Research Protections , Jerry Menikoff, is on record as regarding current practices — where consent forms often promise what the DSMB has been assembled to specifically not provide — as constituting fraudulent behavior. That is, a subject may inherently rely on, to their detriment, information that has been misrepresented in the consent document. In this paper, we assemble some of the enduring questions and top them off with Menikoff's tour de force to present what we hope will be a compelling argument to require that consent forms fairly represent what the DSMB will do — and not do — with trial data as they accumulate. We argue that DSMBs should be used only in rare circumstances, and question the practice of precluding principal investigators from DSMB membership, but our main thrust is to ensure that DSMBs, when used at all, are properly described in trial consent forms. (shrink)

Data Safety and Monitoring Boards were introduced in the 1960s to monitor data in clinical trials to ensure subject safety. It was thought important that DSMB members be experts in the field of interest, but not otherwise involved in the study in order to maximize objectivity. Since then, the use of DSMBs has increased dramatically, and their scope has expanded to include scientific issues — in particular, to avoid bias that can result when trials are stopped early because of evidence (...) that one treatment has greater efficacy or causes greater harm than another; or that no treatment is likely to do better than any other. (shrink)

In The Origin of Species (1859) Darwin challenged many of the most deeply-held beliefs of the Western world. Arguing for a material, not divine, origin of species, he showed that new species are achieved by "natural selection." The Origin communicates the enthusiasm of original thinking in an open, descriptive style, and Darwin's emphasis on the value of diversity speaks more strongly now than ever. As well as a stimulating introduction and detailed notes, this edition offers a register of the many (...) writers referred to by Darwin in the text. (shrink)

This is also where we begin investigating lattices of logics and varieties, rather than particular examples.

In "Variations on a theme of Curry," Humberstone conjectured that a certain logic, intermediate between BCI and BCK, is none other than monothetic BCI—the smallest extension of BCI in which all theorems are provably equivalent. In this note, we present a proof of this conjecture.

Familiarity with Charles Darwin's treatise on evolution is essential to every well-educated individual. One of the most important books ever published--and a continuing source of controversy, a century and a half later--this classic of science is reproduced in a facsimile of the critically acclaimed first edition.

The present edition provides a detailed and accessible discussion ofhis theories and adds an account of the immediate responses to the book on publication.

Should engineering ethics be taught? Despite the obvious truism that we all want our students to be moral engineers who practice virtuous professional behavior, I argue, in this article that the question itself obscures several ambiguities that prompt preliminary resolution. Upon clarification of these ambiguities, and an attempt to delineate key issues that make the question a philosophically interesting one, I conclude that engineering ethics not only should not, but cannot, be taught if we understand “teaching engineering ethics” to mean (...) training engineers to be moral individuals (as some advocates seem to have proposed). However, I also conclude that there is a justification to teaching engineering ethics, insofar as we are able to clearly identify the most desirable and efficacious pedagogical approach to the subject area, which I propose to be a case study-based format that utilizes the principle of human cognitive pattern recognition. (shrink)

David Charles presents a major new study of Aristotle's views on meaning, essence, necessity, and related topics. These interconnected views are central to Aristotle's metaphysics, philosophy of language, and philosophy of science, and are also highly relevant to current philosophical debates. Charles aims to reach a clear understanding of Aristotle's claims and arguments, to assess their truth, and to evaluate their importance to ancient and modern philosophy.

This wide-ranging anthology of philosophical writings on the concept of God presents a systematic overview of the chief conceptions of deity as well as skeptical and atheistic critiques of theological ideas. The selections cover key philosophic developments in this subject area from ancient times to modern in both the East and West. Editors Hartshorne and Reese-two of the most highly respected scholars in the philosophy of religion-have not only selected many arresting passages from the world's great thinkers but have also (...) analyzed and evaluated the underlying ideas, showing how they fit into major, overarching systems of thought. Part One, "Classical Views," includes passages from ancient Egyptian, Indian, Chinese, and Judeo-Christian scriptures as well as philosophical writings from ancient Greece, the medieval church, and the Enlightenment. Part Two, "Modern Views," considers the ideas of more recent influential thinkers from diverse cultures and philosophical schools: Schelling, Peirce, Whitehead, Schweitzer, Buber, Radhakrishnan, and Watts, among others, are represented and discussed. Part Three, "Skeptical or Atheistic Views: Ancient and Modern," examines various kinds of skepticism and includes selections from Carneades, Buddha, Hume, Schopenhauer, Feuerbach, Nietzsche, Dennes, and Freud. Throughout their presentation the editors analyze and contrast theistic, atheistic, pantheistic, and panentheistic systems of thought. Philosophers Speak of God is a richly varied selection of high-quality writing on a perennial subject that will provide the serious student a thorough foundation in the philosophy of religion. (shrink)

Alan Robinson This set of essays pays tribute to Bob Kowalski on his 60th birthday, an anniversary which gives his friends and colleagues an excuse to celebrate his career as an original thinker, a charismatic communicator, and a forceful intellectual leader. The logic programming community hereby and herein conveys its respect and thanks to him for his pivotal role in creating and fostering the conceptual paradigm which is its raison d’Œtre. The diversity of interests covered here reflects the variety (...) of Bob’s concerns. Read on. It is an intellectual feast. Before you begin, permit me to send him a brief personal, but public, message: Bob, how right you were, and how wrong I was. I should explain. When Bob arrived in Edinburgh in 1967 resolution was as yet fairly new, having taken several years to become at all widely known. Research groups to investigate various aspects of resolution sprang up at several institutions, the one organized by Bernard Meltzer at Edinburgh University being among the first. For the half-dozen years that Bob was a leading member of Bernard’s group, I was a frequent visitor to it, and I saw a lot of him. We had many discussions about logic, computation, and language. (shrink)

Monomodal logic has exactly two maximally normal logics, which are also the only quasi-normal logics that are Post complete, and they are complete for validity in Kripke frames. Here we show that addition of a propositional constant to monomodal logic allows the construction of continuum many maximally normal logics that are not valid in any Kripke frame, or even in any complete modal algebra. We also construct continuum many quasi-normal Post complete logics that are not normal. The set of extensions (...) of S4.3 is radically altered by the addition of a constant: we use it to construct continuum many such normal extensions of S4.3, and continuum many non-normal ones, none of which have the finite model property. But for logics with weakly transitive frames there are only eight maximally normal ones, of which five extend K4 and three extend S4. (shrink)

This book proposes a new paradigm for the interpretation of Plato's early and middle dialogues. Rejecting the usual assumption of a distinct 'Socratic' period in the development of Plato's thought, this view regards the earlier works as deliberate preparation for the exposition of Plato's mature philosophy. Differences between the dialogues do not represent different stages in Plato's own thinking but rather different aspects and moments in the presentation of a new and unfamiliar view of reality. Once the fictional character of (...) the Socratic genre is recognised, there is no reason to regard Plato's early dialogues as representing the philosophy of the historical Socrates. The result is a unified interpretation of all of the dialogues down to the Republic and the Phaedrus. (shrink)

According to Clarke and Beck (C&B), the approximate number system (ANS) represents numbers. We argue that the ANS represents pure magnitudes. Considerations of explanatory economy favor the pure magnitudes hypothesis. The considerations C&B direct against the pure magnitudes hypothesis do not have force.

Monomodal logic has exactly two maximally normal logics, which are also the only quasi-normal logics that are Post complete, and they are complete for validity in Kripke frames. Here we show that addition of a propositional constant to monomodal logic allows the construction of continuum many maximally normal logics that are not valid in any Kripke frame, or even in any complete modal algebra. We also construct continuum many quasi-normal Post complete logics that are not normal. The set of extensions (...) of S4.3 is radically altered by the addition of a constant: we use it to construct continuum many such normal extensions of S4.3, and continuum many non-normal ones, none of which have the finite model property. But for logics with weakly transitive frames there are only eight maximally normal ones, of which five extend K4 and three extend S4. (shrink)

Quasi-MV algebras are generalisations of MV algebras arising in quantum computational logic. Although a reasonably complete description of the lattice of subvarieties of quasi-MV algebras has already been provided, the problem of extending this description to the setting of quasivarieties has so far remained open. Given its apparent logical repercussions, we tackle the issue in the present paper. We especially focus on quasivarieties whose generators either are subalgebras of the standard square quasi-MV algebra S , or can be obtained therefrom (...) through the addition of some fixpoints for the inverse. (shrink)

Niniejszy tekst podejmuje kwestię bogów i bohaterów mitów greckich, odnosząc ją do obecnej w psychologii głębi koncepcji archetypów i nieświadomości zbiorowej. Główny cel badań sprowadza się tym samym do bacznego przyjrzenia się potencjalnej korelacji pomiędzy zewnętrznymi w rozumieniu starożytnego Greka postaciami bogów i bogiń, a wewnętrznymi przejawami nieświadomości zbiorowej, które mogą stanowić – według Carla Gustava Junga – istotę antycznych bóstw. Ponadto został poddany namysłowi problem wpływu „wewnętrznych bogów” na sposób myślenia, odczuwania i działania jednostki, wpływu zarówno pozytywnego, jak i (...) negatywnego. Wynikająca z przeprowadzonych badań konkluzja zwraca uwagę na wartość sfery irracjonalnej – źródła pochodzenia zapomnianych, politeistycznych bogów, zamieszkujących psychikę współczesnego człowieka. ---------------------- Zgłoszono: 14/04/2022. Zrecenzowano: 11/05/2022. Zaakceptowano do publikacji: 30/05/2022. (shrink)

In Part 1, I contend (using Coriolanus as my mouthpiece) that Keeley and Clarke have failed to show that there is anything intellectually suspect about conspiracy theories per se. Conspiracy theorists need not commit the ‘fundamental attribution error’ there is no reason to suppose that all or most conspiracy theories constitute the cores of degenerating research programs, nor does situationism - a dubious doctrine in itself - lend any support to a systematic skepticism about conspiracy theories. In Part 2. I (...) argue (in propria persona) that the idea that there is something suspect about conspiracy theories is one of the most dangerous and idiotic superstitions to disgrace our political culture. (shrink)

According to the conceptualist view in the philosophy of perception, we must possess concepts for all the objects, properties and relations which feature in our perceptual experiences. In this paper, I investigate the possibility of developing an argument against the conceptualist view by appealing to the notion of attention. In Part One, I begin by setting out an apparently promising version of such an argument, a version which appeals to a link between attention and perceptual demonstrative concept possession. In Part (...) Two, however, I show how the conceptualist can challenge what appears to be the key premise of the argument, and I go on to describe, in Part Three, an important further difficulty which we face if we attempt to overcome this challenge in a particular way. My conclusion will be that the conceptualist's challenge to the argument is convincing and hence that the argument remains inconclusive. (shrink)

Racial inequities in medicine are the consequence of intersecting, multidimensional factors. As detailed in the articles by Braddock, Mithani, Cooper, and Boyd, and Yearby, the...

Of laws in general -- Of laws directly derived from the nature of government -- Of the principles of the three kinds of government -- That the laws of education ought to be relative to the principles of government -- That the laws given by the legislator ought to be relative to the nature of government -- Consquences of the principles of different governments, with respect to the simplicity of civil and criminal laws, the form of judgements, and inflicting of (...) punishments -- Consquences of the different principles of the three governments, with respect to sumptuary laws, luxury, and the condition of women -- Of the corruption of the principles of the three governments -- Of the laws in the relation they bear to defensive force -- Of laws, in the relation they bear to offensive force. (shrink)

The place of religion in society has changed profoundly in the last few centuries, particularly in the West. In what will be a defining book for our time, Taylor takes up the question of what these changes mean, and what, precisely, happens when a society becomes one in which faith is only one human possibility among others.

The problem we discuss is whether mammalian cells possess genes whose expression is specifically enhanced by DNA damage in order to cope with the damage. The paradigm is the SOS response in E. coli. We conclude that there is compelling evidence that DNA‐damaging agents do affect gene expression, and that mutation frequencies are increased, but proof that a repair process per se is induced remains elusive. We offer here the hypothesis that recognition of the presence of DNA damage by poly(ADPribose) (...) polymerase effects preprogrammed changes in gene expression. (shrink)

Am(B m B). Specifically I was wondering whether for every BCI-provable formula A there is a B for which the inset formula was provable. If you want to read about this issue, which I..

There are books that debate math, science, and history; there are books that help you build walls or even pyramids; there are even books that discuss Neanderthals with tools and autotrophs that drool. This book discusses philosophy. But you don't need an IQ of 187 to enjoy it. I swear to cow! As you'll see, the philosophy is theoretical, but the fun is real.

Previous research suggests a higher perceived risk associated with a risky behavior predicts a lower likelihood of involvement in that behavior; however, this relationship can vary based on personality characteristics such as impulsivity and behavioral activation. During the COVID-19 pandemic, individuals began to re-evaluate the level of risk associated with everyday behaviors. But what about risks associated with “typical” risk-taking behaviors? In the present study, 248 undergraduate student participants completed measures of impulsivity, behavioral activation and inhibition, propensity to take risks, (...) numeracy, and perceptions of and involvement in both risk-taking behavior and health promoting behavior. Our study revealed that higher behavioral inhibition and greater propensity to take risks predicted greater likelihood of involvement in COVID-19-related risk behaviors, even after accounting for perceived risks and benefits of the behavior. Greater likelihood of involvement in social risk behaviors was predicted by greater numeracy and risk-taking propensity. Identifying as male, a greater propensity to take risks, and greater impulsivity predicted increased health/safety risk behaviors. Younger age, lower risk-taking propensity, and lower impulsivity were associated with a greater likelihood of donating blood. For the likelihood of registering to become an organ donor, increasing risk perception, both before and during the pandemic, was associated with greater likelihood of registering, but greater risk-taking propensity was associated with a decreased likelihood of organ donation registration. For flu vaccination, a greater propensity to take risks was associated with a greater likelihood of flu vaccination during the 2020–2021 flu season. Both cognitive and personality factors can predict involvement in risk-taking and health-promotion behaviors, warranting their continued examination. (shrink)

We study model theory of actions of finite groups on substructures of a stable structure. We give an abstract description of existentially closed actions as above in terms of invariants and PAC structures. We show that if the corresponding PAC property is first order, then the theory of such actions has a model companion. Then, we analyze some particular theories of interest (mostly various theories of fields of positive characteristic) and show that in all the cases considered the PAC property (...) is first order. (shrink)

The transcendental aesthetic -- Arithmetic and the categories -- Remarks on pure natural science -- Two studies in the reception of Kant's philosophy of arithmetic: postscript to part I -- Some remarks on Frege's conception of extension -- Postscript to essay 5 -- Frege's correspondence: postscript to essay 6 -- Brentano on judgment and truth -- Husserl and the linguistic turn.