Discussions about the merits and shortcomings of non-inferiority trials are becoming increasingly common in the medical community and among regulatory agencies. However, criticisms targeting the ethical standing of non-inferiority trials have often been mistargeted. In this article we review the ethical standing of trials of non-inferiority. In the first part of the article, we outline a consequentialist position according to which clinical trials are best conceived as epistemic tools aimed at fostering the proper ends of medicine. According to this view, (...) clinical trials are means to ends, and thus their moral status depends both on how well they perform as means to reach desired ends and on which ends they are meant to achieve. Building upon this normative framework in the next two sections we analyze the specific ethical issues raised by non-inferiority trials. By making it clear that clinical trials are just epistemic tools – i.e. means to certain ends – it is possible not only to clarify the conceptual debate over a fundamental issue in clinical research, but also to identify which ethically relevant considerations ought to be addressed in setting up a non-inferiority trial. (shrink)

Shamans, healers, and doctors have always known that patients may improve even if no real therapy is administered. In the Charmides, Plato noted that to soothe a headache, one needed "a kind of leaf, which required to be accompanied by a charm, and if a person would repeat the charm at the same time he used the cure, he would be made whole; but that without the charm would be of no avail". Similarly, more than two millennia later, Thomas Jefferson (...) observed, "One of the most successful physicians I have even known has assured me that he used more bread pills, drops of colored water, and powder of hickory ashes, than of all other medication put together"; Jefferson famously labeled this... (shrink)

In this article, Charlotte Blease argues that patient access to online shared clinical notes (also called ‘open notes’) may cause or exacerbate nocebo effects in two ways. 1 First, open notes may enhance patient understanding about the adverse effects of medications and treatments. However, reading information about adverse effects may lead patients to form negative expectations that, in turn, may cause or worsen symptoms via nocebo mechanisms. Second, open notes may paradoxically lower the quality of the therapeutic relationship by allowing (...) patients to detect signs of discrimination and stigma in clinical notes. By accessing their shared notes, patients may identify (or think that they are identifying) signs of stigmatisation and discrimination in clinicians’ words. This may diminish their trust while increasing their anxieties and fears, all factors that have been associated with enhanced nocebo effects. The article then suggests different strategies to mitigate nocebo effects while using open... (shrink)

Doctor–patient communication is a crucial component in any therapeutic encounter. Physicians use words to formulate diagnoses and prognoses, to disclose the risks and benefits of medical interventions, and to explain why, how, and when a therapy will be administered to a patient. Likewise, patients communicate to describe their symptoms, to make sense of their conditions, to report side effects, to explore other therapeutic options, and to share their feelings. Throughout the history of medicine, the ethics of the doctor–patient communication has (...) been traditionally grounded on considerations of paternalistic beneficence and nonmaleficence. In this respect, it was no different from the ethics regulating.. (shrink)

The genealogy of lexicography represents an ideal standpoint to reveal how sign-making practices may shape cultural objects. In this paper I discuss the revolution that lexicography undertook during the nineteenth century, showing why this process required the availability of a specific set of concepts, and then how it led up to the emergence of new social techniques, to the coming into being of a new kind of people, and to the introduction of new practices of sign-manipulation. Finally, I confront the (...) historical development of lexicography with the project of the dictionary of Newspeak that Orwell envisioned in 1984. (shrink)

In the field of placebo studies residual disagreement about the terminology ‘placebo’ and ‘placebo effect’ still persists. We differentiate between the conceptualization of placebos in clinical trials; and placebo effects understood as a psychobiological phenomenon. With respect to the latter, we argue that a scientific ‘placebo paradigm’ has emerged, indicating that—at least among placebo scientists—there exists relatively stable consensus about how to conceive of placebo effects. We claim that existence of a placebo paradigm does not protect concepts from revision; nonetheless, (...) we argue that scientific progress is dependent on, and guided by relative conceptual stability. Therefore, to mount persuasive arguments for conceptual revision in respect of ‘placebo effects’ we argue, critics either need to defend the claim that a placebo paradigm is not underway, or that there are major scientific failings in respect of it. With these considerations in mind we examine three alternative proposals for conceptual reform: Grünbaum/Howick’s relativity models of placebo concepts; Moerman/Brody’s meaning response; and Nunn/Turner’s proposal for conceptual eliminativism. We derive two conclusions from this evaluation. First, we conclude that no convincing arguments have so far been presented for conceptual overhaul of ‘placebo effects.’ Notwithstanding this analysis, we conclude that refinement of this concept is likely. Second, we agree with Turner and Nunn that the term ‘placebo’ in the context of randomized controlled trials remains a source of confusion for many researchers, risking the design and scientific integrity of clinical findings. Therefore, in these contexts, replacing the term ‘placebo’ with ‘control’ is justified. (shrink)

Over 200 years ago, doctors' most effective tools were typically not found in their medical bags. Indeed, most treatments in the history of medicine have, until relatively recently, caused more harm than good. Prior to the biomedical revolution in the late 19th century, doctors' most reliable and effective instruments of healing were their skills of communication with patients and an aptitude for a positive and supportive bedside manner. Bearing out this portrait of medicine, Thomas Jefferson, writing in 1807, noted that (...) "one of the most successful physicians I have ever known has assured me that he used more bread pills, drops of colored water, and powers of hickory ashes, than of all other medicines put together"... (shrink)

The American Journal of Bioethics, Volume 12, Issue 9, Page 55-57, September 2012.

We prove that the category of Nachbin’s compact ordered spaces and order-preserving continuous maps between them is dually equivalent to a variety of algebras, with operations of at most countable arity. Furthermore, we observe that the countable bound on the arity is the best possible: the category of compact ordered spaces is not dually equivalent to any variety of finitary algebras. Indeed, the following stronger results hold: the category of compact ordered spaces is not dually equivalent to any finitely accessible (...) category, any first-order definable class of structures, and any class of finitary algebras closed under products and subalgebras. An explicit equational axiomatisation of the dual of the category of compact ordered spaces is obtained; in fact, we provide a finite one, meaning that our description uses only finitely many function symbols and finitely many equational axioms. In preparation for the latter result, we establish a generalisation of a celebrated theorem by Mundici: our result—whose proof is independent of Mundici’s theorem—asserts that the category of unital commutative distributive lattice-ordered monoids is equivalent to the category of what we call MV-monoidal algebras.Abstract taken directly from the thesis.E-mail: marco[email protected]: https://air.unimi.it/retrieve/handle/2434/812809/1698986/phd_unimi_R11882.pdf. (shrink)

Why are mistaken beliefs about Covid-19 so prevalent? Political identity, education and other demographic variables explain only a part of individual differences in the susceptibility to Covid-19 misinformation. This paper focuses on another explanation: epistemic vice. Epistemic vices are character traits that interfere with acquiring, maintaining, and transmitting knowledge. If the basic assumption of vice epistemology is right, then people with epistemic vices such as indifference to the truth or rigidity in their belief structures will tend to be more susceptible (...) to believing Covid-19 misinformation. We carried out an observational study (US sample, n = 998) in which we measured the level of epistemic vice of participants using a novel Epistemic Vice Scale. We also asked participants questions eliciting the extent to which they subscribe to myths and misinformation about Covid-19. We find overwhelming evidence to the effect that epistemic vice is associated with susceptibility to Covid-19 misinformation. In fact, the association turns out to be stronger than with political identity, educational attainment, scores on the Cognitive Reflection Test, personality, dogmatism, and need for closure. We conclude that this offers evidence in favor of the empirical presuppositions of vice epistemology. (shrink)

According to the extended cognition thesis, an agent’s cognitive system can sometimes include extracerebral components amongst its physical constituents. Here, we show that such a view of cognition has an unjustifiably anthropocentric focus, for it tends to depict cognitive extensions as a human-only affair. In contrast, we will argue that if human cognition extends, then the cognition of many non-human animals extends too, for many non-human animals rely on the same cognition-extending strategies humans rely on. To substantiate this claim, we (...) will proceed as follows. First (Sect. 1), we will introduce the extended cognition thesis, exposing its anthropocentric bias. Then, we will show that humans and many non-human animals rely on the same cognition-extending strategies. To do so, we will discuss a variety of case studies, including “intrabodily” cognitive extensions such as the spinal cord (Sect. 2), the widespread reliance on epistemic actions to solve cognitive tasks (Sect. 3) and cases of animal cognitive offloading (Sect. 4). We’ll then allay some worries our claim might raise (Sect. 5) to then conclude the paper (Sect. 6). (shrink)

In this article, I address a controversial aspect of Rawls’s treatment of the question of justice between generations: how the parties in the original position could be motivated to select Rawls’s preferred principle of intergenerational savings, which he dubs the just savings principle. I focus on the explanation found in his later work, where he proposes that the correct savings principle is the principle that any generation would have wanted preceding generations to have followed. By expanding upon this explanation, I (...) respond to the objection that this explanation disregards the perspective of the first generation. I demonstrate that this objection ceases to be a concern when a proper account of the parties’ reasoning is developed. What is notable about the explanation I defend is that it relies on the parties adopting maximax – not maximin – as a rule for rational decision making. Having established this intermediary conclusion, I depart with Rawls and consider what savings principle the parties would choose if given more options. Ultimately, I argue that the parties would select a principle that Rawls would have undoubtedly rejected if presented to him at face value. This is because the principle of savings I argue would be selected requires continual economic growth over generations to increase upwards indefinitely – a conclusion Rawls is explicitly trying to avoid in his theory of justice. (shrink)

In his 1920 monograph Relativitätstheorie und Erkenntnis apriori the young Reichenbach distinguished between two meanings of the a priori: ‚apodictically valid, true for all time‘ and ‚constituting the concept of object‘. At the end of the 1990s Michael Friedman drew again the attention of philosophers of science to this forgotten distinction. In the spirit of Reichenbach’s early Kantianism Friedman attempted to construct a relativized or temporally variable a priori, which is nevertheless constitutive of the object of knowledge. Friedman rejects an (...) alternative historicized version of the a priori elaborated by the Marburg school and in particular by Cassirer. According to Friedman, Cassirer defended a regulative, but absolute version of the a priori, the existence of a yet-to-be-found set of final principles that are conditions of all scientific experience. This paper suggests that using the constitutive/regulative distinction as a basis for comparison is misleading. In order to understand the Marburg school’s conception of the a priori one should get back to Hermann Cohen’s interpretation of Kant and in particular to his own distinction between two meanings of the a priori. A more suitable comparison is that between Cohen’s opposition metaphysical-vs.-transcendental a priori and Reichenbach’s distinction apodictic-vs.-constitutive a priori. If the comparison is conducted along these lines—as already suggested in the mid-1920 s by the Dutch neo-Kantian Alfred C. Elsbach—it turns out that Cohen and the Marburg school and not Reichenbach provided a good example of a relativized a priori. (shrink)

This book fills a major gap in the ever-increasing secondary literature on Hannah Arendt's political thought by providing a dedicated and coherent treatment of the many, various and interesting things which Arendt had to say about law. Often obscured by more pressing or more controversial aspects of her work, Arendt nonetheless had interesting insights into Greek and Roman concepts of law, human rights, constitutional design, legislation, sovereignty, international tribunals, judicial review and much more. This book retrieves these aspects of her (...) legal philosophy for the attention of both Arendt scholars and lawyers alike. The book brings together lawyers as well as Arendt scholars drawn from a range of disciplines (philosophy, political science, international relations), who have engaged in an internal debate the dynamism of which is captured in print. Following the editors' introduction, the book is split into four Parts: Part I explores the concept of law in Arendt's thought; Part II explores legal aspects of Arendt's constitutional thought: first locating Arendt in the wider tradition of republican constitutionalism, before turning attention to the role of courts and the role of parliament in her constitutional design. In Part III Arendt's thought on international law is explored from a variety of perspectives, covering international institutions and international criminal law, as well as the theoretical foundations of international law. Part IV debates the foundations, content and meaning of Arendt's famous and influential claim that the 'right to have rights' is the one true human right. (shrink)

O ficcionalismo, geralmente classificado como um tipo de nominalismo, apresenta como perspectiva precípua a tese de que os entes matemáticos são ficções. Para o ficcionalista, o discurso matemático é desprovido de conteúdo. Hartry Field, que é o principal defensor dessa concepção ontológica da matemática, contesta, em Science Without Numbers, a utilização de entes matemáticos na redação de teorias da física, alegando que a defesa mais plausível do realismo ontológico matemático é o argumento da indispensabilidade de Quine-Putnam. O ficcionalismo defendido por (...) Field nos permite, de acordo com Shapiro, classificá-lo no grupo filosofia-primeiro, ou seja, entre os filósofos que defendem que a filosofia deve ser responsável por legislar a respeito da prática matemática. Dessa forma, podemos considerar Field um revisionista epistemológico. Como se sabe, a dependência da ciência moderna em relação ao discurso matemático coloca a tese ficcionalista em xeque. Ainda assim, se partirmos dos pressupostos filosóficos da vertente formalista da filosofia da matemática, que concebe a matemática como constituída de um conjunto de regras sem significado que podem ser manipuladas de maneira puramente sintática, poderemos traçar importantes analogias entre matemática e ficção, tal como também entre metamatemática e metaficção. Para um formalista simpático à tese ficcionalista, o estatuto ontológico da matemática é semelhante ao das regras de um jogo de xadrez. (shrink)

A view that emancipates free will by means of quantum indeterminism is frequently rejected based on arguments pointing out its incompatibility with what we know about quantum physics. However, if one carefully examines what classical physical causal determinism and quantum indeterminism are according to physics, it becomes clear what they really imply–and, especially, what they do not imply–for agent-causation theories. Here, we will make necessary conceptual clarifications on some aspects of physical determinism and indeterminism, review some of the major objections (...) against libertarian conjectures, and show that there is no conceptual incompatibility preventing us from taking a ‘quantum-libertarian’ approach to the problem of free will. In particular, we will illustrate the possible role of self-causation (causa sui) as a potential solution to otherwise apparently incompatible or even paradoxical statements concerning free will and quantum indeterminism. (shrink)

Traz depoimentos dirigidos de filósofos brasileiros sobre temas clássicos e contemporâneos da filosofia, processos de formação intelectual e a vida cultural brasileira. Ao final, apresenta breve biografia do depoente e lista das suas principais publicações.

This article gives a practice-based overview of the implementation aspects of Corporate Responsibility. After discussing the success factors for implementing Corporate Responsibility, the article describes a model for implementing Corporate Responsibility. Special attention is given to the success factors in the subsequent phases of implementation (sensitivity to the organizational environment, awareness of core values and clear leadership), to ensure that the most optimal results attainable for the organization can be reached. The implementation-model is clarified by looking at experiences in implementing (...) Corporate Responsibility at Chiquita. (shrink)

This article gives a practice-based overview of the implementation aspects of Corporate Responsibility. After discussing the success factors for implementing Corporate Responsibility, the article describes a model for implementing Corporate Responsibility. Special attention is given to the success factors in the subsequent phases of implementation (sensitivity to the organizational environment, awareness of core values and clear leadership), to ensure that the most optimal results attainable for the organization can be reached. The implementation-model is clarified by looking at experiences in implementing (...) Corporate Responsibility at Chiquita. (shrink)

The classification of medical interventions as either invasive or non-invasive is commonly regarded to be morally important. On the most commonly endorsed account of invasiveness, a medical intervention is invasive if and only if it involves either breaking the skin (‘incision’) or inserting an object into the body (‘insertion’). Building on recent discussions of the concept of invasiveness, we show that this standard account fails to capture three aspects of existing usage of the concept of invasiveness in relation to medical (...) interventions—namely, (1) usage implying that invasiveness comes in degrees, (2) that the invasiveness of an intervention can depend on the characteristics of the salient alternative interventions, and (3) that medical interventions can be invasive in non-physical ways. We then offer the beginnings of a revised account that, we argue, is able to capture a wider range of existing usage. Central to our account is a distinction between two properties: basic invasiveness and threshold invasiveness. We end by assessing what the standard account gets right, and what more needs to be done to complete our schematic account. (shrink)

An exploration of panpsychism in Harman's Object-Oriented Ontology.

Nel suo pionieristico lavoro Conditions in Königsberg and the Making of Kant's Philosophy, Giorgio Tonelli lamentava l'assenza di un'indagine approfondita sul contesto intellettuale di Königsberg e sull'eventuale influenza che esso esercitò su alcuni aspetti del pensiero di Kant. Questo libro vuole colmare questa lacuna prestando particolare attenzione alla tradizione aristotelica, alla Schulphilosophie, e alla corrente dell'eclettismo, che dominarono l'ambiente regiomontano sino all'avvento della filosofia critica kantiana. Il lavoro mostra come dai fallimenti dei progetti logici e metafisici precritici, legati alle influenze (...) ricevute dall'ambiente di Königsberg, Kant abbia tratto le idee e gli spunti per la stesura della Kritik der reinen Vernunft. (shrink)

In this issue, Marshall et al discuss the importance of capacity and autonomy in the setting of opioid overdose, in Revise and Refuse: Capacity, Autonomy, and Refusal of Care After Opioid Overdose...

Computational models of meaning trained on naturally occurring text successfully model human performance on tasks involving simple similarity measures, but they characterize meaning in terms of undifferentiated bags of words or topical dimensions. This has led some to question their psychological plausibility (Murphy, 2002;Schunn, 1999). We present here a fully automatic method for extracting a structured and comprehensive set of concept descriptions directly from an English part‐of‐speech‐tagged corpus. Concepts are characterized by weighted properties, enriched with concept–property types that approximate classical (...) relations such as hypernymy and function. Our model outperforms comparable algorithms in cognitive tasks pertaining not only to concept‐internal structures (discovering properties of concepts, grouping properties by property type) but also to inter‐concept relations (clustering into superordinates), suggesting the empirical validity of the property‐based approach. (shrink)