Unrealistic therapeutic beliefs are very common—the majority of patient-subjects enrol in phase 1 trials seeking and expecting significant medical benefit, even though the likelihood of such benefit has historically proven very low. The high prevalence of therapeutic misestimation and unrealistic optimism in particular has stimulated debate about whether unrealistic therapeutic beliefs in early-phase clinical trials preclude adequate informed consent. We seek here to help resolve this controversy by showing that a crucial determination of when such therapeutic beliefs are ethically problematic (...) turns on whether they are causally linked and instrumental to the motivation to participate in the trial. Thus, in practice, it is ethically incumbent on researchers to determine which understanding and beliefs lead to the participant’s primary motivation for enrolling, not to simply assess understanding, beliefs and motivations independently. We further contend that assessing patient-subjects’ appreciation as a component of informed consent—it is already an established component of decision-making capacity assessments—can help elucidate the link between understanding-beliefs and motivation; appreciation refers to an individual’s understanding of the personal significance of both the medical facts and the experience of trial participation. Therefore, we recommend that: in addition to the usual question, ‘Why do you want to participate in this trial?’, all potential participants should be asked the question: ‘What are you giving up by participating in this trial?’ and researchers should consider the settings in which it may be possible and practical to obtain ‘two-point consent’. (shrink)

Volume 20, Issue 8, August 2020, Page 1-4.

ABSTRACT This article describes the digital critical edition of the works and letters of Nietzsche published by Nietzsche Source compared with the different versions of the Colli/Montinari critical edition.

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

Conciliatory views on disagreement claim that one should “split the difference” between the epistemic peers’ opinions. Nevertheless, when they apply to the disagreement on conciliatory positions themselves, they give incoherent instructions. A semi-conciliatory position is one that accepts that the peers’ opinions are part of the whole body of evidence relevant in these situations. If one adopts this kind of view, all cases that seems to favor conciliatory views can be explained, and without compromising with the anti–intuitive consequences conciliatory positions (...) have. In particular, a semi-conciliatory view is not condemned to give incoherent instructions when applied to disagreement about it. (shrink)

The paper aims at detecting and evaluating Deleuze’s symptomatological and minoritarian concepts at work within his transcendental theory. By using these two philosophical items, the paper refers to the Nietzschean posture Deleuze develops within the transcendental field and to the N-1 formula that accompanies his conceptual path. In this vein, the essay retakes the issue highlighted by Rametta in his essay «The Transcendental and its Metamorphoses in Modern Thinking». In particular, if Rametta insists on Deleuze’s reading of Kant as a (...) kind of deconstruction of the relationships between philosophical concepts and the primacy of Representation, but also on the freeing of multiplicities that such a deconstruction allows, the present essay proposes three minoritarian paths that Deleuze takes from the history of philosophy and lead to transcendental empiricism. The first path is focused on “experience”, the second on “forces and violence”, while the third on “events and concepts”. (shrink)