In this paper I draw on the French philosopher Michel Foucault for a viewpoint on aspects of EBM. This means that I develop his idea of the spaces occupied by disease. I give much of the paper to only one of these spaces, the space of perception of disease, in order to major on the medical gaze, one of Foucault’s best-known contributions to the philosophy of medicine. As I explain what I mean by each of the spaces of disease, I (...) configure EBM into this space. The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Evidence-based clinical practice requires integration of individual clinical expertise and patient preferences with the best available external clinical evidence from systematic research and consideration of available resources. EBM can be considered a subcategory of evidence-based healthcare, which also includes other branches of health-care practice such as evidence-based nursing or evidence-based physiotherapy. EBM subcategories include evidence-based surgery and evidence-based cardiology (Guyatt et al. 2008 , 783). (shrink)

This book examines from different perspectives the moral significance of non-human members of the biotic community and their omission from climate ethics literature. The complexity of life in an age of rapid climate change demands the development of moral frameworks that recognize and respect the dignity and agency of both human and non-human organisms. Despite decades of careful work in non-anthropocentric approaches to environmental ethics, recent anthologies on climate ethics have largely omitted non-anthropocentric approaches. This multidisciplinary volume of international scholars (...) tackles this lacuna by presenting novel work on non-anthropocentric approaches to climate ethics. Written in an accessible style, the text incorporates sentiocentric, biocentric, and ecocentric perspectives on climate change. With diverse perspectives from both leading and emerging scholars of environmental ethics, geography, religious studies, conservation ecology, and environmental studies, this book will offer a valuable reading for students and scholars of these fields. (shrink)

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 717 the work of Arthur Danto. Here the stimulus to reflection is those elements in modern art which " make a farce of traditional art and art theories hy giving us artworks indiscernible from objects found on grocery shelves or in lavatories." If, as Danto suggests, whatever is to count as art is simply what an " artworld " decrees, then the distinction between artefact and artwork (...) can disappear completely (except in terms of somebody's bank balance). The trouble with the remaining essays in this collection is that their authors have not appropriated a truth given lapidary expression in Woods' essay on Kant: "Attention to the works of genius throughout the ages cultivates the sensus communis and establishes a community involved in the beautiful." Thus, while Ted Cohen is right to consider television a possible artistic medium, the objects of televisual appreciation he considers usually witness to a breakdown of a community involved in the beautiful, while the frequently nugatory objects discussed in John Brough's "Who's Afraid of Marcel Duchamp? " testify to the disintegration of the sensus communis concerned. Finally, if Paul Weiss is right in his "Creativity and Beauty" not only to designate beauty " the excellence pertinent to the creation of a work of art," but also to house it together with the quartet of truth, goodness, glory, and justice, then we can get a sense of how wisdom in both philosophy and artistic practice might he restored: through a re· discovery of the interdependence of the transcendentals. But perhaps only the Judaeo-Christian revelation now holds the key to this possibility. AIDAN NICHOLS, O.P. Blackfriars Cambridge, England Through the Tempest: Theological Voyages in a Pluralistic Culture. By LANGDON GILKEY. Ed. Jeff B. Pool. Minneapolis: Fortress Press, 1991. Pp. xx + 252. Langdon Gilkey: Theologian for a Culture in Decline. By BRIAN J. WALSH. Lanham, MD: University Press of America/Institute for Christian Studies, 1991. Pp. xii + 324. $47.50 (cloth); $22.50 (paper). With the exception of two mid-1970s papers, Through the Tempest is a collection of some of the addresses and essays written in the 1980s hy Langdon Gilkey, Shailer Mathews Professor Emeritus at the University of Chicago Divinity School. Title and subtitle are meant to re· 718 BOOK REVIEWS fleet three elements of Gilkey's temper. First, the tempest corresponds to his dramatic vision of the twentieth-century world, with its wars, up· heavals, and destructive forces. Second, the preposition through expresses the sober hope that for all the darkness that surrounds our century, we are actually moving toward a destination beyond the turmoil. And third, his explorations and assessments of the many facets of contemporary culture are theological voyages. In these pages readers will find many of the themes Gilkey has tackled over the years, such as God, Jesus, Creation, Providence, spirituality, the function of symbols, ethics, suffering and death, Christianity and other religions, faith and science, church and public policy. Among the most original pieces are, to my mind, Ch. 10, on the different attitudes to ethics in Christianity and Buddhism, and Ch. 14, which clarifies many aspects of suffering. The general readership made up of those interested in religion will probably enjoy these lectures, while specialists in theology or human studies are likely to find them merely impressionistic and too vague both in their cultural analyses and in their conceptual discussions. Further, there is a discrepancy between Gilkey's assessment of the human predicament and :the theological solutions he puts forward. On the one hand, the mood and the content of his assessment is neo· orthodox (inspired by his master Reinhold Niebuhr). For instance, chapters 11 and 13, on evil and sin, are typical of an acute awareness of the dark side of human conduct. As he follows this vein, Gilkey raises pertinent, profound, and difficult questions. On :the other hand, his prescriptions do not match the depth of his diagnoses. Despite his efforts at overcoming theological liberalism, he often remains confined within the limits of the Western Enlightenment. For example, like most eighteenth-century thinkers, he rejects "a level of grace beyond nature " (54). What he repudiates is in all likeliness the modern separation between nature and supernature, and... (shrink)

In _The Later Middle Ages,_ the third volume of his monumental _History of Political Ideas,_ Eric Voegelin continues his exploration of one of the most crucial periods in the history of political thought. Illuminating the great figures of the high Middle Ages, Voegelin traces the historical momentum of our modern world in the core evocative symbols that constituted medieval civilization. These symbols revolved around the enduring aspiration for the _sacrum imperium,_ the one order capable of embracing the transcendent and immanent, (...) the ecclesiastical and political, the divine and human. The story of the later Middle Ages is that of the "civilizational schism"—the movement in which not only the reality but the aspiration for the _sacrum imperium_ gradually disappeared and the unification of faith and reason dissolved. His recognition of this civilizational schism provides Voegelin with a unique perspective on medieval society. William of Ockham, Dante, Giles of Rome, and Marsilius of Padua all emerge in Voegelin's study as predecessors to modern thought; each turns to personal authority and intellectual analysis in an attempt to comprehend the loss of the _sacrum imperium_ as an authoritative ideal. Voegelin is further drawn into investigations that, despite insufficient attention by scholars, still bear relevance to the study of the later Middle Ages. The mysticism apparent in _Piers Plowman_ and the apocalyptic revolt of Cola di Rienzo are merely two reactions to the disintegration of wholeness. Yet the story of the later Middle Ages does not merely revolve around disintegration. Voegelin recognizes the emergence of the constitutional political tradition as the most positive development of this period. He is at his best when explaining the difference between the presence of a representative institution and the growth of communal consciousness. Voegelin's study of the English political pattern is matched only by his unique perspective on the German imperial zone, culminating in a fitting conclusion on Nicholas of Cusa—the one political thinker with the ability to evoke the unity of mankind beyond fragmentation. _The Later Middle Ages_ is at once a brilliant examination of the symbols that characterized medieval society and a remarkable predecessor to Voegelin's study of the modern world, beginning with the Renaissance and the Reformation. (shrink)

In “The Impossibility of Pure Libertarianism” Braham and van Hees prove that four conditions on rights—completeness, conclusiveness, non-imposition, and symmetry—cannot be satisfied simultaneously. If Braham and van Hees’s proof is to have any relevance, at least some prominent libertarians must endorse their four conditions, and libertarianism as a philosophical position must in some way be committed to all the axioms. In this paper we demonstrate the irrelevance of Braham and van Hees’s proof by showing that some of the most prominent (...) libertarians do not endorse the completeness and conclusive conditions, and that there is nothing about libertarianism as a philosophical position that commits the libertarian to these two axioms. Indeed, we show that, more generally, there are strong reasons for libertarians to reject both conditions. As such, libertarians should not lose any sleep over Braham and van Hees’s proof. (shrink)

Significant contributions to debates in the philosophy of evidence-based medicine (EBM) have come from a variety of different philosophical quarters, yet mainstream discourse in the field has been largely devoid of contributions from scholars working in the pragmatist tradition. This is a particularly conspicuous omission, given pragmatism’s commitment to the melioristic view that philosophy both can, and should, be about the business of concretely bettering the human estate. Two exceptions to this oversight come from Brian Walsh and Maya (...) Goldenberg. Unfortunately, in both cases, the misapplication of pragmatist thinking leads to the mistaken view that EBM is committed to some form of pernicious objectivism. This article aims to revise these pragmatist critiques in order to bring them more consistently in line with pragmatist values and commitments. Doing so shows that EBM is defensible on pragmatist grounds against objectivist attacks. (shrink)

This text represents an exploration of the possible significance of Bernard S. Cohn's 1980 essay, `History and Anthropology: The State of Play', for understanding the present of historical anthropology and its futures. My discussion has two aims: (1) to reflect on both Bernard S. Cohn's pedagogy and mode of inquiry; and (2) to explore the complexity and nuance of citationality as a generative principle within the constitution of historical anthropology's subject. Toward this, I examine Cohn's notion of `the colonial situation' (...) and reflect on how the emergence of the human sciences is intertwined with the proliferation of colonialism's enduring legacy within postcoloniality. (shrink)

H.L.A. Hart described his classic book, The Concept of Law, as a work in «descriptive sociology», and his aspiration was to produce a general jurisprudence. He was less than successful in achieving both of these aims. This article attempts a comprehensive reconstruction of legal positivism in a manner that will render it more compatible with a sociological approach, and more amenable to the project of general jurisprudence. The label «socio-legal positivism» reflects the fact that this article grafts the insights and (...) orientation of socio-legal theory onto the core tenets of legal positivism. In the course of this reconstruction, certain traditional views of legal positivists, especially those regarding the function of law and the nature of the concept of law, are discarded or modified. A number of Hart's key insights are preserved, but resituated within a broader framework. And the relationship between legal positivism and natural law is altered dramatically. The result of this reconstruction is the foundation for the construction of a general jurisprudence that better fits the complex and variable situation of law in society today. (shrink)

ABSTRACTThe idea of public reason requires that citizens in their public deliberation employ considerations stemming from a shared conception of justice. One worry is that public reason's content will be incomplete, in that it does not contain sufficient material for adequate public debate. Rawls has a way of expanding the content of public reason to address such concerns—by including in public reason all those things you and I say in our justification of the conception of justice. After arguing that this (...) strategy fails, a new way of expanding public reason's content is proposed. Instead of understanding the Supreme Court—which Rawls famously calls the “exemplar” of public reason—as an institution that appeals to exogenously determined public reasons, we should understand the judicial authority in a liberal democratic society as an endogenous fountain of public reason. (shrink)

Negotiations are central to the operation of the international system, found at the heart of every conflict and every act of cooperation. Negotiation is the primary vehicle that states use to manage conflict and build prosperity in a complicated and dangerous international system. International Relations as Negotiation provides an overview of world politics that is both approachable and detailed. It explores the factors that help or undermine efforts to negotiate solutions to international problems. Key topics including international conflict and security, (...) the global economy, international law and governance, and environmental sustainability are explored in turn. The history of the international system is traced through major treaty agreements and peace conferences, and the future of the international system is projected. The result is a survey of world politics that provides a seamless narrative about conflict and cooperation in the international system. (shrink)

φτρασ θῄβησ νοικοι, λεσσετ', οíδíπονσ δε σ τ κλεíν' αíνíγματ' δει και κρτιστοσ ν νρ, ο τíσ ο ζλ πολιτν τασ τχαισ πβλεπεν, εíσ ντ' κεíνην τν τελενταíαν íσεíν μραν πισκοποντα μνδν' λβíζεη, πρíν ν τρμα το βíον περσ μηδν λγεινóν παθν.

Badcock, and Nesse and Lloyd, have argued that there are important points of agreement between Freud's theory of the mind and a theory of mind suggested by adaptive reasoning. Buller, on the other hand, draws attention to the need to avoid confusing an adaptive rationale with an unconscious motivation. The present paper attempts to indicate what role adaptive reasoning might have to play in justifying psychoanalytic claims. First, it is argued that psychoanalytic claims cannot be justified by the clinical experience (...) of psychoanalysts alone. It is urged that, to avoid interpretative proliferation, it is necessary to base interpretation on some theory which is external to psychoanalysis. Next, Buller's reservations about using adaptive reasoning to justify claims about a personal unconscious, are summarized. Then an argument for the existence of a personal unconscious, is offered, based on experimental evidence from Gur and Sackeim. Then it is argued that adaptive reasoning, though it cannot itself provide evidence for the existence of any psychological mechanism, can valuably guide the search for such evidence. It is argued that such an approach has borne fruit, both in biology generally and specifically in psychology. Finally, it is argued that psychoanalysis is important enough to justify such a research project. (shrink)