Personalised medicine has been discussed as a medical paradigm shift that will improve health while reducing inefficiency and waste. At the same time, it raises new practical, regulatory, and ethical challenges. In this paper, we examine PM strategies epistemologically in order to develop capacities to address these challenges, focusing on a recently proposed strategy for developing patient-specific models from induced pluripotent stem cells so as to make individualised treatment predictions. We compare this strategy to two main PM strategies—stratified medicine and (...) computational models. Drawing on epistemological work in the philosophy of medicine, we explain why these two methods, while powerful, are neither truly personalised nor, epistemologically speaking, novel strategies. Both are forms of correlational black box. We then argue that the iPSC models would count as a new kind of black box. They would not rely entirely on mechanistic knowledge, and they would utilise correlational evidence in a different way from other strategies—a way that would enable personalised predictions. In arguing that the iPSC models would present a novel method of gaining evidence for clinical practice, we provide an epistemic analysis that can help to inform the practical, regulatory, and ethical challenges of developing an iPSC system. (shrink)

Everyone knows what is feels like to be in pain. Scraped knees, toothaches, migraines, giving birth, cancer, heart attacks, and heartaches: pain permeates our entire lives. We also witness other people - loved ones - suffering, and we 'feel with' them. It is easy to assume this is the end of the story: 'pain-is-pain-is-pain', and that is all there is to say. But it is not. In fact, the way in which people respond to what they describe as 'painful' has (...) changed considerably over time. In the eighteenth and nineteenth centuries, for example, people believed that pain served a specific (and positive) function - it was a message from God or Nature; it would perfect the spirit. 'Suffer in this life and you wouldn't suffer in the next one'. Submission to pain was required. Nothing could be more removed from twentieth and twenty-first century understandings, where pain is regarded as an unremitting evil to be 'fought'. Focusing on the English-speaking world, this book tells the story of pain since the eighteenth century, addressing fundamental questions about the experience and nature of suffering over the last three centuries. How have those in pain interpreted their suffering - and how have these interpretations changed over time? How have people learnt to conduct themselves when suffering? How do friends and family react? And what about medical professionals: should they immerse themselves in the suffering person or is the best response a kind of professional detachment? (shrink)

Haneke’s film Funny Games is a reflection on the nature of pain and representation. I argue that the film closely follows Elaine Scarry’s arguments about the structure of torture. Further, by refusing to appeal to categories of generalization such as ‘sadism’ and ‘psychopathy’, Haneke undermines the process of finding meaning in violence. Haneke positions his audiences as more than just witnesses to torture, but active participants in cruelty.

Who was truly capable of experiencing pain? In this article, I explore ideas about the distribution of bodily sensitivity in patients from the early nineteenth century to 1965 in Anglo-American societies. While certain patients were regarded as “truly hurting,” other patients’ distress could be disparaged or not even registered as being “real pain.” Such judgments had major effects on regimes of pain-alleviation. Indeed, it took until the late twentieth century for the routine underestimation of the sufferings of certain groups of (...) people to be deemed scandalous. Often the categorizations were contradictory. For instance, the humble status of workers and immigrants meant that they were said to be insensitive to noxious stimuli; the profound inferiority of these same patients meant that they were especially likely to respond with “exaggerated” sensitivity. How did physicians hold such positions simultaneously? Pain-assignation claimed to be based on natural hierarchical schemas, but the great Chain of Feeling was more fluid than it seemed. (shrink)

There are two main questions which it is possible to ask about war. The first is, whether it is inevitable; the second, whether it is desirable. The former question is one of fact, the latter one of value. In the discussions of ordinary conversation the two are frequently-confused and obscured; arguments to prove war desirable may be heard based upon the supposed fact of its inevitability, and conversely. It is worth while considering how the two are related.

There are two main questions which it is possible to ask about war. The first is, whether it is inevitable; the second, whether it is desirable. The former question is one of fact, the latter one of value. In the discussions of ordinary conversation the two are frequently-confused and obscured; arguments to prove war desirable may be heard based upon the supposed fact of its inevitability, and conversely. It is worth while considering how the two are related.

From the earliest human cultures, nonhuman animals have been central to the sexual imaginary of humans. This article traces the modern history of bestiality from the nineteenth century, culminating...

Psychological trauma is a favoured trope of modernity. It has become commonplace to assume that all ‘bad events’ – and particularly those which involve violence – have a pathological effect on the sufferer’s psyche, as well as that of the perpetrators. This essay explores the ways victims of rape and sexual assault were understood in psychiatric, psychological, forensic, and legal texts in Britain and America from the 19th to the late 20th century. It argues that, unlike most other ‘bad events’, (...) which were incorporated within trauma narratives from the 1860s, the ascription of psychological trauma was only applied to rape victims a century later. Why and what were the consequences? (shrink)

The brutalities of the past century have taken place in the milieu of Enlightenment values. At present, even the ideals of human rights have been used to (at the very least) tolerate and (and at its worst) justify barbaric acts, such as torture. This article interrogates the diverse ways British, American, and Australian individuals engaged in extremes of violence during three major conflicts of the 20th century. Like servicemen and servicewomen today, these combatants struggled to find a language capable of (...) making sense of their violent deeds. Constraining their excesses of violence proved a formidable task. In particular, I examine the ways in which sexual violence was normalized. Finally, on returning home after the war, these individuals and civilian society more broadly struggled with the problem of ‘remembering’ wartime violence in the post-war world. The act of ‘framing’ extremes of violence was integral to the process of enabling perpetrators of violence to assimilate his or her acts into a peacetime self. (shrink)

There may in general be said to be two ways in which progress may be made in the understanding and towards the solution of a problem. The one is that of the continual development of it in the form originally given to it, by confirming this and rejecting that point in the light of fresh evidence, by clarification of concepts, and by detecting and resolving ambiguities and inconsistencies. Here it is assumed that the standpoint from which the problem has been (...) approached is relevant and adequate. The other is entered upon when an “impasse” has been reached which can only be avoided by the realization that the original question was asked in a way which was either partially or wholly false or misleading. This is the more radical way of partial or total reformulation of the problem to be solved. (shrink)

Incentivising has shown to improve participation in clinical trials. However, ethical concerns suggest that incentives may be coercive, obscure trial risks and encourage individuals to enrol in cli...