The diversity of bone proteoglycan (PG) structure and localisation (pericellular, extracellular in the organic bone matrix) reflects a broad spectrum of biological functions within a unique tissue. PGs play important roles in organizing the bone extracellular matrix, taking part in the structuring of the tissue itself as active regulators of collagen fibrillogenesis. PGs also display selective patterns of reactivity with several constituents including cytokines and growth factors, such as transforming growth factor‐β or osteoprotegerin thereby modulating their bio‐availability and biological activity (...) in the bone tissue. In this review, the complex PG composition in bone will be addressed together with the specific role played by PGs (or their GAGs chains) in bone biology, as regulatory molecules for bone resorption and their involvement in bone tumor development. These roles have been determined after modulation of PG expression or mutations in their corresponding genes, which revealed specific roles for these compounds in bone pathologies (e.g. perlecan or glypican‐3 mutations observed respectively in chondrodysplasia or dysmorphic syndrome). Finally, the potential therapeutic interest of PGs is discussed based on recent data, more particularly on bone tumor‐associated osteolysis as these molecules are involved both in bone resorption and tumor development. BioEssays 29:758–771, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

In this incisive new book one of Britain's most eminent philosophers explores the often overlooked tension between voluntariness and involuntariness in human cognition. He seeks to counter the widespread tendency for analytic epistemology to be dominated by the concept of belief. Is scientific knowledge properly conceived as being embodied, at its best, in a passive feeling of belief or in an active policy of acceptance? Should a jury's verdict declare what its members involuntarily believe or what they voluntarily accept? And (...) should statements and assertions be presumed to express what their authors believe or what they accept? Does such a distinction between belief and acceptance help to resolve the paradoxes of self-deception and akrasia? Must people be taken to believe everything entailed by what they believe, or merely to accept everything entailed by what they accept? Through a systematic examination of these problems, the author sheds new light on issues of crucial importance in contemporary epistemology, philosophy of mind, and cognitive science. (shrink)

The book was planned and written as a single, sustained argument. But earlier versions of a few parts of it have appeared separately. The object of this book is both to establish the existence of the paradoxes, and also to describe a non-Pascalian concept of probability in terms of which one can analyse the structure of forensic proof without giving rise to such typical signs of theoretical misfit. Neither the complementational principle for negation nor the multiplicative principle for conjunction applies (...) to the central core of any forensic proof in the Anglo-American legal system. There are four parts included in this book. Accordingly, these parts have been written in such a way that they may be read in different orders by different kinds of reader. (shrink)

Johnathan Cohen's book provides a lucid and penetrating treatment of the fundamental issues of contemporary analytical philosophy. This field now spans a greater variety of topics and divergence of opinion than fifty years ago, and Cohen's book addresses the presuppositions implicit to it and the patterns of reasoning on which it relies.

Two new philosophical problems surrounding the gradation of certainty began to emerge in the 17th century and are still very much alive today. One is concerned with the evaluation of inductive reasoning, whether in science, jurisprudence, or elsewhere; the other with the interpretation of the mathematical calculus of change. This book, aimed at non-specialists, investigates both problems and the extent to which they are connected. Cohen demonstrates the diversity of logical structures that are available for judgements of probability, and explores (...) the rationale for their appropriateness in different contexts of application. Thus his study deals with the complexity of the underlying philosophical issues without simply cataloging alternative conceptions or espousing a particular "favorite" theory. (shrink)

The clinical ethics literature is striking for the absence of an important genre of scholarship that is common to the literature of clinical medicine: systematic reviews. As a consequence, the field of clinical ethics lacks the internal, corrective effect of review articles that are designed to reduce potential bias. This article inaugurates a new section of the annual "Clinical Ethics" issue of the Journal of Medicine and Philosophy on systematic reviews. Using recently articulated standards for argument-based normative ethics, we provide (...) a systematic review of the literature on concealed medication for the management of psychiatric disorders. Four steps are completed: identify a focused question; conduct a literature search using key terms relevant to the focused question; assess the adequacy of the argument-based methods of the papers identified; and identify conclusions drawn in each paper and whether they apply to the focused question. We identified seven papers and provide an assessment of them. While none of the papers fully meet the standards of argument-based ethics, they did provide rationales for the use of concealed medications, with the important requirement such a practice be accountable in explicit organizational policy to prevent abuse of patients with mental illness or dementia. (shrink)

First published in 1962, The Diversity of Meaning was written to provide a more constructive criticism of the philosophy of ordinary language than the more destructive approach that it was commonly subjected to at the time of publication. The book deals with a range of philosophical problems in a way that cuts underneath the more typical orthodoxies of the time. It is concerned primarily with the concept of meaning and asks not just how people ordinarily speak or think about meanings, (...) but also what is gained or lost by their so doing. The author challenges the assumption that there is only one way of talking about meanings and instead argues that no single analysis of meaning can suit the semantics of lexicographers, language-teachers, translators, logicians, historians of ideas, psychologists and philosophers. By examining various common concepts of meaning and their relations to one another, the book sheds light on the issues most alive in philosophical controversy at the time of publication, giving it lasting relevance for those interested in the history of philosophical thought and theory. (shrink)

Né à Cordoue en 1126, mort en 1198, Ibn Rusd (Averroès), juge, médecin et philosophe andalou, a laissé une œuvre considérable : outre des traités polémiques (contre Galien, contre al-Gazâli) et de nombreux essais, il a consacré à Platon, et surtout à Aristote, des commentaires appelés à exercer une influence particulièrement grande dans les domaines de la logique, de la métaphysique, de la noétique. Rédigé dans les dernières années de sa vie, le Grand Commentaire de la Métaphysique marque le couronnement (...) de l'œuvre philosophique d'Averroès. Ce volume présente la première traduction française annotée du texte arabe de Bêta et du commentaire qu'Averroès y consacre. Souvent considéré comme une introduction générale à toute la métaphysique aristotélicienne, le livre Bêta expose une série d'apories que rencontre le philosophe et qu'il doit tâcher de résoudre. La traduction est précédée d'une introduction qui tente de montrer dans quelle perspective Averroès envisage la " problématique " de la métaphysique. Quels sont les principes, les limites, l'objet ou les enjeux de la métaphysique? Voilà les questions, aussi vastes que capitales, auxquelles Averroès tente ici d'apporter une réponse. (shrink)

In LOT 2: The Language of Thought Revisited, Jerry Fodor argues that concept learning of any kind—even for complex concepts—is simply impossible. In order to avoid the conclusion that all concepts, primitive and complex, are innate, he argues that concept acquisition depends on purely noncognitive biological processes. In this paper, we show (1) that Fodor fails to establish that concept learning is impossible, (2) that his own biological account of concept acquisition is unworkable, and (3) that there are in fact (...) many promising general models for explaining how concepts are learned. (shrink)

The concept of medicine as a profession in the English-language literature of medical ethics is of recent vintage, invented by the Scottish physician and medical ethicist, John Gregory (1724-1773). Gregory wrote the first secular, philosophical, clinical, and feminine medical ethics and bioethics in the English language and did so on the basis of Hume's principle of sympathy. This paper provides a brief account of Gregory's invention and the role that Humean sympathy plays in that invention, with reference to key texts (...) in Gregory's work. The paper also considers two interesting and perhaps provocative ways in which Hume can be read through Gregory: first, sympathy as a principle of scientific discovery in Hume's science of man and moral physiology; and sympathy as gendered feminine in Hume's moral philosophy. Hume's principle of sympathy is at the core of Gregory's medical ethics and the histories of Western medical ethics and bioethics pivot on Gregory - and, therefore, on Hume - as it does on few other figures. (shrink)

Managed care employs two business tools of managed practice that raise important ethical issues: paying physicians in ways that impose conflicts of interest on them; and regulating physicians' clinical judgment, decision making, and behavior. The literature on the clinical ethics of managed care has begun to develop rapidly in the past several years. Professional organizations of physicians have made important contributions to this literature. The statements on ethical issues in managed care of four such organizations are considered here, the American (...) Medical Association, the American College of Physicians, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics. Three themes common to these statements are identified and critically assessed: the primacy of meeting the medical needs of each individual patient; disclosure of conflicts of interest in how physicians are paid; and opposition to gag orders. The paper concludes with an argument for a basic concept in the clinical ethics of managed care: physicians and institutions as economically disciplined moral co-fiduciaries of populations of patients. (shrink)

Taking the critical turn is one of the main tools of the humanities and inculcates an intellectual discipline that prevents ossification of thinking about issues and of organizational policies in clinical ethics. The articles in this "Clinical Ethics" number of the Journal take the critical turn with respect to cherished ways of thinking in Western clinical ethics, life extension, the clinical determination of death, physicians' duty to treat even at personal risk, clinical ethics at the interface of research ethics, and (...) the pertinence of the Hippocratic Oath to clinical ethics. These articles challenge clinical ethicists to inculcate the intellectual discipline of the critical turn into everyday practice and continuous quality enhancement of clinical ethics. (shrink)

The pluralism of methodologies and severe time constraints pose important challenges to pedagogy in clinical ethics. We designed a step-by-step student handbook to operate within such constraints and to respect the methodological pluralism of bioethics and clinical ethics. The handbook comprises six steps: Step 1: What are the facts of the case?; Step 2: What are your obligations to your patient?; Step 3: What are your obligations to third parties to your relationship with the patient?; Step 4: Do your obligations (...) converge or conflict?; Step 5: What is the strongest objection that could be made to the identification of convergence in step 4 or the arguments in step 4? How can this objection be effectively countered?; and Step 6: How could the ethical conflict, or perceived ethical conflict, have been prevented? (shrink)

Moral concerns about the authority, power, and trustworthiness of physicians have become important topics in clinical ethics during the past three decades. These concerns have come to greater prominence with the increasing involvement of large-scale private institutions in the organization and delivery of medical services, especially managed care organizations, and with the increasing involvement of government in the payment for and organization and delivery of medical services. When physicians act as the agents of large institutions or governments, the power of (...) physicians over their patients increases. The purposes of this article are (1) to reflect briefly on the historical origins of the moral problem of physicians' power in medicine, and (2) to introduce the articles in the 1999 annual number of the Journal of Medicine and Philosophy on topics in clinical ethics. (shrink)

The results of empirical research in psychology and psychiatry are increasingly being used to formulate as well as understand problems at the interface of law and psychiatry. There has been a proliferation of studies, such as the determinants of individual competence or threat to self or others, the results of which are influencing policy and legislative decisions as well as buttressing holdings in court cases. In this article, I explore the issues of interpretation of epidemiological studies, particularly the role of (...) ideological positions on the design and results of empirical findings, the importance of the way data are interpreted, and the role of ideologies in the way research findings are presented to provide support for policy positions. Two levels of analysis are involved in determining the validity of a study. The first addresses the questions of whether the study meets the statistical and epidemiological requirements for reliable results. These include considerations such as the appropriateness of the study design and methods for gathering and interpreting data. The second focuses on the underlying framework of the study. This involves factors such as the perspectives and values of those conducting the study, the explicit and implicit dominating ideologies where they operate, and the extent to which the study is constructed to reaffirm specific ideologies. This level of analysis is essential for disclosing the influences of ideologies on the results of studies and the way in which data are interpreted. In this article, I try to demonstrate through critiques of selected studies that the first stage of analysis is insufficient without an examination of underlying preconceived values to establish the meaningfulness of results. (shrink)

Das allgemeine Prinzip der „Relativität der Begriffe” — vom Verfasser a. a. O. dargelegt — behauptet, dass ein und dieselbe Situation der Wirklichkeit auf verschiedene Weisen beschrieben werden kann, die sprachlich und begrifflich zwar verschieden sein mögen, doch grundsätzlich die gleichen bleiben. Die verbalen oder begrifflichen Unterschiede führen uns zu der falschen Annahme, dass den Elementen, welchen im Denken oder im sprachlichen Ausdruck weniger Bedeutung zugemessen wird, auch weniger Bedeuten in Wirklichkeit zukommen, oder dass sie weniger real sind.Die bedeutendste Anwendung (...) dieser Lehre auf die Biologie betrifft die Interpretation des „Individuellen”. Soll man das Individuum als eine Einheit verstehen, oder kommt der Begriff der Einheit einerseits den Teilen zu, wie z. B. Zellen, Molekülen und Atomen, oder andererseits höheren und synthetischen Einheiten wie z.B. Klassen, Arten, dem „élan vital”, u.s.w. ? Alle diese drei Ansichten haben etwas für sich, doch stehen auch jeder entscheidende Gegengründe gegenüber, so dass die einzig-mögliche Schlussfolgerung die Annahme der Begriffsrelativität ist. Jeder der drei Standpunkte ist nur in so weit wahr, als er etwas Positives beibringt, falsch jedoch solange er nur die beiden andern leugnet.Le principe de la relativité des concepts, ayant une application générale dans toutes: parties de la philosophie et de la science, est développé ailleurs par l'auteur. Ce principe propose qu'une situation quelconque peut être discutée dans plusieurs manières, se différant entre elles dans le choix des mots ou des concepts, tout en étant au fond indentiques. Les differences linguistiques ou conceptuelles nous mènent à l'assomption fausse que les éléments moins importants dans la pensée ou dans le langage sont moins importants dans la nature, ou même que ces éléments sont moins réels.En biologie, ce principe a une importance notable en ce qui concerne l'interprétation de l'individu. Doit-on entendre par l'individu les cellules, les molécules, les atomes, et les autres éléments qui le composent; ou bien l'individu même; ou encore doit-on oublier et l'individu et les éléments qui le composent, et baser sa philosophie sur les entités synthétiques telles que les espèces, les genres, et l'élan vital ? Chacune de ces trois opinions a des considérations en sa faveur; mais chacune d'elles se bute à des objections plus considérables encore qui l'empêchent d'être acceptée. La seule conclusion qui semble être possible est l'adoption du principe de la relativité des concepts, et l'assomption que chaque manière d'envisager l'individu est valide tant qu'elle a quelque chose de positif à dire; chaque manière est fausse quand elle nie Ja validité des autres points de vue. (shrink)

There are no new fallacies under the sun, any more than there are any new methods of reasoning. Therefore, the Fluxive Fallacy is nothing new. Yet, pointing out the Fluxive Fallacy and giving it a name has a distinct advantage in that it directs one's attention to errors which, without the advantage of a definite name and description, might pass unobserved.

The R-Being is, by definition, that entity which possesses all qualities which, expressed in English adjectives, begin with the letter R. It is of course unknown, at the commencement of our inquiry, whether any such entity exists, but it is nevertheless possible to determine the characteristics which such a being, whether existent or not, must possess.

This article comments on the treatment of critical-care ethics in four preceding articles about critical-care medicine and its ethical challenges in mainland China, Hong Kong, Japan, and the Philippines. These articles show how cultural values can be in both synchrony and conflict in generating these ethical challenges and in the constraints that they place on the response of critical-care ethics to them. To prevent ethical conflict in critical care the author proposes a two-step approach to the ethical jus tification of (...) critical-care management: (1) the decision to resuscitate and initiate critical-care management, which is based on the obligation to prevent imminent mortality without permanent loss of consciousness; and (2) the decision to continue critical-care management, which is based on the obligation both to prevent imminent death without permanent loss of consciousness and to avoid unnecessary, significant iatrogenic costs to the patient and psychosocial costs to the family when the reduction of morta lity risk is marginal. Physicians and hospitals should restore the critical-care physician's authority and power - against prevailing cultural values, if necessary - to control when critical-care intervention is offered, when it is recommended to continue, and when it is recommended to be discontinued and the patient allowed to die. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bioethics in the Twenty-First Century: Why We Should Pay Attention to Eighteenth-Century Medical EthicsLaurence B. McCullough (bio)Those of us who work in the field of bioethics tend to think that, because the word “bioethics” is new, so too the field is new in all respects, but we are not the first to do bioethics. John Gregory (1724–1773) did bioethics just as we do it, at least two centuries before (...) we thought to do it (Gregory 1772). He deployed philosophical methods as sophisticated as our own. Indeed, Gregory took up the very best moral philosophy available to thinkers of the Scottish Enlightenment, namely, David Hume’s moral philosophy and its core concept of sympathy. Gregory also responded in a conceptually powerful and clinically applicable way to the problems of his time, just as we do. I want here to outline Gregory’s accomplishment and to identify some aspects of its importance for bioethics in the twenty-first century.Gregory’s “Problem List”Gregory wrote his medical ethics as a response to the then current state of medicine in Britain. We now follow Gregory in our writing of bioethics and clinical ethics in response to the problems of our time. A great deal that we now take for granted did not then exist. 1There was not, as there is now, any uniform pathway into medicine. Nor did there exist universal licensure. The Royal Colleges did attempt to assert, but failed to achieve, monopoly control of medical practice. The concepts of health and disease were themselves contested and therefore competed for their success in the market place. There was a marked oversupply of practitioners who competed fiercely—very fiercely indeed—in the medical market place for their concepts of health and disease, their treatments, and therefore their livelihoods. Patients had their own concepts of health and disease, engaged in “self-physicking” or self-care, and often traded physician’s prescriptions.Medicine exhibited little scientific discipline in its accounts of disease and in determining the efficacy of treatments, a fact that Gregory (1743) laments as a [End Page 329] medical student. There was no marked improvement when he began to give his medical ethics lectures nearly a quarter of a century later. Treatments failed as often, perhaps more often, than they succeeded in benefiting patients. The sick usually sought out the help of a physician after trying self-physicking.Physicians, Gregory taught, could not hope to control human biology, though they could aim to manage its processes well. When nature underresponds to disease the physician should assist her processes; when nature overresponds, the physician should tamp down nature’s responses, to lessen their “violence”—in both cases always attentive to the limits of medicine’s capacities in treating disease.Physicians attended the well-to-do sick at home, and the sick person summoned and dismissed physicians, surgeons, or apothecaries at will. A physician therefore might find himself—no women had yet been admitted to the ranks of university-trained physicians—summoned before, after, or simultaneously with a competitor, with his concepts and diagnosis and treatment put to the acid test. In this setting, there existed only a patient-physician relationship, not a physician-patient relationship.Physicians left off the care of dying patients, a practice that was made a matter of duty by Friederich Hoffmann (1749). One would suffer punishing economic consequences if one had a high mortality rate. Better, then, to label the patient incurable, withdraw, and turn matters over to clergy. Gregory attacks this practice as intellectual fraud and calls for the physician to continue to attend the dying. Indeed, he says, “It is as much the business of a physician to alleviate pain, and to smooth the avenues of death, when unavoidable, as to cure diseases” (Gregory 1772, p. 35). He does not explicitly address what we now call physician-assisted suicide; neither does he condemn it, and he is quick to condemn some things—e.g., sexual abuse of female patients or “sporting” with patients in the Royal Infirmary by using experiments as the first line of treatment.The Royal Infirmary was established to care for the deserving, working poor, who received free care... (shrink)