Big data and artificial intelligence (“AI”) promise to transform virtually all aspects of biomedical research and health care (Matheny et al. 2019), through facilitation of drug development, diagno...

Thomas Lyson argued that civic markets were possible and could have positive impacts on rural development. Increasingly local governments are being forced into market-based governance regimes of privatization, decentralization and free trade. This article explores the impacts of these trends on rural local governments in the US. These market trends can erode civic foundations, but recent data show local governments are balancing markets with civic concerns and giving increased attention to citizen interests in the service delivery process.

: A familiar criticism of bioethics charges it with being more conceptual than practical—having little application to the "real world." In order to answer its critics and keep its feet on the ground, bioethics must utilize the social sciences more effectively. Empirical research can provide the bridge between conceiving a moral vision of a better world, and actually enacting it.

The use of racial categories in biomedicine has had a long history in the United States. However, social hierarchy and discrimination, justified by purported scientific differences, has also plagued the history of racial categories. Because “race” has some correlation with biological and genetic characteristics, there has been a call not to “throw the baby out with the bathwater” by eliminating race as a research or clinical category. I argue that race is too undefined and fluid to be useful as a (...) proxy for biology or genetics. (shrink)

The experimental interventions that provide evidence of causal relations are notably similar to those that provide evidence of constitutive relevance relations. In the first two sections, I show that this similarity creates a tension: there is an inconsistent triad between Woodward’s popular interventionist theory of causation, Craver’s mutual manipulability account of constitutive relevance in mechanisms, and a variety of arguments for the incoherence of inter-level causation. I argue for an interpretation of the views in which the tension is merely apparent. (...) I propose to explain inter-level relations without inter-level causation by appealing to the notion of fat-handed interventions, and an argument against inter-level causation which dissolves the problem. (shrink)

What is bioethics to do when it strives to assess the quality of its research and scholarship and when it needs to justify its work to prospective funders, especially a funder like the National Institutes of Health that privileges empirical discovery? In “A Conceptual Model for the Translation of Bioethics Research and Scholarship,” Debra Mathews and colleagues take an important first step at advancing an answer. The authors describe what they call a translational process, whereby bioethics “outputs” are translated into (...) changes of three types: in thinking, practice, and policy. It goes nearly without saying that bioethics research and scholarship must be held accountable for changes in thinking. What raison d'etre do we have if not to deepen thinking, question assumptions, and encourage ourselves and others to examine hard issues from novel approaches? Assuredly it is hard to assess quality, and even harder to assess specific changes in thinking for which high-quality scholarship may be responsible, but it is a necessary goal and one for which we should strive without reservation. Bioethics should also affect policy and practice. We should document how it does and the extent to which it does as often and as prominently as possible. However, let us be wary of pinning too much on practice and policy changes as the primary way of establishing bioethics’ worth. (shrink)

The reward system of science is the priority rule. The first scientist making a new discovery is rewarded with prestige, while second runners get little or nothing. Michael Strevens, following Philip Kitcher, defends this reward system, arguing that it incentivizes an efficient division of cognitive labor. I argue that this assessment depends on strong implicit assumptions about the replicability of findings. I question these assumptions on the basis of metascientific evidence and argue that the priority rule systematically discourages replication. My (...) analysis leads us to qualify Kitcher and Strevens’s contention that a priority-based reward system is normatively desirable for science. (shrink)

Advocates of the self-corrective thesis argue that scientific method will refute false theories and find closer approximations to the truth in the long run. I discuss a contemporary interpretation of this thesis in terms of frequentist statistics in the context of the behavioral sciences. First, I identify experimental replications and systematic aggregation of evidence (meta-analysis) as the self-corrective mechanism. Then, I present a computer simulation study of scientific communities that implement this mechanism to argue that frequentist statistics may converge upon (...) a correct estimate or not depending on the social structure of the community that uses it. Based on this study, I argue that methodological explanations of the “replicability crisis” in psychology are limited and propose an alternative explanation in terms of biases. Finally, I conclude suggesting that scientific self-correction should be understood as an interaction effect between inference methods and social structures. (shrink)

A belief that high school students have the cognitive ability to analyze and assess moral choices and should be encouraged to do so but have rarely been helped to do so was the motivation for developing Exploring Bioethics, a six-module curriculum and teacher guide for grades nine through twelve on ethical issues in the life sciences. A multidisciplinary team of bioethicists, science educators, curriculum designers, scientists, and high school biology teachers worked together on the curriculum under a contract between the (...) National Institutes of Health and Education Development Center, a nonprofit research and development organization with a long history of innovation in science education. At the NIH, the Department of Bioethics within the Clinical Center and the Office of Science Education within the Office of the Director guided the project.Our overarching goal for Exploring Bioethics was to introduce students to bioethics as a field of inquiry and to enable them to develop ethical reasoning skills so they could move beyond “gut reactions” to more nuanced positions. (shrink)

As we write, U.S. cities and states with extensive community transmission of Covid‐19 are in harm's way—not only because of the disease itself but also because of prior and current failures to act. During the 2009 influenza pandemic, public health agencies and hospitals developed but never adequately implemented preparedness plans. Focused on efficiency in a competitive market, health systems had few incentives to maintain stockpiles of essential medical equipment. Just‐in‐time economic models resulted in storage of only those supplies needed then. (...) At the same time, global purchasing in search of lower prices reduced the number of U.S. suppliers, with hospitals dependent on foreign companies. There is still a possibility that the pandemic will be manageably bad rather than unmanageably catastrophic in this country. Immediate, powerful, and sustained federal action could make the difference. (shrink)

Institutional ethics consultation services for biomedical scientists have begun to proliferate, especially for clinical researchers. We discuss several models of ethics consultation and describe a team-based approach used at Stanford University in the context of these models. As research ethics consultation services expand, there are many unresolved questions that need to be addressed, including what the scope, composition, and purpose of such services should be, whether core competencies for consultants can and should be defined, and how conflicts of interest should (...) be mitigated. We make preliminary recommendations for the structure and process of research ethics consultation, based on our initial experiences in a pilot program. (shrink)

Background: Eye movement desensitization and reprocessing [EMDR] is an innovative, evidence-based and effective psychotherapy for post-traumatic stress disorder [PTSD]. As with other psychotherapies, the effectiveness of EMDR contrasts with a limited knowledge of its underlying mechanism of action. In its relatively short life as a therapeutic option, EMDR has not been without controversy, in particular regarding the role of the bilateral stimulation as an active component of the therapy. The high prevalence of EMDR in clinical practice and the dramatic increase (...) in EMDR research in recent years, with more than 26 randomized controlled trials published to date, highlight the need for a better understanding of its mechanism of action. Methods: We conducted a thorough systematic search of studies published until October 2017, using PubMed, ScienceDirect, Web of Knowledge and Scopus databases that examined the mechanism of action of EMDR or provided conclusions within the framework of current theoretical models of EMDR functioning. Results: Seventy-five studies were selected for review and classified into three overarching models; (i) psychological models (ii) psychophysiological models and (iii) neurobiological models. The evidence available from each study was analysed and discussed. Results demonstrated a reasonable empirical support for the working memory hypothesis and for the physiological changes associated with successful EMDR therapy. Recently, more sophisticated structural and functional neuroimaging studies using high resolution structural and temporal techniques are starting to provide preliminary evidence into the neuronal correlates before, during and after EMDR therapy. Discussion: Despite the increasing number of studies that published in recent years, the research into the mechanisms underlying EDMR therapy are still in its infancy. Studies in well-defined clinical and non-clinical populations, larger sample sizes and tighter methodological control are further needed in order to establish firm conclusions. (shrink)

I present a discussion of some issues in the ontology of spacetime. After a characterisation of the controversies among relationists, substantivalists, eternalists, and presentists, I offer a new argument for rejecting presentism, the doctrine that only present objects exist. Then, I outline and defend a form of spacetime realism that I call event substantivalism. I propose an ontological theory for the emergence of spacetime from more basic entities. Finally, I argue that a relational theory of pre-geometric entities can give rise (...) to substantival spacetime in such a way that relationism and substantivalism are not necessarily opposed positions, but rather complementary. In an appendix I give axiomatic formulations of my ontological views. (shrink)

A familiar criticism of bioethics charges it with being more conceptual than practical—having little application to the “real world.” In order to answer its critics and keep its feet on the ground, bioethics must utilize the social sciences more effectively. Empirical research can provide the bridge between conceiving a moral vision of a better world, and actually enacting it.

Institutional ethics consultation services for biomedical scientists have begun to proliferate, especially for clinical researchers. We discuss several models of ethics consultation and describe a team-based approach used at Stanford University in the context of these models. As research ethics consultation services expand, there are many unresolved questions that need to be addressed, including what the scope, composition, and purpose of such services should be, whether core competencies for consultants can and should be defined, and how conflicts of interest should (...) be mitigated. We make preliminary recommendations for the structure and process of research ethics consultation, based on our initial experiences in a pilot program. (shrink)

Romero, Francisco. Alejandro Korn.--Vassallo, Angel. Presentación de A. Korn, filósofo.--Aznar, Luis. Apuntaciones biográficas.--Apéndices: Romero, Francisco. Recuerdo de A. Korn. El testamento de un filósofo.

“There's glory for you!”“I don't know what you mean by ‘glory,’ ” Alice said.Humpty Dumpty smiled contemptuously. “Of course, you dont—till I tell you. I meant ‘there's a nice knock-down argument.’”“But ‘glory’ doesn't mean a ‘nice knock-down argument,” Alice objected.“When I use a word,” Humpty Dumpty said, in rather a scornful tone, “it means just what I choose it to mean—neither more nor less.”“The question is,” said Alice, “whether you can make words mean so many different things.”“The question is,” said (...) Humpty Dumpty, “which is to be master, that's all.”When applied bioethics confronts the topic of futility, the question of who is to be master turns out to be central. Indeed, much of the literature on futility has focused on exactly this question: who gets to define the terms of the debate? Who gets to decide that treatment is “futile” and therefore allowably withheld or withdrawn? (shrink)

I present a formal ontological theory where the basic building blocks of the world can be either things or events. In any case, the result is a Parmenidean worldview where change is not a global property. What we understand by change manifests as asymmetries in the pattern of the world-lines that constitute 4-dimensional existents. I maintain that such a view is in accord with current scientific knowledge.

This paper advances a new paradigm in clinical ethics education that not only emphasizes development of individual cli but also focuses on the institutional context within which health care professionals work. This approach has been applied to the goal of improving the care provided to critically and terminally ill adults. The model has been adopted by about thirty hospitals and nursing homes; additional institutions will soon join the program, entitled Decisions Near the End of Life. Here, we describe the history (...) and rationale for this approach, its goals, pedagogical assumptions, and design. (shrink)

“There's glory for you!”“I don't know what you mean by ‘glory,’ ” Alice said.Humpty Dumpty smiled contemptuously. “Of course, you dont—till I tell you. I meant ‘there's a nice knock-down argument.’”“But ‘glory’ doesn't mean a ‘nice knock-down argument,” Alice objected.“When I use a word,” Humpty Dumpty said, in rather a scornful tone, “it means just what I choose it to mean—neither more nor less.”“The question is,” said Alice, “whether you can make words mean so many different things.”“The question is,” said (...) Humpty Dumpty, “which is to be master, that's all.”When applied bioethics confronts the topic of futility, the question of who is to be master turns out to be central. Indeed, much of the literature on futility has focused on exactly this question: who gets to define the terms of the debate? Who gets to decide that treatment is “futile” and therefore allowably withheld or withdrawn? (shrink)

The idea of a moving present or ‘now’ seems to form part of our most basic beliefs about reality. Such a present, however, is not reflected in any of our theories of the physical world. I show in this article that presentism, the doctrine that only what is present exists, is in conflict with modern relativistic cosmology and recent advances in neurosciences. I argue for a tenseless view of time, where what we call ‘the present’ is just an emergent secondary (...) quality arising from the interaction of perceiving self-conscious individuals with their environment. I maintain that there is no flow of time, but just an ordered system of events. (shrink)

Physically frail, badly educated girls, brought up to lead useless lives as idle gentlewomen, married to dominant husbands, and relegated to "separate spheres" of life—these phrases have often been used to describe Victorian upper-middle-class women. M. Jeanne Peterson rejects such formulations and the received wisdom they embody in favor of a careful examination of Victorian ladies and their lives. Focusing on a network of urban professional families over three generations, this book examines the scope and quality of gentlewomen's education, their (...) physical lives, their relationship to money, their experience of family illness and death, and their relationships to men (brothers and friends as well as fathers and husbands). Peterson also examines the prominent place of work in the lives of these "leisured" Victorian ladies, both single and married. Far from idle, the mothers, wives, and daughters of Victorian clergymen, doctors, lawyers, university dons, and others were accomplished and productive members of society who made substantial public and private contributions to virtually every sphere of Victorian life. (shrink)

Bioethics is reexamining how to implement diversity, equity, inclusion, and justice concerns into scholarship. However, bioethicists should question the categories used to define diversity. The act of categorization is value laden, and classification systems confer power and benefits and generate harms. For example, what conditions count as disabilities? We should consider the equity implications of offering only “male” and “female” options for self‐identification in health records. However, we should also interrogate all ideas about categorization, including how categories are formed, why (...) they are formed, and who decides. Bioethicists cannot comprehend fully what equity and justice mean for underrepresented, underserved, or marginalized people until there is an understanding of how the boundaries of marginalization are created. (shrink)

Le thème de la femme dans les pays en voie de développement continue à faire couler beaucoup d’encre dans les universités américaines où la division d’hier entre chercheurs confirmant l’exploitation de la femme et leurs collègues prouvant l’éveil de la conscience féministe se mue aujourd’hui en une analyse plus nuancée qui met en évidence la complexité et les contradictions du vécu féminin. En tant que chercheurs examinant la situation de la femme au Maghreb, que nous soyons « insider » ou (...) «... (shrink)

Le thème de la femme dans les pays en voie de développement continue à faire couler beaucoup d’encre dans les universités américaines où la division d’hier entre chercheurs confirmant l’exploitation de la femme et leurs collègues prouvant l’éveil de la conscience féministe se mue aujourd’hui en une analyse plus nuancée qui met en évidence la complexité et les contradictions du vécu féminin. En tant que chercheurs examinant la situation de la femme au Maghreb, que nous soyons « insider » ou (...) «... (shrink)

The Institute of Medicine has called on health care leaders to transform their health systems into “learning health care systems,” capable of studying and continuously improving their practices. Learning health care systems commit to carrying out numerous kinds of investigations, ranging from clinical effectiveness studies to quality improvement research and implementation science. There has been progress in realizing the IOM's vision, but also many challenges. One of these challenges has been lingering uncertainty about whether the data collection and monitoring central (...) to learning health care systems is actually research and if so, what kind of ethical oversight it should have. This is not a new question. Yet so far, there has been no foundational analysis of the fit between the existing human subjects protection framework in use in the United States and the new kinds of data collection activities that are being, and increasingly will be, undertaken by learning health care systems. Two companion feature articles in this volume, by a team at Johns Hopkins, fill this void. (shrink)

Transformar el modo de vida individual es necesario para abordar la crisis ecosocial, y resulta perentorio que las políticas comprometidas con su resolución promocionen una capacidad individual de acción ecosocial. Sin embargo, parece que cierta brecha motivacional está obstaculizando la transformación del modo de vida individual. A fin de dar respuesta a esta brecha, ensayamos una mixtura del enfoque de las capacidades con las teorías de Hartmut Rosa. Argumentamos que la resonancia natural funge de factor personal de conversión necesario, si (...) bien no suficiente, para la capacidad de acción ecosocial; y que una política que promocione la resonancia natural se adecuaría también a los requisitos impuestos al desarrollo humano tanto por el enfoque de las capacidades como por la sostenibilidad. (shrink)

I argue for a four dimensional, non-dynamical view of space-time, where becoming is not an intrinsic property of reality. This view has many features in common with the Parmenidean conception of the universe. I discuss some recent objections to this position and I offer a comparison of the Parmenidean space-time with an interpretation of Heraclitus’ thought that presents no major antagonism.

Across the world, an authoritarian and exclusionary form of populism is gaining political traction. Historically, some populist movements have been democratic and based on a sense of inclusive justice and the common good. But the populism on the rise at present speaks and acts otherwise. It is challenging constitutional democracies. The polarization seen in authoritarian populism goes beyond the familiar left-right political spectrum and generates disturbing forms of extremism, including the so-called alternative right in the United States and similar ethnic (...) and nationalistic political movements in other countries. The field of bioethics will be profoundly affected if authoritarian populism displaces constitutional democracy. But the field has a significant contribution to make to rebuilding the communal and civic foundations upon which constitutional democracy rests. (shrink)

This book provides an up-to-date revision of materialism’s central tenets, its main varieties, and the place of materialistic philosophy vis a vis scientific knowledge. Materialism has been the subject of extensive and rich controversies since Robert Boyle introduced the term for the first time in the 17th century. But what is materialism and what can it offer today? The term is usually defined as the worldview according to which everything real is material. Nevertheless, there is no philosophical consensus about whether (...) the meaning of matter can be enlarged beyond the physical. As a consequence, materialism is often defined in stark exclusive and reductionist terms: whatever exists is either physical or ontologically reducible to it. This conception, if consistent, mutilates reality, excluding the ontological significance of political, economic, sociocultural, anthropological and psychological realities. Starting from a new history of materialism, the present book focuses on the central ontological and epistemological debates aroused by today’s leading materialist approaches, including some little known to an anglophone readership. The key concepts of matter, system, emergence, space and time, life, mind, and software are checked over and updated. Controversial issues such as the nature of mathematics and the place of reductionism are also discussed from different materialist approaches. As a result, materialism emerges as a powerful, indispensable scientifically-supported worldview with a surprising wealth of nuances and possibilities. (shrink)