Precision medicine is an emerging approach to treatment and disease prevention that relies on linkages between very large datasets of health information that is shared amongst researchers and health professionals. While studies suggest broad support for sharing precision medicine data with researchers at publicly funded institutions, there is reluctance to share health information with private industry for research and development. As the private sector is likely to play an important role in generating public benefits from precision medicine initiatives, it is (...) important to understand what the concerns are and how they might be mitigated. This study reports outcomes of a deliberative method of citizen engagement in Singapore that asked whether sharing precision medicine data with private industry would be permissible, and if so, under what circumstances. Findings from this citizens’ jury suggest sharing with industry would be permissible under certain conditions that are set out in nine recommendations. Implications of the recommendations and their underlying assumptions for policy decision makers are discussed. This study aligns with prior international studies which found conditional acceptance for data sharing with private industry, a public benefit requirement, specific reluctance to share with insurance companies and an emphasis on accountability and transparency to demonstrate trustworthiness. However, our results differ from prior studies in that opt-in consent did not dominate the deliberations as jurors were able to set it aside as an assumed prerequisite for participation in a precision medicine programme. (shrink)

Although continued investments in nanotechnology are made, atomically precise manufacturing (APM) to date is still regarded as speculative technology. APM, also known as molecular manufacturing, is a token example of a converging technology, has great potential to impact and be affected by other emerging technologies, such as artificial intelligence, biotechnology, and ICT. The development of APM thus can have drastic global impacts depending on how it is designed and used. This paper argues that the ethical issues that arise from (...) APM - as both a standalone technology or as a converging one - affects the roles of stakeholders in such a way as to warrant an alternate means furthering responsible innovation in APM research. This paper introduces a value-based design methodology called Value Sensitive Design (VSD) that may serve as a suitable framework to adequately cater to the values of stakeholders. Ultimately, it is concluded that VSD is a strong candidate framework for addressing the moral concerns of stakeholders during the preliminary stages of technological development. (shrink)

The success of precision medicine depends on obtaining large amounts of information about at-risk populations. However, getting consent is often difficult. Why? In this commentary I point to the differentials in social status involved. These differentials are inevitable once personal information is surrendered, but are particularly intense when the studied populations are socioeconomically or socioculturally disadvantaged and/or ethnically stigmatized groups. I suggest how the deep distrust of the latter groups can be partially justified as a lack of confidence that their (...) core values or interests will sufficiently be taken into account. Hence, the ethical challenge here lies not in avoiding status differentials, but in dealing with them appropriately. Scientists should not assume trust from others but adopt a norm of “demonstrating trustworthiness”. (shrink)

En este ensayo propongo una lectura de los contornos de la primera Meditación. Con ella intento resaltar una dimensión importante del pensamiento de Descartes en torno a la virtud de la precisión. Contrasto la preocupación por la verdad en la vida cotidiana y en la indagación cartesiana, exploro la manera en que Descartes enfrenta algunos riesgos epistémicos en el curso de su meditación, señalo algunos aspectos de su concepción de la agencia epistémica y concluyo con una breve disquisición alrededor de (...) la apuesta de Pascal. (shrink)

Marine chronometers, often considered precision instruments, proliferated in navigational practices during the nineteenth century. This paper examines their use in the hands of naval officers in the early-nineteenth century. It argues that both the instruments and their operators required careful management and regulation. In addition, officers learnt and adapted observatory practices relating to the process of data collection and management. Through these means, chronometric data was collected, organized, and reduced to negotiate accurate results.

Autism Spectrum Condition presents a challenge to social and relational accounts of the self, precisely because it is broadly seen as a disorder impacting social relationships. Many influential theories argue that social deficits and impairments of the self are the core problems in ASC. Predictive processing approaches address these based on general purpose neurocognitive mechanisms that are expressed atypically. Here we use the High, Inflexible Precision of Prediction Errors in Autism approach in the context of cultural niche construction to explain (...) atypicalities of the relational self, specifically its minimal, extended, and intersubjective aspects. We contend that the social self in ASC should not be seen as impaired, but rather as an outcome of atypical niche construction. We unpack the scientific, ethical, and practical consequences of this view, and discuss implications for how the challenges that autistic persons face should be approached. (shrink)

When we see objects blurrily, in the periphery, or in dim light, we often experience their features unclearly. This paper argues that perceptual clarity is a dimension along which experiences vary, distinct from their distal contents. Drawing on models in perception science, the paper accounts for clarity by using the probabilistic notion of precision. The account’s first part is ecumenical: it says that experiences carry information about the precision of the representations from which each distal content of experience was selected (...) and that this precision information accounts for perceptual clarity. The account’s second part entails that experiences carry the relevant precision information in the manner in which their distal contents are represented. The precision account of clarity is shown to conform to common intuitions about experiences’ contents and accuracy conditions. And it is used to illustrate how experiences could assign probability distributions over distal possibilities, even while experiences’ contents are non-probabilistic. (shrink)

Autism Spectrum Condition presents a challenge to social and relational accounts of the self, precisely because it is broadly seen as a disorder impacting social relationships. Many influential theories argue that social deficits and impairments of the self are the core problems in ASC. Predictive processing approaches address these based on general purpose neurocognitive mechanisms that are expressed atypically. Here we use the High, Inflexible Precision of Prediction Errors in Autism approach in the context of cultural niche construction to explain (...) atypicalities of the relational self, specifically its minimal, extended, and intersubjective aspects. We contend that the social self in ASC should not be seen as impaired, but rather as an outcome of atypical niche construction. We unpack the scientific, ethical, and practical consequences of this view, and discuss implications for how the challenges that autistic persons face should be approached. (shrink)

This paper problematizes the precision medicine approach embraced by the All of Us Research Program (US) and by Genomics England (UK) in terms of benefits distribution, by arguing that current “diversity and inclusion” efforts do not prevent exclusiveness, unless the framing and scope of the projects are revisited in public health terms. Grounded on document analysis and fieldwork interviews, this paper analyzes efforts to address potential patterns of exclusion upstream (from participating in precision medicine research) and downstream (from benefitting from (...) precision medicine outputs). It argues that efforts for inclusion upstream are not corresponded downstream, and this unbalance jeopardizes the equitable capacities of the projects. It concludes that enhanced focus on socio-environmental determinants of health and aligned public health interventions as precision medicine outputs would be to the benefit of all and especially of those who are most at risk of (upstream as well as downstream) exclusion. (shrink)

Precision medicine and digital phenotyping are two prominent data-based approaches within digital medicine. While precision medicine historically used primarily genetic data to find targeted treatment options, digital phenotyping relies on the usage of big data deriving from digital devices such as smartphones, wearables and other connected devices. This paper first focusses on the aspect of data type to explore differences and similarities between precision medicine and digital phenotyping. It outlines different ways of data collection and production and the consequences thereof. (...) Second, it shows how these sorts of data influence dominant beliefs in the field: The field of precision medicine relying on the dominant understanding of ‘genetic determinism’ imported from genetics, digital phenotyping building on the logic of ‘data fundamentalism’. In the end, the analysis shows how digital data informs potentials as well as challenges of precision medicine and digital phenotyping: a better health care for individuals connected with individualisation and responsibilisation for all, with a prognosed shift from reactive to preventive medicine. Additionally, data-based approaches might facilitate epistemological and ontological redirections for the whole field of medicine that will also affect knowledge production and a reassessment of the value of different types of knowledge with all its consequences. Institutionally, it might lead to shifts in distribution of power to experts in big data related technologies, i.e. private companies. (shrink)

Ground Representationism is the position that for each phenomenal feature there is a representational feature that accounts for it. Against this thesis, Ned Block (The Puzzle of Phenomenal Precision, 2015) has provided an intricate argument that rests on the notion of “phenomenal precision”: the phenomenal precision of a percept may change at a different rate from its representational counterpart. If so, there is then no representational feature that accounts for a specific change of this phenomenal feature. Therefore, Ground Representationism cannot (...) be generally true. -/- Although the notion of phenomenal precision is intuitive, it is admittedly in need of clarification. Here I reconstruct Block’s argument by suggesting a way of estimating phenomenal precision that is based on the assumption that parts of perceptual wholes can share phenomenal features independently of their place in the whole. Understood like this, the overall argument shows what it is supposed to show. -/- A more thorough look at the notion of phenomenal precision suggests tension with Block’s other work: in order to be non-trivial, we have to accept that some of our phenomenality is not concrete, but only generic. Such “solely generic phenomenology”, however, is a position mainly held by opponents to Block’s Access- vs. Phenomenal Consciousness-distinction. Interpreting phenomenal imprecision as constituted by introspective imprecision does not suffice as a way out. It seems that phenomenal precision is either trivial, self-contradictory, or incompatible with Block’s position elsewhere. So some additional elucidation on this crucial notion is needed. (shrink)

As opposed to a ‘one size fits all’ approach, precision medicine uses relevant biological, medical, behavioural and environmental information about a person to further personalize their healthcare. This could mean better prediction of someone’s disease risk and more effective diagnosis and treatment if they have a condition. Big data allows for far more precision and tailoring than was ever before possible by linking together diverse datasets to reveal hitherto-unknown correlations and causal pathways. But it also raises ethical issues relating to (...) the balancing of interests, viability of anonymization, familial and group implications, as well as genetic discrimination. This article analyses these issues in light of the values of public benefit, justice, harm minimization, transparency, engagement and reflexivity and applies the deliberative balancing approach found in theEthical Framework for Big Data in Health and Research to a case study on clinical genomic data sharing. Please refer to that article for an explanation of how this framework is to be used, including a full explanation of the key values involved and the balancing approach used in the case study at the end. Our discussion is meant to be of use to those involved in the practice as well as governance and oversight of precision medicine to address ethical concerns that arise in a coherent and systematic manner. (shrink)

Precision Medicine has become a common label for data-intensive and patient-driven biomedical research. Its intended future is reflected in endeavours such as the Precision Medicine Initiative in the USA. This article addresses the question whether it is possible to discern a new ‘medical cosmology’ in Precision Medicine, a concept that was developed by Nicholas Jewson to describe comprehensive transformations involving various dimensions of biomedical knowledge and practice, such as vocabularies, the roles of patients and physicians and the conceptualisation of disease. (...) Subsequently, I will elaborate my assessment of the features of Precision Medicine with the help of Michel Foucault, by exploring how precision medicine involves a transformation along three axes: the axis of biomedical knowledge, of biomedical power and of the patient as a self. Patients are encouraged to become the managers of their own health status, while the medical domain is reframed as a data-sharing community, characterised by changing power relationships between providers and patients, producers and consumers. While the emerging Precision Medicine cosmology may surpass existing knowledge frameworks; it obscures previous traditions and reduces research-subjects to mere data. This in turn, means that the individual is both subjected to the neoliberal demand to share personal information, and at the same time has acquired the positive ‘right’ to become a member of the data-sharing community. The subject has to constantly negotiate the meaning of his or her data, which can either enable self-expression, or function as a commanding Superego. (shrink)

The United States’ ambitious Precision Medicine Initiative proposes to accelerate exponentially the adoption of precision medicine, an approach to health care that tailors disease diagnosis, treatment, and prevention to individual variability in genes, environment, and lifestyle. It aims to achieve this by creating a cohort of volunteers for precision medicine research, accelerating biomedical research innovation, and adopting policies geared toward patients’ empowerment. As strategies to implement the PMI are formulated, critical consideration of the initiative's ethical and sociopolitical dimensions is needed. (...) Drawing on scholarship of nationalism and democracy, we discuss the PMI's construction of what we term “genomic citizenship”; the possible normative obligations arising therefrom; and the ethical, legal, and social challenges that will ensue. Although the PMI is a work in progress, discussion of the existing and emerging issues can facilitate the development of policies, structures, and procedures that can maximize the initiative's ability to produce equitable and socially sensitive outcomes. Our analysis can also be applied to other population-based, precision medicine research programs. (shrink)

Solidarity is a fundamental social value in many European countries, though its precise practical and theoretical meaning is disputed. In a health care context, I agree with European writers who take solidarity normatively to mean roughly equal access to effective health care for all. That is, solidarity includes a sense of justice. Given that, I will argue that precision medicine represents a potential weakening of solidarity, albeit not a unique weakening. Precision medicine includes 150 targeted cancer therapies (mostly for (...) metastatic cancer), all of which are extraordinarily expensive. Our critical question: Must a commitment to solidarity as defined mean that all these targeted cancer therapies should be guaranteed to all within each country in the European Union, no matter the cost, no matter the degree of effectiveness? Such a commitment would imply that cancer was ethically special, rightfully commandeering unlimited resources. That in itself would undermine solidarity. I offer multiple examples of how current and future dissemination of these targeted cancer drugs threaten a commitment to solidarity. An alternative is to fund more cancer prevention efforts. However, that too proves a threat to solidarity. Solidarity, with or without a sense of justice, is too abstract a notion to address these challenges. Further, we need to accept that we can only hope to achieve “rough justice” and “supple solidarity.” The precise practical meaning of these notions needs to be worked out through a fair and inclusive process of rational democratic deliberation, which is the real and practical foundation of just solidarity. (shrink)

Many countries currently invest in technologies and data infrastructures to foster precision medicine (PM), which is hoped to better tailor disease treatment and prevention to individual patients. But who can expect to benefit from PM? The answer depends not only on scientific developments but also on the willingness to address the problem of structural injustice. One important step is to confront the problem of underrepresentation of certain populations in PM cohorts via improved research inclusivity. Yet, we argue that the perspective (...) needs to be broadened because the (in)equitable effects of PM are also strongly contingent on wider structural factors and prioritization of healthcare strategies and resources. When (and before) implementing PM, it is crucial to attend to how the organisation of healthcare systems influences who will benefit, as well as whether PM may present challenges for a solidaristic sharing of costs and risks. We discuss these issues through a comparative lens of healthcare models and PM-initiatives in the United States, Austria, and Denmark. The analysis draws attention to how PM hinges on—and simultaneously affects—access to healthcare services, public trust in data handling, and prioritization of healthcare resources. Finally, we provide suggestions for how to mitigate foreseeable negative effects. (shrink)

Argues for a failure of correspondence between perceptual representation and what it is like to perceive. If what it is like to perceive is grounded in perceptual representation, then, using considerations of veridical representation, we can show that inattentive peripheral perception is less representationally precise than attentive foveal perception. However, there is empirical evidence to the contrary. The conclusion is that perceptual representation cannot ground what it is like to perceive.

Following from my criticisms of Calcott’s analysis on the permissive/instructive distinction, I rebut his claims that 1) he clarifies my measure one-to-one specificity; 2) for all intents and purposes of his analysis his notion of precision is different from my measure of one- to-one specificity; 3) Waddington box is a better and different model than the extension of Woodward’s radio I propose.

1. Sometimes perceptual experience is crystal clear, as when one inspects an object close-up in bright light with corrective lenses. But experience can be less clear. To illustrate how experiences...

_More Precisely_ provides a rigorous and engaging introduction to the mathematics necessary to do philosophy. It is impossible to fully understand much of the most important work in contemporary philosophy without a basic grasp of set theory, functions, probability, modality and infinity. Until now, this knowledge was difficult to acquire. Professors had to provide custom handouts to their classes, while students struggled through math texts searching for insight. _More Precisely_ fills this key gap. Eric Steinhart provides lucid explanations of the (...) basic mathematical concepts and sets out most commonly used notational conventions. Furthermore, he demonstrates how mathematics applies to many fundamental issues in branches of philosophy such as metaphysics, philosophy of language, epistemology, and ethics. (shrink)

The use of forward models is well established in cognitive and computational neuroscience. We compare and contrast two recent, but interestingly divergent, accounts of the place of forward models in the human cognitive architecture. On the Auxiliary Forward Model account, forward models are special-purpose prediction mechanisms implemented by additional circuitry distinct from core mechanisms of perception and action. On the Integral Forward Model account, forward models lie at the heart of all forms of perception and action. We compare these neighbouring (...) but importantly different visions and consider their implications for the cognitive sciences. We end by asking what kinds of empirical research might offer evidence favouring one or the other of these approaches. (shrink)

An intuitive idea concerning degrees of precision is widely accepted, and it is that we increase precision of theories by paying attention to ever decreasing orders of magnitude of measurements which we incorporate in these theories. We increase precision of measuring or of predicting measurement of length, for instance, if we pay attention not only to centimeters but also to millimeters, microns, angstroms, and so on. And our theories are precise to centimeters, then to millimeters, and so on respectively. (...) The idea is that increased precision is the process of capturing a point within nested intervals, and that this is reflected both in experimental and in theoretical progress. An intuitive analogy may be drawn with series of photos made by a camera which approaches the moon's surface. A corollary from this intuitive idea which has been stated by a number of writers is that observation reports and theories are not overthrown even when superseded by more accurate observation because within the limits of their own precision-range they are still valid. When a law in physics is stated, it is stated usually without such qualifications; but this is a mere matter of convenience, we are told. The idea is that a tacit proviso is understood and the law should be understood to be not the statement “such and such is the case” but the statement “within this and that limit of accuracy such and such is the case”; in such a formulation, the law, once verified, remains unshaken regardless of further progress in the field. (shrink)

We construct four models containing one supercompact cardinal in which level by level equivalence between strong compactness and supercompactness and level by level inequivalence between strong compactness and supercompactness are precisely controlled at each non‐supercompact measurable cardinal. In these models, no cardinal κ is ‐supercompact, where is the least inaccessible cardinal greater than κ.

Precision livestock farming promises to allow modern, large-scale farms to replicate, at scale, caring farmers who know their animals. PLF refers to a suite of technologies, some only speculative. The goal is to use networked devices to continuously monitor individual animals on large farms, to compare this information to expected norms, and to use algorithms to manage individual animals automatically. Supporters say this could not only create an artificial version of the partially mythologized image of the good steward caring for (...) his or her animals, but to also improve on it. As one paper in favor of PLF has said, “We can not only replace the farmer’s ‘eyes and ears’ to each individual animal as in the past, but several other variables will soon be measurable in practice” Livestock production and society, Wageningen Academic Publishers, Wageningen, pp 287–292, 2006). Yet these methods of monitoring and control raise a host of ethical issues, including alienation of laborers, further consolidation of farms, and further cover for meat consumption. In this paper, I will address these ethical issues, and suggest a different, under-examined concern: namely, that though PLF may indeed improve the lives of livestock, and the sustainability of livestock operations, it is possible that it will do so at the cost of a loss of identity and relationships for farmers, as well as for the animals in their charge. (shrink)

This article maps out the lexical landscape of precision from the late seventeenth to the early eighteenth century and investigate the various meanings of precision, both as a word and a concept, within the Paris Observatory and beyond. It argues that precision was first an attribute of instruments supposed to produce numerical measurements, like clocks and divided circles or sectors attached to optical devices. Less often, precision was applied to observers, the handling of instruments, and observational methods, including mathematical corrections (...) applied to raw data. When all these aspects were combined the numerical result finally was also deemed to be precise. Moving to the debate about the shape of the Earth that shook the Academy of Sciences in the 1730s, it follows the way in which wider audiences were conveyed the various meanings of precision. Between the Cartesian resistance to the emergence of a professional science of precision and the pedagogical approach followed by the Newtonians such as Maupertuis, it argues that Cassini III embraced the professionalism of modern science, but did not feel that methodological precision was out of the reach of an educated public. While Maupertuis has seemed content with a discussion focusing on the precision of instruments and results, Cassini III set himself the hefty task of producing an accessible account of precision as a method of inquiry. (shrink)

What exactly is a “wicked problem”? It is a social or economic problem that is so complex and so interconnected with other issues that it is extraordinarily difficult or impossible to resolve. This is because all proposed resolutions generate equally complex, equally wicked problems. In this essay, I argue that precision medicine, especially in the context of the U.S. healthcare system, generates numerous wicked problems related to distributive justice. Further, I argue that there are no easy solutions to these wicked (...) problems. The need for trade-offs is inescapable. Rough justice is the best outcome we can hope for, and that outcome requires a commitment to processes of public reason that are fair and inclusive. (shrink)

Berichte zur Wissenschaftsgeschichte, Volume 45, Issue 3, Page 487-498, September 2022.

Berichte zur Wissenschaftsgeschichte, Volume 45, Issue 3, Page 487-498, September 2022.

ABSTRACTThe standard view in philosophy of mind is that the way to understand the difference between perception and misperception is in terms of accuracy. On this view, perception is accurate while...

Galasso calls for “the actualization of the public health potential of precision medicine….as the best realistic contribution to health equity” (Galasso 2024, 83). Unfortunately, this is wishful th...

The science of metrology characterizes the concept of precision in exceptionally loose and open terms. That is because the details of the concept must be filled in—what I call narrowing of the concept—in ways that are sensitive to the details of a particular measurement or measurement system and its use. Since these details can never be filled in completely, the concept of the actual precision of an instrument system must always retain some of the openness of its general characterization. The (...) idea that there is something that counts as the actual precision of a measurement system must therefore always remain an idealization, a conclusion that would appear to hold very broadly for terms and the concepts they express. (shrink)

An uncertainty report describes the extent of an agent’s uncertainty about some matter. We identify two basic requirements for uncertainty reports, which we call faithfulness and completeness. We then discuss two pitfalls of uncertainty assessment that often result in reports that fail to meet these requirements. The first involves adopting a one-size-fits-all approach to the representation of uncertainty, while the second involves failing to take account of the risk of surprises. In connection with the latter, we respond to the objection (...) that it is impossible to account for the risk of genuine surprises. After outlining some steps that both scientists and the bodies who commission uncertainty assessments can take to help avoid these pitfalls, we explain why striving for faithfulness and completeness is important. (shrink)

Blended learning has gained increasing popularity in colleges and universities with mixed results. Precision teaching can effectively promote learning performance. The relation between perceived precision teaching and the learning performance of college students in a blended learning environment is investigated in this paper. In the research survey is featuring a structural model, 256 college students who attended blended learning courses featuring precision teaching participated. The model results revealed that PPT is directly and positively related to self-efficacy and learning motivation. Self-efficacy (...) and learning motivation are directly and positively related to cognitive, teaching, and social presence. Additionally, cognitive, teaching, and social presence are directly and positively related to learning performance. Therefore, PPT is remotely and indirectly related to learning performance. These findings provide a new perspective for the theoretical study on blended learning performance and provide a realistic reference for precision teaching practice in the blended learning environment. (shrink)

Galasso (2024) helpfully puts her finger on what is perhaps the most troubling feature of precision medicine research today: Champions of the science are targeting communities of color and other ma...

BackgroundIn precision medicine biomarkers stratify patients into groups that are offered different treatments, but this may conflict with the principle of equal treatment. While some patient characteristics are seen as relevant for unequal treatment and others not, it is known that they all may influence treatment decisions. How biomarkers influence these decisions is not known, nor is their ethical relevance well discussed.MethodsWe distributed an email survey designed to elicit treatment preferences from Norwegian doctors working with cancer patients. In a forced-choice (...) conjoint analysis pairs of hypothetical patients were presented, and we calculated the average marginal component effect of seven individual patient characteristics, to estimate how each of them influence doctors’ priority-setting decisions.ResultsA positive biomarker status increased the probability of being allocated the new drug, while older age, severe comorbidity and reduced physical function reduced the probability. Importantly, sex, education level and smoking status had no significant influence on the decision.ConclusionBiomarker status is perceived as relevant for priority setting decisions, alongside more well-known patient characteristics like age, physical function and comorbidity. Based on our results, we discuss a framework that can help clarify whether biomarker status should be seen as an ethically acceptable factor for providing unequal treatment to patients with the same disease. (shrink)

The contents of representations in non-human animals, human core cognition, and perception cannot precisely be characterized by sentences of a natural language. However, this fact does not stop us from giving imprecise characterizations of these contents through natural language. In this paper, I develop an account of the precision of content characterizations by appealing to possible-world semantics combined with set and measurement theory.