Pains are subject to obvious, well-documented, and striking top-down influences. This is in stark contrast to visual perception, where the debate over cognitive penetrability tends to revolve around fairly subtle experimental effects. Several authors have recently taken up the question of whether top-down effects on pain count as cognitive penetrability, and what that might show us about traditional debates. I review some of the known mechanisms for top-down modulation of pain, and suggest that it reveals an issue with a relatively (...) neglected part of the cognitive penetrability literature. Much of the debate inherits Pylyshyn’s stark contrast between transducers and cognition proper. His distinction grew out of his running fight with Gibson, and is far too strong to be defensible. I suggest that we might therefore view top-down influences on pain as a species of transducer calibration. This provides a novel but principled way to distinguish between several varieties of top-down effect according to their architectural features. (shrink)

Nada Gligorov (2018), in this issue’s target article, covers a lot of ground concerning the science and ethics of pain management. I find substantial chunks of her argument compelling, including he...

Unlike its friendly cousin the placebo effect, the nocebo effect (the effect of expecting a negative outcome) has been almost ignored. Epistemic and ethical confusions related to its existence have gone all but unnoticed. Contrary to what is often asserted, adverse events following from taking placebo interventions are not necessarily nocebo effects; they could have arisen due to natural history. Meanwhile, ethical informed consent (in clinical trials and clinical practice) has centred almost exclusively on the need to inform patients about (...) intervention risks with patients to preserve their autonomy. Researchers have failed to consider the harm caused by the way in which the information is conveyed. In this paper, I argue that the magnitude of nocebo effects must be measured using control groups consisting of untreated patients. And, because the nocebo effect can produce harm, the principle of non-maleficence must be taken into account alongside autonomy when obtaining (ethical) informed consent and communicating intervention risks with patients. (shrink)

Unlike its friendly cousin the placebo effect, the nocebo effect has been almost ignored. Epistemic and ethical confusions related to its existence have gone all but unnoticed. Contrary to what is often asserted, adverse events following from taking placebo interventions are not necessarily nocebo effects; they could have arisen due to natural history. Meanwhile, ethical informed consent has centred almost exclusively on the need to inform patients about intervention risks with patients to preserve their autonomy. Researchers have failed to consider (...) the harm caused by the way in which the information is conveyed. In this paper, I argue that the magnitude of nocebo effects must be measured using control groups consisting of untreated patients. And, because the nocebo effect can produce harm, the principle of non-maleficence must be taken into account alongside autonomy when obtaining informed consent and communicating intervention risks with patients. There are no data in this work. (shrink)