ABSTRACT: Abstract Most modern knowledge is not science. The physical sciences have successfully validated theories to infer they can be used universally to predict in previously unexperienced circumstances. According to the conventional conception of science such inferences are falsified by a single irregular outcome. And verification is by the scientific method which requires strict regularity of outcome and establishes cause and effect. -/- Medicine, medical research and many “soft” sciences are concerned with individual people in complex heterogeneous populations. (...) These populations cannot be tested to demonstrate strict regularity of outcome in every individual. Neither randomised controlled trials nor observational studies in medicine are science in the conventional conception. Establishing and using medical and other “soft science” theories cannot be scientific. It requires conceptually different means: requiring expert judgement applying all available evidence in the relevant available factual matrix. -/- The practice of medicine is observational. Prediction of outcomes for the individual requires professional expertise applying available medical knowledge and evidence. Expertise in any profession can only be acquired through experience. Prior cases are the fundament of knowledge and expertise in medicine. Case histories, studies and series can provide knowledge of extremely high reliability applicable to establishing reliable general theories and falsifying others. Their collation, study and analysis should be a priority in medicine. Their devaluation as evidence, the failure to apply their lessons, the devaluation of expert professional judgement and the attempt to emulate the scientific method are all historic errors in the theory and practice of modern medicine. (shrink)

It is a plausible speculation that conventional choices in outcome measures might influence the results of meta-analyses. We test that speculation by simulating data from trials on antidepressants. We vary real drug effectiveness while modulating conventional values for outcome measures. We had previously shown that one conventional choice used in meta-analyses of antidepressants falls in a narrow range of values that maximize estimates of effectiveness. Our present analysis investigates why this phenomenon occurs. Moreover, our results suggest the (...) superiority of absolute outcome measures over relative measures. This research program can be extended to test numerous other aspects of clinical research. (shrink)

This article develops a constructive criticism of methodological conventionalism. Methodological conventionalism asserts that standards of inductive risk ought to be justified in virtue of their ability to facilitate coordination in a research community. On that view, industry bias occurs when conventional methodological standards are violated to foster industry preferences. The underlying account of scientific conventionality, however, is problematically incomplete. Conventions may be justified in virtue of their coordinative functions, but often qualify for posterior empirical criticism as research advances. Accordingly, (...) industry bias does not only threaten existing conventions but may impede their empirically warranted improvement if they align with industry preferences. My empiricist account of standards of inductive risk avoids such a problem by asserting that conventional justification can be pragmatically warranted but has, in principle, only a provisional status. Methodological conventions, therefore, should not only be defended from preference-based infringements on their coordinative function but ought to be subjected to empirical criticism. (shrink)

Diagnoses are central to the practice of medicine, where they serve a variety of functions for clinicians, patients, and society. They aid communication, explain symptoms, inform predictions, guide therapeutic interventions, legitimize sickness, and authorize access to resources. Insofar as psychiatry is a discipline whose practice is shaped by medical conventions, its diagnoses are sometimes presented as if they serve the same sorts of function as diagnoses in bodily medicine. However, there are philosophical problems that cast doubt on whether (...) the functions of psychiatric diagnoses can legitimately be considered to be equivalent to those of medical diagnoses. The aim of this chapter is to explicate some of these problems, particularly conceptual and epistemological problems pertaining to the roles of diagnoses as explanations. I begin with an overview of the various functions that medical diagnoses normally serve and suggest that many of these functions receive justificatory support from the explanatory roles of the diagnoses. I then present issues regarding the epistemic functions of psychiatric diagnoses and how these issues have featured in the arguments of prominent critics of psychiatry. (shrink)

This paper argues that it is morally irresponsible for modern medical providers or health care institutions to support and advocate the integration of CAM practices (i.e. homeopathy, acupuncture, energy healing, etc.) with conventional modern medicine. The results of such practices are not reliable beyond that of placebo. As a corollary, it is argued that prescribing placebos perceived to stand outside the norm of modern medicine is morally inappropriate. Even when such treatments do no direct physical harm, they (...) create unnecessary barriers to patients' informed understanding of their health. (shrink)

The new Coronavirus, namely Sars-CoV-2, took the world by surprise and grew into a pandemic worldwide in a couple of months since the beginning of 2020. It managed to lockdown at home almost half of the world population under the threat of illness and sudden death. Due to the extreme medical advises of containing the spread and damages of this threat, mostly directed towards social distancing, public gatherings cancelation, and contact tracing, each State imposed such regulations to their people and (...) for all areas of social activity, including the religious ones. This articles analyses four topics: 1. Restrictions imposed by the State and reactions by religious organizations. The theological-ethical response focused on the fact that all religions what to save lives and defeat death. 2. The pandemic shows the sensitive relation between the State and religions and shows the differences in power relations in the different countries. The theological-ethical response calls for a partnership between the State and the religions in their territory. 3. The relation between science and religion is tested during the pandemic. Whereas the majority of believers adhere to scientific results, a good part refuses scientific knowledge. The theological-ethical response of the authors is that science and religion are complementary and not contradictory. 4. Pandemics as situations of high uncertainty are often accompanied by conspiracy theories that claim to know who is guilty for the disaster, who is the scapegoat, which has to be punished. The theological-ethical response gives theological reasons to say no to conspiracies and scapegoats and yes to take responsibility wherever we are in order to save lives. (shrink)

A lively topic of debate in decision theory over recent years concerns our understanding of the different risk attitudes exhibited by decision makers. There is ample evidence that risk-averse and risk-seeking behaviours are widespread, and a growing consensus that such behaviour is rationally permissible. In the context of clinical medicine, this matter is complicated by the fact that healthcare professionals must often make choices for the benefit of their patients, but the norms of rational choice are conventionally grounded in (...) a decision maker’s own desires, beliefs and actions. The presence of both doctor and patient raises the question of whose risk attitude matters for the choice at hand and what to do when these diverge. Must doctors make risky choices when treating risk-seeking patients? Ought they to be risk averse in general when choosing on behalf of others? In this paper, I will argue that healthcare professionals ought to adopt a deferential approach, whereby it is the risk attitude of the patient that matters in medical decision making. I will show how familiar arguments for widely held anti-paternalistic views about medicine can be straightforwardly extended to include not only patients’ evaluations of possible health states, but also their attitudes to risk. However, I will also show that this deferential view needs further refinement: patients’ higher-order attitudes towards their risk attitudes must be considered in order to avoid some counterexamples and to accommodate different views about what sort of attitudes risk attitudes actually are. (shrink)

In this book I show that science suffers from a damaging but rarely noticed methodological disease, which I call rationalistic neurosis. It is not just the natural sciences which suffer from this condition. The contagion has spread to the social sciences, to philosophy, to the humanities more generally, and to education. The whole academic enterprise, indeed, suffers from versions of the disease. It has extraordinarily damaging long-term consequences. For it has the effect of preventing us from developing traditions and institutions (...) of learning rationally devoted to helping us learn how to make progress towards a wiser, more civilized world. On our fragile earth, overcrowded, fraught with injustice, inequality and conflict, menaced by unprecedented and terrifying technological and industrial means for change and destruction, we urgently need to acquire a little more wisdom and civilization if we are to avoid repeating horrors of the kind suffered by so many during the 20th century (and already suffered by many in the first few years of the 21st century). We can ill afford to have in our hands instruments of learning botched and bungled from the standpoint of helping us learn how to live more wisely. It may seem scarcely credible that something as important as our institutions of learning can suffer from wholesale, structural defects. Why has this not been noticed before? Why have not armies of scientists and scholars appreciated the point and, long ago, put the matter right? The answer will emerge as my argument unfolds. I will show that one of the most damaging features of rationalistic neurosis is that it has built-in methodological and institutional mechanisms which effectively conceal that anything is wrong. But there is also an immediately obvious reason: specialization, and the resulting fragmentation of academia, has resulted in a situation in which hardly anyone takes responsibility for the overall ideals, the overall aims and methods, of academic inquiry. Academics, these days, are specialists, furiously trying to keep abreast of developments in their own specialist fields. They have no time, and no inducement, to lift their eyes from their particular disciplines, and look at the whole endeavour. Science has long been under attack, at least since the Romantic movement. Blake objected to “Single vision & Newton’s sleep” and declared that “Art is the Tree of Life... Science is the Tree of Death”. Keats lamented that science will “clip an Angel’s wings” and “unweave a rainbow”. Whereas the Enlightenment had valued science and reason as tools for the liberation of humanity, Romanticism found science and reason oppressive and destructive, and instead valued art, imagination, inspiration, individual genius, emotional and motivational honesty rather than careful attention to objective fact. Much subsequent opposition to science stems from, or echoes, the Romantic opposition of Blake, Wordsworth, Keats and many others. There is the movement Isaiah Berlin has described as the “Counter-Enlightenment” (Berlin, 1979, ch. 1). There is existentialism, with its denunciation of the tyranny of reason, its passionate affirmation of the value and centrality of irrationality in human life, from Dostoevsky, Kierkegaard and Nietzsche to Heidegger and Sartre (see, for example, Barrett, 1962). There is the attack on Enlightenment ideals concerning science and reason undertaken by the Frankfurt school, by postmodernists and others, from Horkheimer and Adorno to Lyotard, Foucault, Habermas, Derrida, MacIntyre and Rorty (see Gascardi, 1999). The soul-destroying consequences of valuing science and reason too highly is a persistent theme in literature: it is to be found in the works of writers such as D.H. Lawrence, Doris Lessing, Max Frisch, Y. Zamyatin. There is persistent opposition to modern science and technology, and to scientific rationality, often associated with the Romantic wing of the green movement, and given expression in such popular books as Marcuse’s One Dimensional Man, Roszak’s Where the Wasteland Ends, Berman’s The Reenchantment of the World and Appleyard’s Understanding the Present. There is the feminist critique of science and conceptions of science: see, for example, Fox Keller (1984) and Harding (1986). And there are the corrosive implications of the so-called “strong programme” in the sociology of knowledge, and of the work of social constructivist historians of science, which depict scientific knowledge as a belief system alongside many other such conflicting systems, having no more right to claim to constitute knowledge of the truth than these rivals, the scientific view of the world being no more than an elaborate myth, a social construct (see Barnes and Bloor, 1981; Bloor, 1991; Barnes, Bloor and Henry, 1996; Shapin and Schaffer, 1985; Shapin, 1994; Pickering, 1984; Latour, 1987). This latter literature has provoked a counter-attack by scientists, historians and philosophers of science seeking to defend science and traditional conceptions of scientific rationality: see Gross and Levitt (1994), Gross, Levitt and Lewis (1996), and Koertge (1998). This debate between critics and defenders of science came abruptly to public attention with the publication of Alan Sokal’s brilliant hoax article ‘Transgressing the boundaries’ in a special issue of the cultural studies journal Social Text in 1996 entitled Science Wars: see Sokal and Bricmont (1998). What does this book have to contribute, given the above avalanche of criticism of science? The criticisms of science developed in this book are diametrically opposed to the above, in so far as the above criticisms oppose scientific rationality, seek to diminish or restrict its influence, or hold that it is unattainable. My central point is that we suffer, not from too much scientific rationality, but from not enough. What is generally taken to constitute scientific rationality is actually nothing of the kind. It is rationalistic neurosis, a characteristic, influential and damaging kind of irrationality masquerading as rationality. Science is damaged by being trapped within a widely upheld but severely defective philosophy of science; free science from this defective philosophy, provide it with a more intellectually rigorous philosophy, and it will flourish in both intellectual and humanitarian terms. And more generally, as we shall see, academic inquiry as a whole is damaged by being trapped within an intellectually defective philosophy of inquiry; free it from this defective philosophy, from its rationalistic neurosis, and it will flourish in intellectual and human terms. It is not reason that is damaging, but defective pretensions to reason — rationalistic neurosis —masquerading as reason. Thus what I seek to do here is the exact opposite of what all those who oppose science and scientific rationality do. I shall argue that Reason, the authentic article, arrived at by generalizing the progress-achieving methods of science, can have profoundly liberating and enriching consequences for all worthwhile, problematic aspects of life, and thus deserves to enter into every aspect of life. The bare bones of the argument of this book can be stated quite simply like this. Science cannot proceed without making the substantial metaphysical assumption that the universe is physically comprehensible (to some extent at least). But this conflicts with the orthodox view that in science everything is assessed impartially with respect to evidence, nothing being permanently assumed independently of evidence. So the metaphysical assumption of comprehensibility is repressed. Science pretends that no such assumption is made. But this damages science. For the assumption is substantial, influential and highly problematic. It needs to be made explicit within science so that it can be critically scrutinized, so that alternatives can be developed and considered. Pretending the assumption is not being made undermines the intellectual rigour of science, its intellectual value and success. And it does not stop there. For science also makes value assumptions. Quite properly, science is concerned to discover that which is of value. New factual knowledge devoid of all value (whether intellectual or practical) does not contribute to science. But the orthodox view of science holds that values have no place within science. As in the case of metaphysics, here too, science pretends that values have no role to play within the intellectual domain of science. And this damages science. For values are, if anything, even more influential and problematic than metaphysics (in influencing the direction of research). Here too, values need to be made explicit within science so that they can be scrutinized, so that alternatives can be developed and assessed. Pretending that values play no role within the intellectual domain damages science; both the intellectual and the practical aspects of science are adversely affected. Science fails to pursue those avenues of research that lie in the best interests of humanity. And it goes further. Science is pursued in a social, cultural, economic and political context. It is a part of various social, economic and political projects which seek to achieve diverse human objectives. But the idea that science is an integral part of humanitarian or political enterprises with political ends clashes, once again, with the official view of science that the aim of science is to improve factual knowledge. The political objectives of science are repressed. And, once again, this damages science. For, of course, the political objectives of science, like all our political objectives, are profoundly problematic. These need to be made explicit so that they can be scrutinized, so that alternatives can be developed and considered. The pretence that science does not have this political dimension once again undermines the intellectual rigour of science, and its human value. It lays science open to becoming a part of economic, corporate and political enterprises that are not in the best interests of humanity. The upshot of the line of argument just indicated is that we need to bring about a revolution in the aims and methods of science, and of academic inquiry more generally. Natural science needs to change; its relationship with the rest of academic inquiry, with social inquiry and the humanities, needs to change; and most importantly and dramatically, academic inquiry as a whole needs to change. The basic task of the academic enterprise needs to become to help humanity learn how to tackle its problems of living in more cooperatively rational ways than at present. We need to put the intellectual tasks of articulating our problems of living, and proposing and critically assessing possible solutions, possible and actual actions, at the heart of academic inquiry. The basic task needs to be to help humanity learn a bit more wisdom – wisdom being the capacity to realize what is of value in life, for oneself and others, wisdom including knowledge and technological know-how, but much else besides. Natural science, despite its flaws, has massively increased our knowledge and technological know-how. This in turn has led to a massive and sometimes terrifying increase in our power to act. Often this unprecedented power to act is used for human good, as in medicine or agriculture. But it is also used to cause harm, whether unintentionally (initially at least) as when industrialization and modern agriculture lead to global warming, destruction of natural habitats and rapid extinction of species, or intentionally, as when the technology of war is used by governments and terrorists to maim and kill. Before the advent of modern science, when we lacked the means to do too much damage to ourselves and the planet, lack of wisdom did not matter too much. Now, with our unprecedented powers to act, bequeathed to us by science, lack of wisdom has become a menace. This is the crisis behind all the other current global crises: science without wisdom. In these circumstances, to continue to pursue knowledge and technological know-how dissociated from a more fundamental quest for wisdom can only deepen the crisis. As a matter of urgency, we need to free science and academia of their neuroses; we need to bring about a revolution in the academic enterprise so that the basic aim becomes to promote wisdom by intellectual and educational means. At present science and the humanities betray both reason and humanity. The argument of this book, which I have just summarized, begins with a discussion of the philosophical and methodological problems that beset theoretical physics. At once, many of those who are concerned about moral, political and environmental issues that plague our world today, will feel impatient. What have the methodological problems of theoretical physics to do with third world poverty, war and the threat of war, pollution, extinction of species, the menace of conventional, chemical, biological and nuclear armaments? I can only plead with such a reader: patience. The root cause of the sickness of our times does indeed lie, I claim, with a methodological sickness of natural science or, even more specifically, of physical science. What makes the modern world so utterly different from all previous ages is our possession of modern science and technology. This is the instrument that has changed the conditions of human life almost beyond all recognition, and put unprecedented, and sometimes terrifying, powers into our hands. One should not dismiss out of hand the suggestion that a part of our problem may lie with this instrument, this engine, of rapid change. We see, here, too, the way in which intellectual specialization, referred to above, has effectively concealed from view the nature and extent of the problem that confronts us. The argument that I shall develop in what follows begins with physics, with problems concerning the aims and methods of physics. But it then leaps to social science, to philosophy, to the humanities, to education, to psychotherapy, and to politics: in the end there is scarcely an aspect of modern life that is not touched and, potentially, affected by the argument. How many academic experts are prepared to follow, to take seriously, an argument that ranges so recklessly across such a wide range of academic disciplines? How many non-academic non-experts? But just this is what the argument and message of this book requires. I hope that the reader will endure with patience the somewhat esoteric discussion concerning the aims and methods of physics pursued in chapter one. This may not seem to have anything much to do with the urgent problems of our times, but it does. This is in part how the intellectual disaster I seek to expose in this book conceals itself from view: it buries itself in the obscure, recondite field of the philosophy of physics. Those who devote their lives to the philosophy of physics are, by and large, too myopic to see how their specialized field of study has anything to do with the great and dreadful humanitarian problems and disasters of our age; and those who are above all concerned with these humanitarian disasters have no time at all for abstruse issues concerning the aims and methods of physics. And so the connection is never made. As it happens, the methodological neurosis of physics, with which we begin in chapter one, is actually a quite simple matter to grasp. It does not require any real knowledge of physics to understand. Indeed, physicists and philosophers of physics are much more likely to find the argument difficult to follow than are non-experts. We non-scientists can stand back and see the whole wood; scientists, trained to think in terms of the current orthodox conception of science, trapped in the thickets of research, will find this much harder to do. In an attempt to take this peculiar circumstance into account, I have arranged the exposition as follows. In chapter one I give a simple exposition of the case for declaring natural science to suffer from what I call "rationalistic neurosis"; this avoids all technicalities, and goes straight to the heart of the matter. In the appendix I tackle a host of more technical objections that may be made to the elementary argument of chapter one. So, those experts in the fields of the philosophy of physics and philosophy of science who find the argument of chapter one naïve and unconvincing, should consult the appendix before tossing the book away in disgust. I write in the hope that there will be a few who will not dismiss out of hand the suggestion that the question of how we are to go about learning how to live in wiser and more civilized ways might have something to learn from scientific learning, and will take the trouble to pursue the line of argument traced out in this book. I write in the hope that these few will grasp just how desperate our situation is, how urgent the need to change the status quo, and will do everything in their power to alert others to the need to heal the methodological sickness from which our institutions and traditions of learning at present suffer. To begin with, we need a campaigning organization, modelled perhaps on "Friends of the Earth", which might be called something like "Friends of Wisdom". (shrink)

The automatic integration of rapidly expanding information resources in the life sciences is one of the most challenging goals facing biomedical research today. Controlled vocabularies, terminologies, and coding systems play an important role in realizing this goal, by making it possible to draw together information from heterogeneous sources – for example pertaining to genes and proteins, drugs and diseases – secure in the knowledge that the same terms will also represent the same entities on all occasions of use. In the (...) naming of genes, proteins, and other molecular structures, considerable efforts are under way to reduce the effects of the different naming conventions which have been spawned by different groups of researchers. Electronic patient records, too, increasingly involve the use of standardized terminologies, and tremendous efforts are currently being devoted to the creation of terminology resources that can meet the needs of a future era of personalized medicine, in which genomic and clinical data can be aligned in such a way that the corresponding information systems become interoperable. (shrink)

Cattle farming is a traditional agricultural system that contributes to the rural economic, social, and cultural values of the communities. Cattle as common with other livestock, are affected by many diseases that cause mortality and economic losses. In many rural households, the use of plants and associated knowledge are popular for managing cattle diseases, especially in areas experiencing challenges with conventional veterinary medicine. Evidence on the documentation of indigenous knowledge and biological evaluation of plants used against cattle diseases (...) remain understudied and fragmented. The aim of the review is to collate and analyze the ethnoveterinary knowledge and biological evaluation of plants used against cattle diseases in South Africa. Different scientific databases were systematically explored to extract data from 37 eligible studies. A total of 310 medicinal plants from 81 families were used to treat 10 categories of cattle diseases across seven (7) provinces in South Africa. Leguminosae (Fabaceae), Compositae (Asteraceae), Asparagaceae, and Xanthorrhoeaceae were the most frequently used plant families. Common plant parts used were leaves and roots. Twenty-seven (27) combination remedies involving 2–6 plants were identified as treatment regimes against cattle diseases. Common preparation methods were infusion and decoction while the administration mode was predominantly unspecified (52%) while oral and topical contributed 26 and 22%, respectively. In terms of diseases, the most treated ones were general systems infection, reproduction disorders, and gastrointestinal problems. Currently, an estimated 21% of the 310 plants have been evaluated for diverse biological activities using relevant bioassays related to cattle diseases. Antibacterial activity remained the most studied biological activity. Evidence from the review revealed the significance of ethnoveterinary medicine against cattle diseases especially in rural areas of South Africa. Nevertheless, the use of plants for cattle diseases among other ethnic groups, particularly in the Northern Cape and Western Cape, remains understudied. (shrink)

Though hair loss (alopecia) is not a debilitating or life threatening sickness, the very thought of becoming bald can lead to emotional stress and traumatic experience for those who suffer from premature or excessive hair loss. Many will try anything and everything to bring back their locks. Or at least, some of their once full head of hair. Hair loss sufferers spend billions of dollars annually on remedies ranging from drugs, vitamins to special tonics and shampoos. Conventional treatments of (...) hair thinning includes drugs therapy and hair transplant. Minoxidil and Propecia (Finasteride) are the only two drugs approved by the FDA for hair growth in men. Minoxidil is the only drug available for women with and rogenetic alopecia. These drugs have been proven to show positive results for balding conditions on the vertex region of the scalp. Though these drugs are effective, many are wary of their unknown long-term effect and potential side-effects. This has led to increase interest in alternative remedies such as herbal medicine. (shrink)

Conventional wisdom has it that truth is always evaluated using our actual linguistic conventions, even when considering counterfactual scenarios in which different conventions are adopted. This principle has been invoked in a number of philosophical arguments, including Kripke’s defense of the necessity of identity and Lewy’s objection to modal conventionalism. But it is false. It fails in the presence of what Einheuser (2006) calls c-monsters, or convention-shifting expressions (on analogy with Kaplan’s monsters, or context-shifting expressions). We show that c-monsters (...) naturally arise in contexts, such as metalinguistic negotiations, where speakers entertain alternative conventions. We develop an expressivist theory—inspired by Barker (2002) and MacFarlane (2016) on vague predications and Einheuser (2006) on counterconventionals—to model these shifts in convention. Using this framework, we reassess the philosophical arguments that invoked the conventional wisdom. (shrink)

This paper examines the interplay of semantics and pragmatics within the domain of film. Films are made up of individual shots strung together in sequences over time. Though each shot is disconnected from the next, combinations of shots still convey coherent stories that take place in continuous space and time. How is this possible? The semantic view of film holds that film coherence is achieved in part through a kind of film language, a set of conventions which govern the relationships (...) between shots. In this paper, we develop and defend a new version of the semantic view. We articulate it for a pair of conventions that govern spatial relations between viewpoints. One such rule is already well-known; sometimes called the "180° Rule," we term it the X-Constraint; to this we add a previously unrecorded rule, the T-Constraint. As we show, both have the effect, in different ways, of limiting the way that viewpoint can shift through space from shot to shot over the course of a film sequence. Such constraints, we contend, are analogous to relations of discourse coherence that are widely recognized in the linguistic domain. If film is to have a language, it is a language made up of rules like these. (shrink)

Truth by convention, once thought to be the foundation of a uniquely promising approach to explaining our access to the truth in nonempirical domains, is nowadays widely considered an absurdity. Its fall from grace has been due largely to the influence of an argument that can be sketched as follows: our linguistic conventions have the power to make it the case that a sentence expresses a particular proposition, but they can’t by themselves generate truth; whether a given proposition is true—and (...) so whether the sentence that expresses it is true—is a matter of what the world is like, which means it isn’t a matter of convention alone. The consensus is that this argument is decisive against truth by convention. Strikingly, though, it has rarely been formulated with much precision. Here I provide a new rendering of the argument, one that reveals its structure and makes transparent just what assumptions it requires, and then I assess conventionalists’ prospects for resisting each of those assumptions. I conclude that the consensus is mistaken: contrary to what is almost universally thought, there remains a promising way forward for the conventionalist project. Along the way, I clarify conventionalists’ commitments by thinking about what truth by convention would need to be like in order for conventionalism to do the epistemological work it’s intended to do. (shrink)

We offer a novel account of metalinguistic comparatives, such as 'Al is more wise than clever'. On our view, metalinguistic comparatives express comparative commitments to conventions. Thus, 'Al is more wise than clever' expresses that the speaker has a stronger commitment to a convention on which Al is wise than to a convention on which she is clever. This view avoids problems facing previous approaches to metalinguistic comparatives. It also fits within a broader framework—independently motivated by metalinguistic negotiations and convention-shiftingexpressions— (...) that gives linguistic conventions a role in the semantics. (shrink)

In philosophy of music, formalists argue that pure instrumental music is unable to represent any content without the help of lyrics, titles, or dramatic context. In particular, they deny that music’s use of convention counts as a genuine case of representation because only intrinsic means of representing counts and conventions are extrinsic to the sound structures making up music. In this paper, I argue that convention should count as a way for music to genuinely represent content for two reasons. First, (...) the view that only intrinsic ways of representing counts is too stringent. If use can ground meaning in language, then use might also ground meaning (and representation) in music, too. Second, even if we were to insist on intrinsic features, convention should count as a way for music to genuinely represent because convention is an intrinsic feature of music. Without knowledge of musical systems and encultured listening, music wouldn’t even be recognized as music, so convention is already baked into our listening practices. (shrink)

My aim in this paper is to discuss a metaphysical framework within which to understand “standard linguistic entities” (SLEs), such as words, sentences, phonemes, and other entities routinely employed in linguistic theory. In doing so, I aim to defuse certain kinds of skepticism, challenge convention-based accounts of SLEs, and present a series of distinctions for better understanding what the various accounts of SLEs do and do not accomplish.

Empiricist philosophers like Carnap invoked analyticity in order to explain a priori knowledge and necessary truth. Analyticity was “truth purely in virtue of meaning”. The view had a deflationary motivation: in Carnap’s proposal, linguistic conventions alone determine the truth of analytic sentences, and thus there is no mystery in our knowing their truth a priori, or in their necessary truth; for they are, as it were, truths of our own making. Let us call this “Carnapian conventionalism”, conventionalismC and cognates for (...) short. This conventionalistC explication of the a priori has been the target of sound criticisms. Arguments like Quine’s in “Truth by Convention” are in our view decisive: the truth of conventionalismC requires that the class of logical truths and logical validities be reductively accounted for as conventionally established; however, no such reduction is forthcoming, because logic is needed to generate the entire class from any given set of conventions properly so-called. Granted that conventionalismC is untenable, we want to take issue with a different, usually made criticism. Although the argument uncovers some difficulties for the way conventionalist claims are defended by some of its advocates, we will try to show that it fails. The criticism thus stands in the way of a proper appreciation of why the Carnapian account of the a priori is not correct. We will try to illustrate this by showing that the criticism we will dispute would dispose of conventionalist claims not only regarding philosophically problematic cases – logical and mathematical truths –, but also regarding cases for which they have some prima facie plausibility. One such case is that of truths that follow from mere abbreviations, “nominal” definitions; ‘someone is a bachelor if and only if he is an unmarried adult male’ can serve at this point for illustration. We will try to articulate a clear sense in which the contents of assertion such as this can be truths by convention. We do not need to prove that a conventionalist claim is true in those cases; it is enough for us to show that it is intelligible, for the arguments we will confront question even this. (shrink)

Are there any bona fide boundaries, i.e., boundaries that carve at the joints? Or is any boundary —hence any object—the result of a fiat articulation reflecting our cognitive biases and our so-cial practices and conventions? Does the choice between these two options amount to a choice between realism and wholesome relativism?

n this thesis I describe how conventions specify how to put normative principles into practice. I identify a class of recurring situations where there are some given normative principles in effect, but they underdetermine what each individual should do, and what is best for an individual depends on what others do. I demonstrate that in such cases, whenever the community develops a response that repeatedly brings them to as good an outcome as is available according to their principles, that response (...) is a Lewisian convention where the benefit of an outcome to each individual is measured by the extent to which it conforms to the principles they subscribe to. Since these conventions are constrained by the normative principles, I call them limited conventions. They are supplements to the principles, and are ineradicably involved in moral action insofar as the abovementioned cases of moral underdetermination are in play. That has the consequence that in these cases the only reliable way to follow your principles is to follow the relevant conventions. As examples of this mechanism I offer a conventionalist analysis of authority, such that the commands of an authority is normative when they instantiate a limited convention, and of the variation in understandings of virtue and vice across societies, such that the evaluative vocabulary of each society is a set of different limited conventions about how to express in word and deed the evaluative points of the virtues and vices in question. Finally, I discuss how conventions and similar forms of guidance provide a way for individuals to participate in their community’s moral life without having a full understanding of the principles that underlie it, or even if they are profoundly ignorant or outright mistaken about the demands of morality. (shrink)

I describe conventions not of correct reasoning but of giving and taking advice about reasoning. This article is asn anticipation of part of the first chapter of my forthcoming *Bounded Thinking*, OUP 2012.

We argue that there is a variety of convention, effective coordinating agreement, that has not been adequately identified in the literature. Its distinctive feature is that it is a structure of conditional we-intentions of parties, unlike more familiar varieties of convention, which are structures of expectations and preferences or obligations. We argue that status functions constitutively involve this variety of convention, and that what is special about it explains, and gives precise content to the central feature of status functions, namely, (...) that objects with status functions can perform their functions only insofar as they have been collectively accepted as having them. (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)

Even in the increasingly individualized American medical system, advocates of 'personalized medicine' claim that healthcare isn't individualized enough. With the additional glamour of new biotechnologies such as genetic testing and pharmacogenetics behind it, 'Me Medicine'-- personalized or stratified medicine-- appears to its advocates as the inevitable and desirable way of the future. Drawing on an extensive evidence base, this book examines whether these claims are justified. It goes on to examine an alternative tradition rooted in communitarian ideals, (...) that of the common good as a goal in medicine. (shrink)

In section 1, I develop epistemic communism, my view of the function of epistemically evaluative terms such as ‘rational’. The function is to support the coordination of our belief-forming rules, which in turn supports the reliable acquisition of beliefs through testimony. This view is motivated by the existence of valid inferences that we hesitate to call rational. I defend the view against the worry that it fails to account for a function of evaluations within first-personal deliberation. In the rest of (...) the paper, I then argue, on the basis of epistemic communism, for a view about rationality itself. I set up the argument in section 2 by saying what a theory of rational deduction is supposed to do. I claim that such a theory would provide a necessary, sufficient, and explanatorily unifying condition for being a rational rule for inferring deductive consequences. I argue in section 3 that, given epistemic communism and the conventionality that it entails, there is no such theory. Nothing explains why certain rules for deductive reasoning are rational. (shrink)

What is special about picturing according to the rules of perspectival drawing systems? My answer is at once both radical and conciliatory. I think that depiction essentially involves a distinctive experience, an experience of resemblance. More precisely, the picture must be seen as preserving what Thomas Reid (Enquiry 1764) called the "visible figure" of what is represented. It follows from this, and from some other plausible premises, that if a picture is to depict detailed spatial arrangements, rather than simply to (...) represent them in some other, non-pictorial, way, it must conform to perspectival rules. Hence the radicalism. Perspective does not provide uniquely accurate or realistic ways to depict things, but, for certain aspects of the world, the only way to depict them at all. What of the conciliatory aspect of my view? My account of depiction in no way implies that only perspectival pictures can depict anything at all. Indeed, it is quite consistent with a good deal of variation in the marks which might, in the right context, depict a given content. But better still, the factors determining what we see a picture as resembling, and hence partially determining what it depicts, are just those factors emphasized by those who take perspective to be a matter of convention. They include, for instance, the nature of the subject's perceptual environment, and the sorts of pictures to which he has previously been exposed. Thus, even given the radical claim, the variety in ways of depicting a given thing is neither incomprehensible nor indicative of some kind of failure. We can understand perspective's special status without denigrating the alternatives. (shrink)

This paper has three objectives. The first is to show how David Lewis' influential account of how a population is related to its language requires that speakers be 'conceptually autonomous' in a way that is incompatible with content ascriptions following from the assumption that its speakers share a language. The second objective is to sketch an alternate account of the psychological and sociological facts that relate a population to its language. The third is to suggest a modification of Lewis' account (...) of convention that will allow one to preserve the claim that there are conventions of language. (shrink)

In this paper, I argue that the concept of normality in medical research and clinical practice is inextricable from the concept of ambiguity. I make this argument in the context of Edmund Pellegrino's call for a renewed reflection on medicine’s basic concepts and by drawing on work in critical disability studies concerning Deafness and body integrity identity disorder. If medical practitioners and philosophers of medicine wish to improve their understanding of the meaning of medicine as well as (...) its concrete practice, I contend that they should take seriously the import and centrality of ambiguity for biomedicine. (shrink)

The issue of how to incorporate the individual's first‐hand experience of illness into broader medical understanding is a major question in medical theory and practice. In a philosophical context, phenomenology, with its emphasis on the subject's perception of phenomena as the basis for knowledge and its questioning of naturalism, seems an obvious candidate for addressing these issues. This is a review of current phenomenological approaches to medicine, looking at what has motivated this philosophical approach, the main problems it faces (...) and suggesting how it might become a useful philosophical tool within medicine, with its own individual, but interrelated, contribution to make to current medical debates. After the general background, there is a brief summary of phenomenological ideas and their current usage in a medical context. Next is a critique of four key claims within current phenomenological medical works, concerning both the role phenomenology plays and the supposedly clear divide between phenomenology and other approaches. There are significant problems within these claims, largely because they overlook the complexity of the questions they consider. Finally, there is some more in‐depth examination of phenomenology itself and the true complexity of phenomenological debate concerning subjectivity. The aim is to show that it will be both more productive and truer to phenomenology itself, if we use phenomenology as a philosophical method for explicating and gaining deeper understanding of complex and fundamental problems, which are central to medicine, rather than as providing simple, but flawed solutions. (shrink)

This paper argues against the conception of sport as theatre. Theatre and sport share the characteristic that play is set in a conventionally-defined hypothetical reality, but they differ fundamentally in the relative importance of audience and the narrative point of view. Both present potential for participants for development of selfhood through play and its personal possibilities. But sport is not essentially tied to audience as is theatre. Moreover, conceptualising sport as a form of theatre valorises the spectator’s narrative as normative (...) for sport experience over that of the participant athlete or player, eliding player experience. Imposition of external narratives over experience risks fossilising interpretation and inhibits the beneficial effects of play for self-realisation, especially as a form of self-examination and creation through internal self-narrative. (shrink)

What is the relation between norms (in the sense of ?socially accepted rules?) and conventions? A number of philosophers have suggested that there is some kind of conceptual or constitutive relation between them. Some hold that conventions are or entail special kinds of norms (the ?conventions-as-norms thesis?). Others hold that at least some norms are or entail special kinds of conventions (the ?norms-as-conventions thesis?). We argue that both theses are false. Norms and conventions are crucially different conceptually and functionally in (...) ways that make it the case that it is a serious mistake to try to assimilate them. They are crucially different conceptually in that whereas conventions are not normative and are behaviour dependent and desire dependent, norms are normative, behaviour independent, and desire independent. They are crucially different functionally in that whereas conventions principally serve the function of facilitating coordination, norms principally serve the function of making us accountable to one another. (shrink)

To date there are no studies examining the ability to make a moral/conventional transgression distinction in adolescent offenders with psychopathic traits. Based on the Psychopathy Checklist: Youth Version, we compared males with high (HP, n = 45), medium (MP, n = 31) and low psychopathy scores (LP, n = 39) on the moral convention distinction task. Under normal rule conditions the psychopathy groups did not differ in their ability to make a moral/conventional distinction. The HP group tended to (...) view both transgression types as more permissible and conventional transgressions as less serious, than the LP group. Under modified rule conditions, the HP group exhibited reduced moral/conventional distinction scores com- pared to the MP group. The findings only partially replicate findings from previous M/C studies in children and adults with psychopathic traits. The work fits with more recent reports suggesting that psychopathy is not strongly associated with marked difficulties in cognitive theory of mind, perspective taking and moral judgements. Future studies should focus on the affective aspects of moral reasoning in offender samples. (shrink)

Conspiracy theories should be neither believed nor investigated - that is the conventional wisdom. I argue that it is sometimes permissible both to investigate and to believe. Hence this is a dispute in the ethics of belief. I defend epistemic ‘oughts’ that apply in the first instance to belief-forming strategies that are partly under our control. I argue that the policy of systematically doubting or disbelieving conspiracy theories would be both a political disaster and the epistemic equivalent of self-mutilation, (...) since it leads to the conclusion that history is bunk and the nightly news unbelievable. In fact (of course) the policy is not employed systematically but is only wheeled on to do down theories that the speaker happens to dislike. I develop a deductive argument from hard-to-deny premises that if you are not a ‘conspiracy theorist’ in my anodyne sense of the word then you are an ‘idiot’ in the Greek sense of the word, that is, someone so politically purblind as to have no opinions about either history or public affairs. The conventional wisdom can only be saved (if at all) if ‘conspiracy theory’ is given a slanted definition. I discuss some slanted definitions apparently presupposed by proponents of the conventional wisdom (including, amongst others, Tony Blair) and conclude that even with these definitions the conventional wisdom comes out as deeply unwise. I finish up with a little harmless fun at the expense of David Aaronvitch whose abilities as a rhetorician and a popular historian are not perhaps matched by a corresponding capacity for logical thought. (shrink)

This is a volume of twelve essays concerning the fundamental tension in personalised medicine between individual choice and the common good.

Part of a symposium devoted to ‘Prediction, Understanding, and Medicine’, in which Alex Broadbent argues that the nature of medicine is determined by its competences, i.e., which things it can do well. He argues that, although medicine cannot cure well, it can do a good job of enabling people not only to understand states of the human organism and of what has caused them, but also to predict future states of it. From this Broadbent concludes that (...) class='Hi'>medicine is (at least in part) essentially a practice of understanding and predicting, not curing. In reply to this bold position, I mount two major criticisms. First, I maintain that the reasons Broadbent gives for doubting that medicine can cure provide comparable reason for doubting that medicine can provide an understanding; roughly, the best explanation of why medicine cannot reliably cure is that we still lack much understanding of health and disease. Second, I object to the claim that a practice is medical only if it facilitates understanding and prediction. Although Broadbent has brought to light certain desirable purposes of medicine that are under-appreciated, my conclusion is that he has not yet provided enough reason to think that understanding and prediction are essential to it. Instead of supposing that medicine has an essence, in fact, I suggest that its nature is best understood in terms of a property cluster. (shrink)

A persistent worry concerning conventionalist accounts of law is that such accounts are ill equipped to account for law’s special normativity. I offer a particular kind of conventionalist account that is based on the practice-dependent account of conventional norms I have offered elsewhere and consider whether it is vulnerable to the Normativity Objection. I argue that it isn’t. It can account for all the ways in which law can justly claim to be normative. While there are ways of being (...) normative that it cannot account for, it is an error to suppose that law is normative in any of those ways. (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)

Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue (...) that draws both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. (shrink)

A linguistic convention is a principle or norm that has been adopted by a person or linguistic community about how to use, and therefore what the meaning is of, a specific term. Examples of such norms or principles are those expressed by propositions that express the laws of logic or those that express implicit definitions. Arguments about the epistemic status of linguistic conventions, very broadly, fall into two camps: the one holds that the basis of linguistic conventions is objective and (...) that, therefore, such conventions are genuinely truth-bearing. Knowledge of such conventions is therefore knowledge of the objective truth of such conventions. This camp might be labelled ‘realist’. The other holds that there is no known basis to linguistic conventions and that conventions are, to the best of our knowledge, not objective, but invented. Their truth is stipulated by the relevant speaker or linguistic community. Such truth is, consequently, trivial and knowledge of such conventions simply knowledge of the stipulation. This camp might be labelled ‘anti-realist’. These are three standard accounts of the epistemic status of linguistic conventions, which all play into the first camp: (1) knowledge by intuition, (2) inferential a priori knowledge and (3) a posteriori knowledge. I give reasons why these accounts should be rejected. I then argue that linguistic conventions, if conceived of as trivial truths, are knowable non-inferentially a priori. Such an epistemic account provides support for the second camp. In this regard, I marshal support from some recent work by Wright and Hale. (shrink)

Abstract Conspiracy theories should be neither believed nor investigated - that is the conventional wisdom. I argue that it is sometimes permissible both to investigate and to believe. Hence this is a dispute in the ethics of belief. I defend epistemic “oughts” that apply in the first instance to belief-forming strategies that are partly under our control. But the beliefforming strategy of not believing conspiracy theories would be a political disaster and the epistemic equivalent of selfmutilation. I discuss several (...) variations of this strategy, interpreting “conspiracy theory” in different ways but conclude that on all these readings, the conventional wisdom is deeply unwise. (shrink)

Through this contribution I aim to explore the horizons and limits of digital medicine in light of an embodied approach to the issue of care. I will sketch the historical background of digital medicine and show the contemporary status of this interdisciplinary field, as well as its applications and outcomes. Then, I will address a critique of the computational theory of mind (CTM) upon which many contemporary mental health apps are designed. This approach to the mind is inscribed (...) into the modern trend of neuromania, which conceives the embodied, living human being as a mere series of data analyses and algorithms, with the brain as the seat of the person. Drawing on continental philosophy and classical phenomenology I will develop a notion of health conceived as a moral enterprise, showing how wellbeing and vitality are not reducible to a product made by technologies or doctors, but rather they are the results of an embodied encounter. As such, empathy and person-centered care cannot be achieved by digital medicine. They are the result of a journey into the regions of recognition, embodied presence and the aliveness constituting the person. Finally, I will show how the issue of care cannot be separated from an embodied encounter between people, especially in case of dementia. (shrink)

Recent work in personal identity has emphasized the importance of various conventions, or ‘person-directed practices’ in the determination of personal identity. An interesting question arises as to whether we should think that there are any entities that have, in some interesting sense, conventional identity conditions. We think that the best way to understand such work about practices and conventions is the strongest and most radical. If these considerations are correct, persons are, on our view, conventional constructs: they are (...) in part constituted by certain conventions. A person exists only if the relevant conventions exist. A person will be a conscious being of a certain kind combined with a set of conventions. Some of those conventions are encoded in the being itself, so requiring the conventions to exist is requiring the conscious being to be organized in a particular way. In most cases the conventions in question are settled. There is no dispute about what the conventions are, and thus no dispute about which events a person can survive. These are cases where we take the conventions so much for granted, that it is easy to forget that they are there, and that they are necessary constituents of persons. Sometimes though, conventions are not settled. Sometimes there is a dispute about what the conventions should be, and thus a dispute about what events a person can survive. These are the traditional puzzle cases of personal identity. That it appears that conventions play a part in determining persons’ persistence conditions only in these puzzle cases is explained by the fact that only in these cases are the conventions unsettled. Settled or not though, conventions are necessary constituents of persons. (shrink)

If one had to identify the biggest change within the philosophical tradition in the twenty-first century, it would certainly be the rapid rise of experimental philosophy to address differences in intuitions about concepts. It is, therefore, surprising that the philosophy of medicine has so far not drawn on the tools of experimental philosophy in the context of a particular conceptual debate that has overshadowed all others in the field: the long-standing dispute between so-called naturalists and normativists about the concepts (...) of health and disease. In this paper, I defend and advocate the use of empirical methods to inform and advance this and other debates within the philosophy of medicine. (shrink)

Can hybridism about moral claims be made to work? I argue it can if we accept the conventional implicature approach developed in Barker (Analysis 2000). However, this kind of hybrid expressivism is only acceptable if we can make sense of conventional implicature, the kind of meaning carried by operators like ‘even’, ‘but’, etc. Conventional implictures are a form of pragmatic presupposition, which involves an unsaid mode of delivery of content. I argue that we can make sense of (...) conventional implicatures, but doing so requires we embrace a form of pure, non-hybrid expressivism. This is a cognitivist expressivism I have developed elsewhere. We need cognitivist expressivism to make sense of how we evaluate—judge as correct or incorrect—implicature-bearing sentences. Once we embraced the possibility of this pure expressivism, we might as well be pure expressivists about normative discourse too. I show how we can do that. The motivations for a specifically hybrid theory are dialectically undercut. (shrink)

David Tomasi presents new, groundbreaking research on the science and application of Mind-Body Medicine strategies to improve clinical outcomes in inpatient psychiatry settings. Much more than a list of therapeutic recommendations, this book is a thorough description of how Mind-Body Medicine can be successfully applied, from a therapeutic as well as from an organizational, cost-effective analysis viewpoint, to the full spectrum of psychiatric treatments. Furthermore, this study examines the role of multidisciplinary and interdisciplinary treatment teams, with a special (...) focus on the profession and the role of psychotherapists and group therapists, thereby providing solid scientific evidence of the benefits of patient-provider therapeutic alliances. In this sense, this book serves as a guide for professionals and institutions both in the private and the public sphere, to learn effective treatment and management strategies. About the Author Psychotherapist, Researcher, and Philosopher Dr. David Låg Tomasi is the author of Medical Philosophy (ibidem, 2016) and the co-author of Positive Patient Response to a Structured Exercise Program Delivered in Inpatient Psychiatry (Global Advances in Health and Medicine, 2019), the most-read research item from the University of Vermont (Researchgate, 2019). A member of several national and international Academies of Sciences, Dr. Tomasi works in the Inpatient Psychiatry Unit at the UVM Medical Center, and teaches at the University of Vermont and the Community College of Vermont. ---- Ibidem / Columbia University Press. (shrink)

Existing metasemantic projects presuppose that word- (or sentence-) types are part of the non-semantic base. We propose a new strategy: an endogenous account of word types, that is, one where word types are fixed as part of the metasemantics. On this view, it is the conventions of truthfulness and trust that ground not only the meaning of the words (meaning by convention) but also what the word type is of each particular token utterance (words by convention). The same treatment extends (...) to identifying the populations through which the conventions prevail. We consider whether this proposal leads to new underdetermination challenges for metasemantics, and make a case that it does not. (shrink)