The article presents the advantages and limitations of adaptive clinical trials for assessing the effectiveness of medical interventions and specifies the conditions that contributed to their development and implementation in clinical practice. I advance two arguments by discussing different cases of adaptive trials. The normative argument is that responsible adaptation should be taken seriously as a new way of doing clinical research insofar as a valid justification, sufficient understanding, and adequate operational conditions are provided. The second argument is historical. The (...) development of adaptive trials can be related to lessons learned from research in cases of urgency and to the decades-long efforts to end the productivity crisis of pharmaceutical research, which led to the emergence of translational, personalized, and, recently, precision medicine movements. (shrink)

This paper is about the history of a question in ancient Greek philosophy and medicine: what holds the parts of a whole together? The idea that there is a single cause responsible for cohesion is usually associated with the Stoics. They refer to it as the synectic cause (αἴτιον συνεκτικόν), a term variously translated as ‘cohesive cause,’ ‘containing cause’ or ‘sustaining cause.’ The Stoics, however, are neither the first nor the only thinkers to raise this question or to propose (...) a single answer. Many earlier thinkers offer their own candidates for what actively binds parts together, with differing implications not only for why we are wholes rather than heaps, but also why our bodies inevitably become diseased and fall apart. This paper assembles, up to the time of the Stoics, one part of the history of such a cause: what is called ‘the synechon’ (τὸ συνέχον) – that which holds things together. Starting with our earliest evidence from Anaximenes (sixth century BCE), the paper looks at different candidates and especially the models and metaphors for thinking about causes of cohesion which were proposed by different philosophers and doctors including Empedocles, early Greek doctors, Diogenes of Apollonia, Plato and Aristotle. My goal is to explore why these candidates and models were proposed and how later philosophical objections to them led to changes in how causes of cohesion were understood. (shrink)

This dissertation explores the influence of time constraints on different research practices. The first two parts present case studies, which serve as a basis for discussing the epistemological and ethical implications of temporal limitations in scientific research. Part I is a case study on gravitational wave research, conducted by the LIGO Scientific Collaboration. This exemplifies fundamental research – without immediate societal applications, open-ended in terms of timeline and in terms of research goals. It is based, in part, on qualitative interviews (...) conducted with gravitational wave physicists. I show that considerations about time and speed play a role in every stage of research: goal setting, method design, and the evaluation and communication of results. Part II provides a case study on translational medicine, an approach explicitly dedicated to accelerating research in order to develop and implement new therapies. This epitomizes applied research with high social stakes, motivated by non-epistemic goals. Here, epistemic trade-offs between speed and reliability intersect with ethical trade-offs between different types of harms. In Part III, the insights from both of these case studies are used as the basis for a more general discussion concerning the pragmatic aspects of epistemic practices, especially in relation to current debates centered on the role of values in science. A particular focus is on the value of speed and the ability to generate reliable results, either via choice of methods, or via decisions about which goals to set, as well as decisions about when to stop further testing. The primary thesis of the dissertation is that pragmatic considerations stemming from limitations of resources are a necessary feature of the pursuit of epistemic aims, and that the epistemic is thus inherently pragmatic. (shrink)

The translational research community, in general, and the Clinical and Translational Science Awards (CTSA) community, in particular, share the vision of repurposing EHRs for research that will improve the quality of clinical practice. Many members of these communities are also aware that electronic health records (EHRs) suffer limitations of data becoming poorly structured, biased, and unusable out of original context. This creates obstacles to the continuity of care, utility, quality improvement, and translational research. Analogous limitations to sharing (...) objective data in other areas of the natural sciences have been successfully overcome by developing and using common ontologies. This White Paper presents the authors’ rationale for the use of ontologies with computable semantics for the improvement of clinical data quality and EHR usability formulated for researchers with a stake in clinical and translational science and who are advocates for the use of information technology in medicine but at the same time are concerned by current major shortfalls. This White Paper outlines pitfalls, opportunities, and solutions and recommends increased investment in research and development of ontologies with computable semantics for a new generation of EHRs. (shrink)

Research on the human microbiome has gen- erated a staggering amount of sequence data, revealing variation in microbial diversity at the community, species (or phylotype), and genomic levels. In order to make this complexity more manageable and easier to interpret, new units—the metagenome, core microbiome, and entero- type—have been introduced in the scientific literature. Here, I argue that analytical tools and exploratory statisti- cal methods, coupled with a translational imperative, are the primary drivers of this new ontology. By reducing (...) the dimensionality of variation in the human microbiome, these new units render it more tractable and easier to interpret, and hence serve an important heuristic role. Nonetheless, there are several reasons to be cautious about these new categories prematurely ‘‘hardening’’ into natural units: a lack of constraints on what can be sequenced metagenomically, freedom of choice in taxonomic level in defining a ‘‘core microbiome,’’ typological framing of some of the concepts, and possible reification of statistical constructs. Finally, lessons from the Human Genome Project have led to a translational imperative: a drive to derive results from the exploration of microbiome variation that can help to articulate the emerging paradigm of per- sonalized genomic medicine (PGM). There is a tension between the typologizing inherent in much of this research and the personal in PGM. (shrink)

Recent studies in the History of Botany put forth that the books translated to and authored in Arabic have circulated from the East of the Caspian Sea, to the centre of Iberian Peninsula, strengthening the ‘traditional uses’ of plants and alike. An ancient genre of writing called the ‘book on the Materia medica’ was especially the most favourite in Medieval Islamic Geography. In these books, algae have been mentioned among the kinds of medicinal plants. In this study, I investigate several (...) Materia medica books among which I shall first focus on Avicenna’s Canon of Medicine, then have a look at Aliboron’s Book of Pharmacy since these two were contemporary sources from the 11th century. I shall also investigate two illustrated sources, an Arabic copy of Dioscorides’ Materia Medica and al-Ghafiqi’s Book on Simple Drugs, both from the 13th century. In doing so, on the one hand, I will be able to compare the drawings of algae, and on the other I will shed light on the transfer of knowledge on algae. These two methods will result in the textual apparatus and the illustrative apparatus in my study. (shrink)

Important achievements were obtained in the fields of mathematics, medicine, chemistry, astronomy, physics, optics, mechanics, zoology, botanic, mineralogy, geography and etc. in the Turkish-Islamic world between the ninth and thirteenth centuries. According to the leading historians of science, scholars living in different parts of the TurkishIslamic world not only surpassed their Greek and Byzantine predecessors. They also paved the way for development of these fields of science for following centuries. It is possible to mention many physicians that left non-erasable (...) marks in the medicine history among these distinguished scholars. One of these names is an Andalusian surgeon-physician called Abul-Qāsim alZahrāwī. He is known for his solid and unique contributions to the surgical world and regarded as the founder of surgery in the TurkishIslamic world. al-Zahrāwī wrote many books. One of these books, called al-Taṣrīf (The Method of Medicine) regarded as a medical encyclopedia has reached until today. The book attracted more attention in the European countries than in the Turkish-Islamic world and had an impact on Europe. Different chapters from the book were translated into languages such as Hebrew, French, English and especially Latin. al-Zahrāwī’s scientific heritage has also been discussed with all its aspects in Russia where scientists in the Turkish-Islamic world have especially been studied. Even though it was translated at a later period than Avicenna’s al-Qānūn fī al-Ṭibb (The Canon of Medicine), al-Taṣrīf was translated into Russian. The aim of this study is to identify Russian studies on Zahrawi and his main work, al-Taṣrīf -within the framework of available opportunitiesand to present prominent ones among these. In conclusion, this article also aims to contribute to the Turkish literature on al-Zahrāwī and al-Taṣrīf. Therefore, the author wishes to assist the relevant ongoing studies and the ones to be conducted in the future in terms of bibliography and material index. (shrink)

In the domain of medical science, factual evidence is usually considered as the criterion on which to base decisions and construct hypotheses. Evidence-based medicine is the translation of this approach into the field of patient care, and it means providing only the type of care that is based on evidence that proves its effectiveness and appropriateness. However, while the literature has focused on the types and force of evidence used to establish the recommendation and treatment guidelines, the problem of (...) how evidence is used in doctor–patient interactions to motivate, or refuse, treatment or habit change has been almost completely neglected. In this specific context, characterized by the epistemic unbalance between the interlocutors and a specific conversational goal, the scientific categories of evidence are often irrelevant. The goal of this paper is to address this challenge by analyzing the role evidence plays in doctor–patient interactions in diabetes care. After introducing an analytical distinction between the epistemic and the pragmatic aspect of evidence, we will propose a classification of the types and functions of evidence in chronic care communication, and illustrate its possible uses through its application to our corpus of diabetes-care consultations. From our qualitative analyses, it is possible to observe how in this communicative context a crucial role is played by the conflicts of evidence, in which providers correct patients’ uses of evidence leading them to using less defeasible levels of evidence. (shrink)

“The Ethics of Infection Challenges in Primates,” by Anne Barnhill, Steven Joffe, and Franklin Miller, is an exceptionally timely contribution to the literature on animal research ethics. Animal research has long been both a source of high hopes and a cause for moral concern. When it comes to infection challenge studies with nonhuman primates, neither the hope—to save thousands of human lives from such diseases as Ebola and Marburg—nor the concern—the conviction that primates deserve especially strong protections—could be much higher. (...) Coming just a few years after the National Institutes of Health adopted the Institute of Medicine's recommendations regarding chimpanzees, Barnhill and colleagues attempt to nudge the clarification and specification—one might say the evolution—of NHP research ethics and regulation. They assert that NHP challenge studies “are not justified by marginal gains in human safety or by efficacy gains that are unlikely to translate directly into saving human lives or preventing morbidity.” How, in turn, is their standard—which, although stringent, does permit causing NHPs to suffer and die for human benefit—to be justified? (shrink)

Extensive scientific, philosophical and artistic activities were carried out in the Islamic World’s various science and civilization centers during the early Middle Ages. In these centers, noteworthy works of mathematics, astronomy, geography, medicine, pharmacology, optics, botany, chemistry and other fields of science, which would later determine improvement paths for these fields, were created. Abu al-Izz Ismail ibn al-Razzaz al-Jazari (12th-13th centuries), was a magnificent Muslim scientist known for his work named The Book of Knowledge of Ingenious Mechanical Devices (Kitab (...) fi ma‘rifati’l-hiyal al-handasiyya) and he was born in geography where many scientists were trained. He contributed to the development of science and civilization, the joint legacy of humanity and demonstrated his true capability and success in the field of ilm al-hiyal (the scientific field which addresses the information and practices regarding mechanical technology and engineering in Islamic science history). From this perspective, it is evident that al-Jazari had a wide field of interest, made his mark in the age he lived in with his brave and innovative ideas, and was a wise engineer. al-Jazari’s detailed descriptions and explanations of water clocks, oil lamp clocks and water pumping machines, as well as their construction, were astounding. In addition, al-Jazari’s studies on metal casting techniques, cone valves, wheel balance and the real-world use of aspiration tubes are important in contemporary engineering studies. When all these are considered, it becomes clear that his designation as the “Leonardo da Vinci of the Islamic World” is not a coincidence. Many studies on al-Jazari’s scientific legacy have been conducted in various parts of the world. There are various manuscripts of his aforementioned book. Based on these manuscripts, the work has been -fully or partially- translated into many languages, including Turkish. The German and English translations served as a basis for studies on al-Jazari in other languages. In recent years, studies conducted on al-Jazari in Türkiye (books, articles, domestic and international symposiums, congresses etc.) have demonstrated his brilliance and competence as a scientist. Furthermore, studies on al-Jazari are still ongoing in Türkiye. As for Russia, the scientific legacy of the scientists raised in the Islamic World such as Avicenna, al-Farabi, Abu Bakr al-Razi, Abu Rayhan al-Biruni, Abu al-Qasim al-Zahrawi, Muhammad ibn Musa al-Khwarizmi, al-Battani, al-Kashi, Abd al-Rahman al-Khazini, Nasir al-Din al-Tusi was researched within the scope of a special plan and program. Depending on the relevant studies, al-Jazari and his work drew attention as well. A small portion of the aforementioned Russian studies is known in Türkiye. It is safe to assume that al-Jazari studies in Russia are virtually unknown in Türkiye. The present study primarily aims to contribute to the literature on the scientific legacy of al-Jazari, a Middle Age Islamic scientist best known for his famous work in the mechanical field. More specifically, the present study aims to: 1) to identify the studies on al-Jazari in Russia, and in the former USSR countries, where academic studies are still in Russian after the Soviet Union period, to create a chronological biography and to set forth their compilation; in other words, to create a bibliography which includes Russian studies on al-Jazari; 2) to provide information on the structure and content of the studies in question, to detect the methodological issues encountered in these works, and make solution recommendations to solve these issues; 3) to contribute to continuing and future studies in Türkiye on al-Jazari in terms of source and material index. In conclusion, it should be stated that comparative reading was conducted centered on The Book of Knowledge of Ingenious Mechanical Devices (Kitab fi ma‘rifati’l-hiyal al-handasiyya). It should also be noted that Russian popular internet publications (which are not based on academic research and are created/reproduced for commercial and personal purposes) were excluded from the assessment. (shrink)

Initially the problems of data integration, for example in the field of medicine, were resolved in case by case fashion. Pairs of databases were cross-calibrated by hand, rather as if one were translating from French into Hebrew. As the numbers and complexity of database systems increased, the idea arose of streamlining these efforts by constructing one single benchmark taxonomy, as it were a central switchboard, into which all of the various classification systems would need to be translated only once. (...) By serving as a lingua franca for database integration this benchmark taxonomy would ensure that all databases calibrated in its terms would be automatically compatible with each other. We describe one strategy for creating such a lingua franca, in which philosophical ontology plays a central role. (shrink)

Descartes is not well known for his contributions to ethics. Some have charged that it is a weakness of his philosophy that it focuses exclusively on metaphysics and epistemology to the exclusion of moral and political philosophy. Such criticisms rest on a misunderstanding of the broader framework of Descartes’ philosophy. Evidence of Descartes’ concern for the practical import of philosophy can be traced to his earliest writings. In agreement of wisdom that is sufficient for happiness. The Third part of his (...) Discourse on the Method presents what he calls a provisional morality, a morality to govern our behaviour while we are in the process of revising our beliefs and coming to certainty. In the tree of philosophy, in the Preface to the French translation of the Principles of Philosophy, morals are listed as one of the fruits of the tree, along with medicine and mechanics. It is also a theme in the letters he exchanged with the Princess Elisabeth of Bohemia in the mid-1640s, together with another concern the passions, what they are, and more importantly, how to control them. These themes are intertwined again in Descartes last major work, The Passions of the Soul (1649). Descartes did not write extensively on ethics, and this has led some to assume that the topic lacks a place within his philosophy. It is an attempt to outline Descartes’ ethical ideas mainly in Discourse on the Method. (shrink)

Intellectual history still quite commonly distinguishes between the episode we know as the Scientific Revolution, and its successor era, the Enlightenment, in terms of the calculatory and quantifying zeal of the former—the age of mechanics—and the rather scientifically lackadaisical mood of the latter, more concerned with freedom, public space and aesthetics. It is possible to challenge this distinction in a variety of ways, but the approach I examine here, in which the focus on an emerging scientific field or cluster of (...) disciplines—the ‘life sciences’, particularly natural history, medicine, and physiology —is, not Romantically anti-scientific, but resolutely anti-mathematical. Diderot bluntly states, in his Thoughts on the interpretation of nature, that “We are on the verge of a great revolution in the sciences. Given the taste people seem to have for morals, belles-lettres, the history of nature and experimental physics, I dare say that before a hundred years, there will not be more than three great geometricians remaining in Europe. The science will stop short where the Bernoullis, the Eulers, the Maupertuis, the Clairauts, the Fontaines and the D’Alemberts will have left it.... We will not go beyond.” Similarly, Buffon in the first discourse of his Histoire naturelle speaks of the “over-reliance on mathematical sciences,” given that mathematical truths are merely “definitional” and “demonstrative,” and thereby “abstract, intellectual and arbitrary.” Earlier in the Thoughts, Diderot judges “the thing of the mathematician” to have “as little existence in nature as that of the gambler.” Significantly, this attitude—taken by great scientists who also translated Newton or wrote careful papers on probability theory, as well as by others such as Mandeville—participates in the effort to conceptualize what we might call a new ontology for the emerging life sciences, very different from both the ‘iatromechanism’ and the ‘animism’ of earlier generations, which either failed to account for specifically living, goal-directed features of organisms, or accounted for them in supernaturalistic terms by appealing to an ‘anima’ as explanatory principle. Anti-mathematicism here is then a key component of a naturalistic, open-ended project to give a successful reductionist model of explanation in ‘natural history’, a model which is no more vitalist than it is materialist—but which is fairly far removed from early modern mechanism. (shrink)

Robotics and artificial intelligence are beginning to fundamentally change the relative profitability and productivity of investments in capital versus human labor; creating technological unemployment at all levels of the workforce; from the North to the developing world. As robotics and expert systems become cheaper and more capable the percentage of the population that can find employment will also fall; stressing economies already trying to curtail "entitlements" and adopt austerity. Two additional technology-driven trends will exacerbate the structural unemployment crisis in the (...) coming decades; desktop manufacturing and anti-aging medicine. Desktop manufacturing threatens to disintermediate the half of all workers involved in translating ideas into products in the hands of consumers; while anti-aging therapies will increase the old age dependency ratio of retirees to tax-paying workers. Policies that are being proposed to protect or create employment will have only a temporary moderating effect on job loss. Over time these policies; which will impose raise costs; lower the quality of goods and services; and lower competitiveness; will become fiscally impossible and lose political support. In order to enjoy the benefits of technological innovation and longer; healthier lives we will need to combine policies that control the pace of replacing paid human labor with a universal basic income guarantee provided through taxation and the public ownership of wealth. The intensifying debate over the reform of "entitlements" will be the strategic opening for a campaign for BIG to replace disability and unemployment insurance; Social Security; and other elements of the welfare state. (shrink)

In the first wave of the COVID-19 pandemic, healthcare workers in some countries were forced to make distressing triaging decisions about which individual patients should receive potentially life-saving treatment. Much of the ethical discussion prompted by the pandemic has concerned which moral principles should ground our response to these individual triage questions. In this paper we aim to broaden the scope of this discussion by considering the ethics of broader structural allocation decisions raised by the COVID-19 pandemic. More specifically, we (...) consider how nations ought to distribute a scarce life-saving resource across healthcare regions in a public health emergency, particularly in view of regional differences in projected need and existing capacity. We call this the regional triage question. Using the case study of ventilators in the COVID-19 pandemic, we show how the moral frameworks that we might adopt in response to individual triage decisions do not translate straightforwardly to this regional-level triage question. Having outlined what we take to be a plausible egalitarian approach to the regional triage question, we go on to propose a novel way of operationalising the ‘save the most lives’ principle in this context. We claim that the latter principle ought to take some precedence in the regional triage question, but also note important limitations to the extent of the influence that it should have in regional allocation decisions. (shrink)

Recent bioethical issues that have emerged in the field of medicine include, but are not limited to, eugenics (artificial insemination), palliative care (end of life care), euthanasia (medical resuscitation), abortion, and the development of enhanced human body parts. These bioethical issues have raised ethical questions related to the use of modern technology and how it may affect the future of society. These questions consider issues such as: what is the identity of future children? Have human beings become a commodity (...) exchanged by those who have the ability to own them? What is the meaning of justice in medical treatment? How can physicians and nurses perform humanitarian work? -/- Discussions of these questions should begin by determining their relationships with typical social and cultural values in society, such as life and death, marriage, family, fatherhood, motherhood, relatives, and next-of-kin. -/- This paper presents a review of the important Arabic literature that has been written on these bioethical issues to show the contributions of Arab scholars in this field. Arabic studies in bioethics can be classified into three types: original Arabic writings, translated studies, and congresses held in the Arab region. (shrink)

Two letters of the “Pythagorean” women Melissa and Myia, addressed to their female friends, are translated into the Russian for the first time. In the introduction, the reader will find background information about the origin of the letters, their textual tradition, their discovery in the beginning of the 19th century, and, finally, the formation of a critical approach to them in the context of the emerging studies of so-called Pseudopythagorica. In the complementary notes to the text, I am placing the (...) letters in the context of an appropriate philosophical tradition and making some textual observations. The translation of these two letters is a part of the research project called on to open a much-neglected page in the history of philosophy, and to show that ignoring secondary sources can often lead to a serious narrow-mindedness in our understanding of ancient philosophical tradition. (shrink)

This is the first French translation of Galen’s De optima doctrina, which articulates his view “On the Best Teaching”. The translation is preceded by an introduction on the context in which this text was written, especially on the relationship of Galen towards scepticism in general and Favorinus of Arles in particular. Although it is hard to characterize this “treatise” in terms of its date of redaction and its form, nonetheless it yields clear information on Galen’s critiques with regards to the (...) “Platonists” and the “Pyrrhonists”. (shrink)

Ibn Djuljul from Andalusia who wrote in the Western Islamic World and Nadīm from Baghdād who wrote in the Eastern Islamic World, give information about lots of physicians and translators in their books that contributed significantly to history of science. Both authors write their books at same time or very close time. Sometimes they offer similar information, but sometimes they provide different information. -/- One of the physicians whom Ibn Djuljul mentioned in his book, Māsarjawayh lived at the times of (...) Umayyads. Nadīm gives information about Māsarjīs who lived at the times of Abbāsids. However, in the course of centuries, some authors combined the knowledge about these two people by giving reference to Ibn Djuljul’s and Nadīm’s work and represented as the same person. Accordingly, most of the modern scholars mentioned the two authors as a substitute. -/- This paper wants to keep track of this confusion and wants to clarify whether Māsarjawayh who was mentioned by Ibn Djuljul and Māsarjīs who was told by Nadīm are the same person or not. (shrink)

Vaccination complacency occurs when perceived risks of vaccine-preventable diseases are sufficiently low so that vaccination is no longer perceived as a necessary precaution. Disease outbreaks can once again increase perceptions of risk, thereby decrease vaccine complacency, and in turn decrease vaccine hesitancy. It is not well understood, however, how change in perceived risk translates into change in vaccine hesitancy. -/- We advance the concept of vaccine propensity, which relates a change in willingness to vaccinate with a change in perceived risk (...) of infection—holding fixed other considerations such as vaccine confidence and convenience. (shrink)

In order to achieve the World Health Organization’s Millennium Development Goal of reducing maternal mortality by three quarters by 2015, a strong global commitment is needed to address this issue in low-income nations where the risk to women is greatest. A comprehensive international effort must include provision of obstetric and general medical care as well as community-based interventions, with an emphasis on the latter in nations where the majority of women deliver babies at home without a trained attendant. Methods: This (...) systematic analysis evaluates interventions published in Medline and CINAHL whose outcome measure is maternal mortality. Analysis includes components of the intervention, nation and maternal death rates. Results: Nine studies documented the effectiveness of various clinical and community-based interventions, including specific drug regimens and procedures, in reducing the risk of maternal death. Six studies reported interventions that did not significantly alter maternal mortality outcomes, and the intervention in one study demonstrated increased risk of maternal death. Conclusion: The dearth of evidence highlights the need for increased focus on translational research that bridges the gap between medical advances and community-based interventions that are feasible in low-income nations. This cannot be accomplished without a stronger commitment to reducing maternal mortality by global health practitioners and researchers. (shrink)

Background: Critically ill patients often require complex clinical care by highly trained staff within a specialized intensive care unit (ICU) with advanced equipment. There are currently limited data on the costs of critical care in low-and middle-income countries (LMICs). This study aims to investigate the direct-medical costs of key infectious disease (tetanus, sepsis, and dengue) patients admitted to ICU in a hospital in Ho Chi Minh City (HCMC), Vietnam, and explores how the costs and cost drivers can vary between the (...) different diseases. -/- Methods: We calculated the direct medical costs for patients requiring critical care for tetanus, dengue and sepsis. Costing data (stratified into different cost categories) were extracted from the bills of patients hospitalized to the adult ICU with a dengue, sepsis and tetanus diagnosis that were enrolled in three studies conducted at the Hospital for Tropical Diseases in HCMC from January 2017 to December 2019. The costs were considered from the health sector perspective. The total sample size in this study was 342 patients. -/- Results: ICU care was associated with significant direct medical costs. For patients that did not require mechanical ventilation, the median total ICU cost per patient varied between US$64.40 and US$675 for the different diseases. The costs were higher for patients that required mechanical ventilation, with the median total ICU cost per patient for the different diseases varying between US$2,590 and US$4,250. The main cost drivers varied according to disease and associated severity. -/- Conclusion: This study demonstrates the notable cost of ICU care in Vietnam and in similar LMIC settings. Future studies are needed to further evaluate the costs and economic burden incurred by ICU patients. The data also highlight the importance of evaluating novel critical care interventions that could reduce the costs of ICU care. (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)

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)

The main objective o f this descriptive paper is to present the general notion of translation between logical systems as studied by the GTAL research group, as well as its main results, questions, problems and indagations. Logical systems here are defined in the most general sense, as sets endowed with consequence relations; translations between logical systems are characterized as maps which preserve consequence relations (that is, as continuous functions between those sets). In this sense, logics together with translations form a (...) bicomplete category of which topological spaces with topological continuous functions constitute a full subcategory. We also describe other uses of translations in providing new semantics for non-classical logics and in investigating duality between them. An important subclass of translations, the conservative translations, which strongly preserve consequence relations, is introduced and studied. Some specific new examples of translations involving modal logics, many-valued logics, para- consistent logics, intuitionistic and classical logics are also described. (shrink)

This paper presents a simple pair of first-order theories that are not definitionally (nor Morita) equivalent, yet are mutually conservatively translatable and mutually 'surjectively' translatable. We use these results to clarify the overall geography of standards of equivalence and to show that the structural commitments that theories make behave in a more subtle manner than has been recognized.

Interpretations are generally regarded as the formal representation of the concept of translation.We do not subscribe to this view. A translation method must indeed establish relative consistency or have some uniformity. These are requirements of a translation. Yet, one can both be more strict or more flexible than interpretations are. In this article, we will define a general scheme translation. It should incorporate interpretations but also be compatible with more flexible methods. By doing so, we want to account for methods (...) that seem to imply a sense of translation but are not reducible to interpretations. The main example will be the relative consistent proof between ZF and NBG given by Novak (1950). Further, we will explore a way of combining interpretations. This should account for truth conditions discarded by interpretations in translated theories. (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)

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)

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)

The entry of resonance into chemistry, or the reception of the theory of resonance in the chemical community, has drawn considerable attention from historians of science. In particular, they have noted Pauling's ¯amboyant yet effective style of exposition, which became a factor in the early popularity of the resonance theory in comparison to the molecular orbital theory, another way of applying quantum mechanics to chemical problems.$ To be sure, the non-mathematical presentation of the resonance theory by Pauling and his collaborator, (...) George Wheland, helped to facilitate the reception ; but this presentation was vulnerable to the confusion that arose among chemists owing to the similarity between resonance and tautomerism, or between foreign and indigenous concepts. The reception occurred at the expense of serious misunderstandings about resonance. This paper investigates the ways in which Pauling and Wheland taught, and taught about, the theory of resonance, especially their ways of coping with the difficulties of translating a quantum-mechanical concept into chemical language. Their different strategies for teaching resonance theory deserve a thorough examination, not only because the strategies had to do with their solutions of the philosophical question whether resonance is a real phenomenon or not, and whether the theory of resonance is a chemical theory or a mathematical method of approximation, but also because this examination will illuminate the role of chemical translators in the transmission of knowledge across disciplinary boundaries. (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)

I consider Ralph Waldo Emerson’s creative appropriation of a philosophical doctrine that helps to make sense of an attitude towards life, its gifts and its burdens, that is often expressed in Puritan diaries. The doctrine, now known as the doctrine of continuous creation, holds that in conserving the world, God re-creates it at every moment, making the same creative effort at each ever-advancing now that God made at the very beginning. Continuous creation was explicitly endorsed by at least one Puritan (...) diarist, Jonathan Edwards, and it helps to explain the intense self-inspection and valiant response to life to which other Puritan diarists (including Emerson's aunt, Mary Moody Emerson) testify. Continuous creation was an important ingredient in the idealism of Edwards and, once translated, it became an important ingredient in the idealism of Emerson. My primary aim to describe Emerson’s creative translation of the doctrine as Edwards understood it, but I also discuss Emerson's relation to the Puritan diary, considered as a literary form. I close by suggesting that for us, a version of the doctrine of continuous creation can perhaps be a source of optimism and an incentive to action, as I believe it was for Emerson. I also comment briefly on Emerson's grateful reliance on text-to-text translations. When Emerson studied translations of sacred texts from around the world, what he heard was not difference and dissent, but agreement: agreement on the very points that united him with Edwards, different as they were in other ways. (shrink)

This paper focuses on the Nigerian Translator-training programmes and its challenges. It is a descriptive research premised on a problem raised by Akakuru that most translation graduates from Nigerian universities can neither translate nor talk about translation. This paper sets out to investigate the validity of the statement and to point out where the problems lie as well as propose some solutions to them. Data for this work were collected from websites of some Nigerian universities that train translators up to (...) the Masters and Ph.D. levels. Data were also collected from the websites of some renowned African, European and Canadian universities that equally train translators up to the Masters and Ph.D. levels and whose graduates are performing well in the field of translation in and out of their countries of origin. A comparative analysis of the data collected reveals some lacuna in the Nigerian Postgraduate Translator-Training Programmes at the levels of the trainees, the trainers and the content of the programmes themselves. The paper further suggests that the way forward for a successful translator-training programme in Nigeria is to adapt and implement the European and the Canadian models. (shrink)

This paper uses Martin Luther and Mao Zedong's translation strategies to philosophize anew the dialectic between the national and the global in the history of revolutions. Luther and Mao each instigated a "revolution" by translating a universal faith into a vernacular; the end product in each case was the globalization of his vernacularized faith and the export of his local revolution all over the world. By vernacularizing a universal faith, Luther and Mao respectively inaugurated a new national idiom, a new (...) national identity and, in the case of Mao, founded a new nation. The far more intriguing phenomenon which I identify – and on which I seek to make my most original contributions is: Protestantism and Maoism developed global reach not despite, but because of, their insistence on a local translation-articulation of a universalist ideology. My paper attends to both the similarities and differences between Luther and Mao. (shrink)

This is a Belarusian translation of an essay interpreting the much-neglected Second Part of Kant's book, Conflict of the Faculties, entitled “An old question raised again: Is the human race constantly progressing?”, by showing the close relationship between the themes it deals with and those Kant addresses in the Supplements and Appendices of Perpetual Peace. In both works, Kant portrays the philosopher as having the duty to promote a “secret article”, without which his vision of a lasting international peace through (...) the agency of a federation of states is bound to fail. Both works identify this article as involving the necessity of publicity as a transcendental condition for peace, and call for philosophers to engage politicians and lawyers in a creative attitude towards lawmaking. Kant’s visionary program has failed to reach its goal up to now, not because it is too idealistic, but because philosophers have failed to take up the challenge. (shrink)

This paper addresses the issue of how it is possible to understand the language of an incommensurable theory. The aim is to defend the idea of translation failure against the objection that it incoherently precludes understanding.

This paper discusses how theories of definition and probabilistic theories of categorization could help distinguish between translation and adaptation, and eventually between translation and adaptation studies. Part I suggests readopting the common parlance definition of “translation” as the accurate rendition of the meaning of a verbal expression in another natural language, and “adaptation” as change that leads to better fit. Readopting these common parlance definitions entails categorical implications. The author discusses three parameters: whereas “translation” represents an invariance-oriented, semiotically invested, cross-lingual (...) phenomenon, “adaptation” refers to a variance-oriented phenomenon, which is not semiotically invested, and entails better fit. Part II discusses how theories of categorization could help distinguish between TS and LFAS. The study of the disciplinarization of knowledge involves epistemic and socio-political conditioners. This section concludes that medium specificity, i.e., the linguistic versus lit-film paradigm, plays a major role in separating TS from LFAS. Another player that deserves more attention is the Romantic as opposed to the Classicist value system. (shrink)

The connections between medicine and well-being are myriad. This paper focuses on the place of well-being in clinical medicine. It is here that different views of well-being, and their connection to concepts like “autonomy” and “authenticity”, both illuminate and are illuminated by looking closely at the kinds of interactions that routinely take place between clinicians, patients, and family members. -/- In the first part of the paper, I explore the place of well-being in a paradigmatic clinical encounter, one (...) where a competent patient interacts with a clinician. The main question here is how, or even whether, the pursuit of patient well-being – however we construe it – figures into a paradigmatic clinical encounter. In the second part of the paper, I consider what I will call a marginal clinical encounter – one where the patient is, as Agnieska Jaworska (1999) puts it, at the “margins of agency” – to theorize about the nature of well-being and to show how different theories of well-being can have dramatic consequences for clinical decision-making. (shrink)

Physicians frequently ask whether they should give patients what they want, usually when there are considerations pointing against doing so, such as medicine’s values and physicians’ obligations. It has been argued that the source of medicine’s values and physicians’ obligations lies in what has been dubbed “the internal morality of medicine”: medicine is a practice with an end and norms that are definitive of this practice and that determine what physicians ought to do qua physicians. In (...) this paper, I defend the claim that medicine requires a morality that is internal to its practice, while rejecting the prevalent characterization of this morality and offering an alternative one. My approach to the internal morality of medicine is constructivist in nature: the norms of medicine are constructed by medical professionals, other professionals, and patients, given medicine’s end of “benefitting patients in need of prima facie medical treatment and care.” I make the case that patients should be involved in the construction of medicine’s morality not only because they have knowledge that is relevant to the internal morality of medicine—namely, their own values and preferences—but also because medicine is an inherently relational enterprise: in medicine the relationship between physician and patient is a constitutive component of the craft itself. The framework I propose provides an authoritative morality for medicine, while allowing for the incorporation, into that very morality, of qualified deference to patient values. (shrink)

Amid criticism of medicine's scientific rigor and patient care, this book offers a philosophical examination of the nature and aims of medicine, and new perspectives on how these challenges can be addressed. It offers input for rethinking the agenda of medical research, healthcare delivery, and the education of healthcare personnel.

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)

In this paper, we present a way to translate the metainferences of a mixed metainferential system into formulae of an extended-language system, called its associated σ-system. To do this, the σ-system will contain new operators (one for each standard), called the σ operators, which represent the notions of "belonging to a (given) standard". We first prove, in a model-theoretic way, that these translations preserve (in)validity. That is, that a metainference is valid in the base system if and only if its (...) translation is a tautology of its corresponding σ-system. We then use these results to obtain other key advantages. Most interestingly, we provide a recipe for building unlabeled sequent calculi for σ-systems. We then exemplify this with a σ-system useful for logics of the ST family, and prove soundness and completeness for it, which indirectly gives us a calculus for the metainferences of all those mixed systems. Finally, we respond to some possible objections and show how our σ-framework can shed light on the “obeying” discussion within mixed metainferential contexts. (shrink)

In the wake of modernism studies' global turn, this article considers the role of translation in fostering Iranian modernism. Focusing on the poetic translations of Bijan Elahi (1945-2010), one of Iran's most significant poet-translators, we demonstrate how untranslatability becomes a point of departure for his experimental poetics. Elahi used premodern Sufi hermeneutics to develop his modernist theory of translation, whereby the alien core of the text is recognised at the centre of the original. As he engages the translated text from (...) many angles, Elahi confounds polarities between innovation and imitation, and authorship and translation, that continue to bifurcate translation studies. In contributing to the globalization of modernist studies, this work adds to our understanding of modernism's entanglement within premodern concepts of creation, as well as to modernism's recreation of tradition from a non-European periphery. (shrink)

In this article we wish to share the work in which the Group of Peirce Studies of the University of Navarra has been involved since 2007: the study of a very interesting part of the extensive correspondence of Charles S. Peirce, specifically, his European letters. Peirce wrote some of these letters over the course of his five trips to Europe (between 1870 and 1883), and wrote others to the many European scientists and intellectuals he communicated with over the course of (...) his life. The translation of those letters has been an excellent practical example of the creative and abductive nature of translation, as well as of the cooperative character of research. Translating Peirce's letters has allowed us a deep study of some theoretical aspects, and at the same time it has permitted us to work creatively and cooperatively to enrich the common vision of this scientist and philosopher. (shrink)

The Indeterminacy of Translation and Radical Interpretation The indeterminacy of translation is the thesis that translation, meaning, and reference are all indeterminate: there are always alternative translations of a sentence and a term, and nothing objective in the world can decide which translation is the right one. This is a skeptical conclusion because what it … Continue reading The Indeterminacy of Translation and Radical Interpretation →.

Darwinian ideas were developed and radically transformed when they were transmitted to the alien intellectual background of late nineteenth- and early twentieth-century China. The earliest references to Darwin in China appeared in the 1870s through the writings of Western missionaries who provided the Chinese with the earliest information on evolutionary doctrines. Meanwhile, Chinese ambassadors, literati and overseas students contributed to the dissemination of evolutionary ideas, with modest effect. The ‘evolutionary sensation’ in China was generated by the Chinese Spencerian Yan Fu’s (...) paraphrased translation and reformulation of Thomas Huxley’s 1893 Romanes Lecture ‘Evolution and ethics’ and his ‘Prolegomena’. It was from this source that ‘Darwin’ became well known in China – although it was Darwin’s name, rather than his theories, that reached Chinese literati’s households. The Origin of Species itself began to receive attention only at the turn of the twentieth century. The translator, Ma Junwu (1881–1940), incorporated non-Darwinian doctrines, particularly Lamarckian and Spencerian principles, into his edition of the Chinese Origin. This partially reflected the importance of the pre-existing Chinese intellectual background as well as Yan Fu’s progressive ‘evolutionary paradigm’. In this paper, I will elucidate Ma Junwu’s culturally conditioned reinterpretation of the Origin before 1906 by investigating his transformation of Darwin’s principal concepts. (shrink)

Modern digital technologies—from web-based services to Artificial Intelligence (AI) solutions—increasingly affect the daily lives of billions of people. Such innovation brings huge opportunities, but also concerns about design, development, and deployment of digital technologies. This article identifies and discusses five clusters of risk in the international debate about digital ethics: ethics shopping; ethics bluewashing; ethics lobbying; ethics dumping; and ethics shirking.