This chapter appeared in: G. J. van Nes et al. (eds.), Relational Anthropology for Contemporary Economics. Dordrecht: Springer, 121-132. -/- Abstract: This chapter is a comment on the contribution of Rebecca Klein in this volume, preceded by a conceptual analysis of the argument that is developed in the Homo Amans position paper. The main question that is raised is twofold and concerns the relation between science and worldview on the one hand, and between science and economic life on the other. (...) With respect to the science – worldview relationship, it is doubted that science can play the role the authors of the Homo Amans project expect it can have. What they have in mind is that science helps in validating and legitimizing a biblically informed concept of love. This author disagrees, to a large extent. Science can indeed orient itself on ideas and intuitions that are based on one’s worldview. But it cannot prove the truth of these intuitions and ideas. To think so, is to commit a naturalistic fallacy. With respect to the relationship between science and economic life, the author is also not convinced that science and philosophy as academic disciplines will by themselves be able (and should be expected to be able) to transform deeply ingrained, institutionally anchored economic practices. New theories, concepts, and paradigms are a precondition for change, but they do not bring about change by themselves. What is needed is a change in the practices themselves, a change that is both personal and comprehensive. What is needed is a clear, succinct, and encompassing view on the intrinsic normativity of economic interactions between relevant stakeholders in what we call ‘the’ economy. This is a huge undertaking, that requires painstaking ‘phenomenological’ analyses of a wide variety of economic practices. The chapter agrees with most of Klein’s observations and concerns with respect to the position paper. These observations and concerns gain even more depth and relief given the conceptual distinctions that are made in the chapter. (shrink)

The title of this article is ambiguous in the sense that it may direct the attention to either theism as a system of beliefs of persons who are referring to particular facts that serve as external grounds for the foundation of theist beliefs or to theism as a system of beliefs of persons who are convinced of theism’s truth on grounds that are intrinsic to their belief . Traces of both conceptions of theism can be found in Alvin Plantinga’s thesis (...) of the ‘proper basicality’ of religious belief, for instance in the distinction between evidence of the ‘on the basis of …’- type and evidence of the ‘inclination’- type. However, these two types of evidence do only lead to doxastic experience. In order to be warranted with respect to a particular knowledge claim, beliefs must be produced by noetic capacities that function properly, i.e. according to their design plan and in contexts that are appropriate to these capacities. This externalist epistemology exerts its greatest power in the criticism of the ‘evidentialist objection to belief in God’. However, it raises a number of objections with respect to its positive account of theism. When every community of thinkers creates its own relevant set of examples in order to establish criteria of proper basicality, does this not lead to skepticism? And, can doxastic experience not be honoured as a proper response to being called by divine discourse and, correspondingly, be seen as the relational foundation of theist belief? (shrink)

What is the purpose of Friesen’s 95 theses and what is the audience he has in mind? The title refers to a major church historical event and suggests that — like in 1517 — we are dealing with a concise statement of a new and radical doctrine that is unfolded in opposition to an established canon. But who is the opponent in this case? What is the established canon that is rejected? And what is new or radical in the summary? (...) Dooyeweerd’s philosophy was definitely new and radical at the time of its conception. It still has an enormous potential for the special sciences. It offers important resources for any critique of ‘immanence’ philosophies. However, on first reading and without knowledge of the context, Friesen does not seem to aim at offering a new or radical interpretation of Dooyeweerd’s philosophy. I read the 95 theses as an attempt to wipe off the dust, to provide the overall picture, doing justice to aspects that were neglected or were wrongly understood in the reformational tradition. However, the audience he has in mind seems to be one that is already familiar with the basic concepts and the thrust of Dooyeweerdian thinking; not an audience that is opposed to reformational philosophical thinking, but one that might be helped by a succinct summary in order to encourage further study and discussion. (shrink)

In 1968, Jürgen Habermas claimed that, in an advanced technological society, the emancipatory force of knowledge can only be regained by actively recovering the ‘forgotten experience of reflection’. In this article, we argue that, in the contemporary situation, critical reflection requires a deliberative ambiance, a process of mutual learning, a consciously organised process of deliberative and distributed reflection. And this especially applies, we argue, to critical reflection concerning a specific subset of technologies which are actually oriented towards optimising human cognition. (...) In order to create a deliberative ambiance, fostering critical upstream reflection on emerging technologies, we developed the concept of a mutual learning exercise. Building on a number of case studies, we analyse what an MLE involves, both practically and conceptually, focussing on key aspects such as ambiance and expertise, the role of ‘genres of the imagination’ and the profiles of various ‘subcultures of debate’. Ideally, an MLE becomes a contemporary version of the Socratic agora, providing a stage where multiple and sometimes unexpected voices and perspectives mutually challenge each other, in order to strength-en the societal robustness and responsiveness of emerg-ing technologies. (shrink)

In this paper, we explore the conceptual problems arising when using network analysis in person- centered care (PCC) in psychiatry. Personalized network models are potentially helpful tools for PCC, but we argue that using them in psychiatric practice raises boundary problems, i.e., problems in demarcating what should and should not be included in the model, which may limit their ability to provide clinically-relevant knowledge. Models can have explanatory and representational boundaries, among others. We argue that we can make more explicit (...) what kind of questions personalized network models can address in PCC, given their representational and explanatory boundaries, using perspectival reasoning. (shrink)

In this position paper, we have used Alan Cooper’s persona technique to illustrate the utility of audio- and video-based AAL technologies. Therefore, two primary examples of potential audio- and video-based AAL users, Anna and Irakli, serve as reference points for describing salient ethical, legal and social challenges related to use of AAL. These challenges are presented on three levels: individual, societal, and regulatory. For each challenge, a set of policy recommendations is suggested.

Neuroenhancement involves the use of neurotechnologies to improve cognitive, affective or behavioural functioning, where these are not judged to be clinically impaired. Questions about enhancement have become one of the key topics of neuroethics over the past decade. The current study draws on in-depth public engagement activities in ten European countries giving a bottom-up perspective on the ethics and desirability of enhancement. This informed the design of an online contrastive vignette experiment that was administered to representative samples of 1000 respondents (...) in the ten countries and the United States. The experiment investigated how the gender of the protagonist, his or her level of performance, the efficacy of the enhancer and the mode of enhancement affected support for neuroenhancement in both educational and employment contexts. Of these, higher efficacy and lower performance were found to increase willingness to support enhancement. A series of commonly articulated claims about the individual and societal dimensions of neuroenhancement were derived from the public engagement activities. Underlying these claims, multivariate analysis identified two social values. The Societal/Protective highlights counter normative consequences and opposes the use enhancers. The Individual/Proactionary highlights opportunities and supports use. For most respondents these values are not mutually exclusive. This suggests that for many neuroenhancement is viewed simultaneously as a source of both promise and concern. (shrink)

Ambient assisted living technologies are increasingly presented and sold as essential smart additions to daily life and home environments that will radically transform the healthcare and wellness markets of the future. An ethical approach and a thorough understanding of all ethics in surveillance/monitoring architectures are therefore pressing. AAL poses many ethical challenges raising questions that will affect immediate acceptance and long-term usage. Furthermore, ethical issues emerge from social inequalities and their potential exacerbation by AAL, accentuating the existing access gap between (...) high-income countries and low and middle-income countries. Legal aspects mainly refer to the adherence to existing legal frameworks and cover issues related to product safety, data protection, cybersecurity, intellectual property, and access to data by public, private, and government bodies. Successful privacy-friendly AAL applications are needed, as the pressure to bring Internet of Things devices and ones equipped with artificial intelligence quickly to market cannot overlook the fact that the environments in which AAL will operate are mostly private. The social issues focus on the impact of AAL technologies before and after their adoption. Future AAL technologies need to consider all aspects of equality such as gender, race, age and social disadvantages and avoid increasing loneliness and isolation among, e.g. older and frail people. Finally, the current power asymmetries between the target and general populations should not be underestimated nor should the discrepant needs and motivations of the target group and those developing and deploying AAL systems. Whilst AAL technologies provide promising solutions for the health and social care challenges, they are not exempt from ethical, legal and social issues. A set of ELSI guidelines is needed to integrate these factors at the research and development stage. (shrink)

Neuroenhancement involves the use of neurotechnologies to improve cognitive, affective or behavioural functioning, where these are not judged to be clinically impaired. Questions about enhancement have become one of the key topics of neuroethics over the past decade. The current study draws on in-depth public engagement activities in ten European countries giving a bottom-up perspective on the ethics and desirability of enhancement. This informed the design of an online contrastive vignette experiment that was administered to representative samples of 1000 respondents (...) in the ten countries and the United States. The experiment investigated how the gender of the protagonist, his or her level of performance, the efficacy of the enhancer and the mode of enhancement affected support for neuroenhancement in both educational and employment contexts. Of these, higher efficacy and lower performance were found to increase willingness to support enhancement. A series of commonly articulated claims about the individual and societal dimensions of neuroenhancement were derived from the public engagement activities. Underlying these claims, multivariate analysis identified two social values. The Societal/protective highlights counter normative consequences and opposes the use enhancers. The Individual/proactionary highlights opportunities and supports use. For most respondents these values are not mutually exclusive. This suggests that for many neuroenhancement is viewed simultaneously as a source of both promise and concern. (shrink)

Understanding Hegel's account of particularity has proven to be anything but straightforward. Two main accounts of particularity have been advanced: the particular as an example or instance and the particular as a subjective perspective on a universal concept. The problem with these accounts is that they reduce particularity either to singularity or to universality. As Derrida's analyses make apparent, the ‘structure of exemplarity’ in Hegel is quite intricate. Hegel uses ‘example’ in three senses: it means (1) ‘instance’, ‘illustration’, or (2) (...) ‘model’, ‘exemplary individual’, ‘paradigm’, or (3) a by-play (a meaning derived from Hegel's neologismbeiherspielen, in whichBeispielis understood quasi-etymologically as a ‘by-play’ of accidental moments). ABeispielin the first sense can be replaced by another instance in a free play (by-play). This play of accidental moments, however, is not entirely free; it generates a series (of replacements) that ultimately leads to an example in the second sense, to an exemplary individual. I argue that particularity can be taken as exemplarity of this kind, oscillating between a singular example and a universal paradigm. Within this by-play, the universal concept, its law, is supposed to be mediated and determined. However, out of the differences between the examples the by-play induces another law, the law of non-mediation, which may, in Derrida's view, actually negate the dialectical movement towards universality. I argue, utilizing Malabou's concept of plasticity, that this disruption may be recovered. This implies that each individual example within a series is a particular determination of the universal. Hence, we can take literally Hegel's claim that the movement of the concept is play. (shrink)

The paper deals with the formalistic view on music presented in Eduard Hanslick’s treatise On the Musically Beautiful, which is taken to be the foundingwork of the aesthtetics of music. In the paper I propose an interpretation of Hanslick’s treatise which differs on many points from the interpretations displayed in the works of several most influential contemporary aestheticians of music. My main thesis is that Hanslick’s treatise is misunderstood and incorrectly presented by these authors. I try to demonstrate this (...) thesis by referring to Hanslick’s original formulations in the German edition and by showing that my interpretation renders Hanslick’s view far more coherent and his arguments successful in showing his main conclusions. Accepting this alternative interpretation should have further implications on many contemporary theories in the aesthetics of music that reckon on the failure of Hanslick’s arguments as presented by usual interpretations. (shrink)

Ich möchte philosophische Ideen von Hilary Putnam, Crispin Wright, Donald Davidson und George Eduard Moore zusammenbringen, um hieb- und stichfest zu beweisen, dass die beste skeptische Hypothese (gegen unser Wissen um die Beschaffenheit der Aussenwelt) nicht zutreffen kann. Putnams Externalismus, Wrights zusätzlicher Appell an Disquotationsprinzipien, Davidsons wahrheitskonditionale Semantik und Moores Verweis auf seine eigenen Hände lassen sich zu einem vierzeiligen Beweis verschmelzen, dessen Konklusion besagt, dass wir nicht von Anbeginn Gehirne im Tank sein können.

This chapter explores some of the major developments in the philosophical understanding of suicide in 19th Century Western thought. Two developments in particular are considered. The first is a widespread shift towards thinking about suicide in medical terms rather than moral terms. Deploying methods initiated by a number of French and German thinkers in the preceding century who worked at the then emerging interface between the social and biological sciences, a number of 19th century thinkers ejected what they took to (...) be old metaphysical superstitions about ‘good’ and ‘evil’, and replaced them with (allegedly) hard-nosed scientific diagnoses of ‘health’ and ‘sickness’. Dismissing traditional moral arguments against the permissibility of suicide, the phenomenon came to be viewed as a symptom of decline or degeneration. How variations of this view, in biological and social contexts, reorientated practical responses to suicide in terms of treatment rather than moral condemnation is explored. The second 19th century development in philosophical thought with respect to suicide the chapter considers concerns its place in one of the most significant controversies in Germany from 1860 to the turn of the century: the Pessimismusstreit or ‘pessimism dispute’. While philosophical pessimism might be thought to vindicate or even entail suicide, many of the most prominent pessimists—including Arthur Schopenhauer and Eduard von Hartmann—denied that this was the case, and perhaps surprisingly took suicide to involve a special kind of moral and/or epistemic failing. The chapter aims to elucidate the different arguments which pessimists appealed to in order to ground this position. (shrink)

Thinking of problems of aesthetics has a long and strong tradition in Austrian Philosophy. It starts with Bernard Bolzano (1781-1848); it is famously represented by the critic and musicologist Eduard Hanslick (1825-1904); and it is continued within the school of Alexius Meinong (1853-1920), in particular by Christian von Ehrenfels (1859-1932) and Stephan Witasek (1870-1915). Nowadays the aesthetic writings of Bolzano, Ehrenfels, and Witasek are hardly known, particularly not in the Anglo-Saxon world. Austrian aesthetics is surely less known than Austrian (...) contributions to other philosophical disciplines, like ontology, epistemology or philosophy of science. One of the aims of this paper is to show that this is both regrettable and unjustified for the following reasons: Austrian aestheticians have dealt with a number of problems (mainly concerning the foundations of aesthetics) that are salient until today; in terms of subtlety and depth as well as exactness and originality, in general, they easily stand comparison with today's analytic aesthetics; and many of there views and arguments are still worthy of consideration. In this paper, the focus is on a number of hardly known Austrian contributions to aesthetics. These contributions concern the following, partly interrelated, central problems of philosophical aesthetics: i. The problem of the definition of beauty (What is beauty? What does it mean to say of an object that it is beautiful?) ii. The problem of the ontological status of works of art (What kinds of objects are works of art?) iii. The problem of the objectivity of aesthetic values (Do we claim objective validity for aesthetic value judgements, and if so, is this claim justified?) The answers of Bolzano, Meinong, Witasek and Ehrenfels to these questions will be considered. (shrink)

Searching for the origins of 20th century Philosophical Anthropology, it is quite common to follow the suggestions of A. Gehlen who points to Herder as such an origin. In this study, however, I propose a rather different, until now scarcely considered hypothesis: the origin of Philosophical Anthropology can be brought back to Schelling’s reflections concerning Kant’s Critique of Judgement and the problem of self-organization of nature. Starting from his critical observations on Kant, Schelling works out the concept of a succession (...) of levels in the organic, and that of the ex-centricity that defines human beings. Exactly these two concepts will be discussed by Scheler in The Human Place in the Cosmos and by Plessner in The Stages of the Organic and Man. It is commonly assumed that Schelling did not exert any direct influence upon Philosophical Anthropology; one usually allows only for an indirect influence on Scheler, intermediated by Eduard von Hartmann. This paper shows, however, that a documentable, direct influence of Schelling on Scheler can be demonstrated, and that it was decisive for the birth of Philosophical Anthropology. (shrink)

This article looks at the role of Hellenistic thought in the historical narratives of Martin Heidegger and Hannah Arendt. To a certain extent, both see—with G. W. F. Hegel, J. G. Droysen, and Eduard Zeller—Hellenistic and Roman philosophy as a “modernity in antiquity,” but with important differences. Heidegger is generally dismissive of Hellenistic thought and comes to see it as a decisive historical turning point at which a protomodern element of subjective willing and domination is injected into the classical (...) heritage of Plato and Aristotle. Arendt, likewise, credits Stoic philosophy with the discovery of the will as an active faculty constituting a realm of subjective freedom and autonomy. While she considers Hellenistic philosophy as essentially apolitical and world-alienated—in contrast to the inherently political and practical Roman culture—it nonetheless holds for her an important but unexploited ethical and political potential. (shrink)

This article defends a formalist interpretation of Wittgenstein’s later thought on music by comparing it with Eduard Hanslick’s musical formalism. In doing so, it returns to a disagreement I have had with Bela Szabados who, in his book Wittgenstein as a Philosophical Tone-Poet, claims that the attribution of formalism obscures the role that music played in the development of Wittgenstein’s thought. The paper scrutinizes the four arguments Szabados presents to defend his claim, pertaining to alleged differences between Wittgenstein and (...) Hanslick on their accounts of theory, beauty, rules, and the broader significance of music. I will argue that in each case the similarities between Wittgenstein’s and Hanslick’s respective views outshine possible differences. Ultimately, I will argue that instead of rendering music a marginal phenomenon suited for mere entertainment, formalism –as presented by Hanslick and Wittgenstein, whom I read as influenced by Kant’s aesthetics– underscores music’s ability to show fundamental features of reality and our relation to it. Music does this precisely by being treated as a sensuous yet structured medium that is irreducible to any conceptually determined domain. (shrink)

Na tentativa de resolver problemas concretos para a ciência, Max Weber toma por objeto de estudo o trabalho histórico, em especial o de um renomado historiador, Eduard Meyer. Para demonstrar e fundamentar o trabalho histórico, Eduard Meyer torna-se um exemplo para Weber da confusão lógica em que se encontram as ciências especializadas. Partindo deste fato, este artigo pretende mostrar como Max Weber fundamenta os conceitos lógico metodológicos que o auxiliam na construção da objetividade das ciências histórico-sociais. Nosso objetivo (...) é demonstrar como, através das operações lógicas, a metodologia weberiana distingue a conexão entre aqueles elementos “essenciais” da cadeia causal e outros elementos “acidentais” que se situam entre os infinitos momentos que compõem a determinação de um evento. (shrink)

In the late 19th century, physiologists such as David Ferrier, Eduard Hitzig, and Hermann Munk argued that cerebral brain functions are localized in discrete structures. By the early 20th century, this became the dominant position. However, another prominent physiologist, Friedrich Goltz, rejected theories of cerebral localization and argued against these physiologists until his death in 1902. I argue in this paper that previous historical accounts have failed to comprehend why Goltz rejected cerebral localization. I show that Goltz adhered to (...) a falsificationist methodology, and I reconstruct how he designed his experiments and weighted different kinds of evidence. I then draw on the exploratory experimentation literature from recent philosophy of science to trace one root of the debate to differences in how the German localizers designed their experiments and reasoned about evidence. While Goltz designed his experiments to test hypotheses about the functions of predetermined cerebral structures, the localizers explored new functions and structures in the process of constructing new theories. I argue that the localizers relied on untested background conjectures to justify their inferences about functional organization. These background conjectures collapsed a distinction between phenomena they produced direct evidence for (localized symptoms) and what they reached conclusions about (localized functions). (shrink)

Din punct de vedere metodologic, atât Newton cât și Einstein, și ulterior Dirac, au susținut fără rezerve principiul simplității matematice în descoperirea noilor legi fizice ale naturii. Lor li s-au alăturat și Poincaré și Weyl. Eduard Prugovecki afirmă că gravitația cuantică a impus luarea în considerare a unor întrebări epistemologice fundamentale, care pot fi identificate în filosofie cu problema minții-corp și cu problema liberului arbitru. Aceste întrebări au influențat epistemologia mecanicii cuantice sub forma "paralelismului psiho-fizic" al lui von Neumann (...) și analiza ulterioară a tezei de către Wigner că "colapsul pachetului de unde" are loc în mintea "observatorului". DOI: 10.13140/RG.2.2.20900.42883. (shrink)

The controversy between Richard Wagner and his critic Eduard Hanslick is well known, but rarely looked at in detail. It is mostly believed that Hanslick was unable to see Wagner's genius, stuck deeply in an antiquated aesthetical world. By reassessing Wagner's and Hanslick's letters and publications it can be seen, however, that Hanslick's detailed criticism (and also appreciation) was much more objective and less spiteful than is often assumed.

This essay examines the argumentative context in which early Neo-Kantian philosophers defined and defended "epistemology." The paper defends Richard Rorty's claim that the priority of epistemology influenced how the history of modern philosophy was written but corrects his story by showing that epistemology was defended mainly via antifoundational arguments. The essay begins with a few programmatic arguments by Kuno Fischer and Eduard Zeller but focuses mainly on Otto Liebmann's Kant und die Epigonen. I argue that Liebmann completes the agenda (...) of Fischer and Zeller by giving a detailed account of how a metaphysical system is impossible for anyone who begins with modest, Kantian epistemological principles. (shrink)

Extruded polystyrene (XPS) otherwise known as a thermoplastic polymer has a closed cell structure and is often stronger, with a higher mechanical performance. XPS is a pressed material and is sold in different thicknesses ranging from 2 cm to 10 cm, thus having a weight that varies from 28 to 45 kg/m3 due to the force and pressure exerted on it. In general, XPS material has very low thermal conductivity and is resistant to bending. This material obtains typical values of (...) thermal conductivity between 0.025 and 0.040 W/m∙K., which means that it is ideal for surfaces that have to withstand weight, continuous traffic, etc. It is also resistant to moisture absorption and has a homogeneous density. Other characteristics of the material are good acoustic properties, easy assembly, and high durability over time. It should always be kept in mind that the surface where the thermal insulation will be applied must be leveled, cleaned, and dried. Primer is applied, before placing the thermal insulation on the surface. Then, XPS boards are placed on the surface, adhering to the corresponding mortar. This paper will deal with different cases of application of XPS tiles in the city of Tirana. A closer look at the resistance of this material from the day of application until today will be analyzed. The results during the observations showed high thermal stability of the material and no mold surface. EPS Expanded Polystyrene, otherwise known by the Dow Chemical trademark name STYROFOAM, is a lightweight product made from expanded plastic beads. It was first discovered by Eduard Simon in 1839 in Germany. EPS in its composition has 95% air and only about 5% plastic. This material is used because of its excellent properties, including good thermal insulation, good protective properties, and extremely lightweight. EPS is inert in nature and therefore does not result in any chemical reaction. EPS is durable, strong, and lightweight and can be used as an insulated panel system for facades, walls, roofs, and floors, as floating material in marine construction, and as a lightweight filler in road and railway construction. Different examples from the city of Tirana, of buildings where XPS and EPS materials are applied, are going to be analyzed, drawing conclusions. (shrink)

The notes for Theodor Adorno’s courses in the 1960’s are important resources not only for an understanding of his magnum opus, Negative Dialectics, but also for developing critical responses to this problematic philosophical heir of idealism. Particularly noteworthy among the volumes that have appeared so far is from Adorno’s 1965 course on metaphysics where he engages in a sustained reading of Aristotle’s Metaphysics and explicitly connects it with the project of Negative Dialectics. Adorno’s chief concern is to demonstrate, by way (...) of Eduard Zeller’s work, that Aristotle is indeed a proto-idealist and that his ontology is comprised of a fundamental dualism. Adorno is not an informed reader of Aristotle, as his reliance on Zeller makes clear, but he succeeds in drawing the reader’s attention to the organizing force exerted by  upon . The interest in this organizing force is motivated by an interest in the ethics that is consequent upon it: an ethics that ignores the sufferings of the concrete in the name of a rational ideal. While there are echoes of this in Aristotle’s ethical writings, his account of imagination in De Anima ought to give pause to an account as reductive as Adorno’s. In De Anima, Aristotle provides an account of the imagination () that makes it a power reducible neither to  nor to . The imagination, a power of the bodily senses, and especially sight, is a power that grants to thinking its power but is itself the unmotivated actualization of the purely potential. This essay argues that such a power resists interpretation into any dialectical schema insofar as it constitutes a distinct power of the human animal. At the same time, such an interpretation provides a possible route out of the ethical impasse of the unthinkable concrete. (shrink)

The article presents edmund Husserl’s idea of transcendental phenomenology in the perspec‐ tive of the project of science. this aspect of Husserl’s writings was pointed out by, for example, rudolf Bernet, man ed Brelage, Iso Kern, eduard marbach, eugen Fink, Ludwig Landgrebe, and roman Ingarden. the main aim, realised in the article is to prove the main hypothesis claiming that transcendental phenomenology is closely connected with Husserl’s conception of philosophy, the idea of philosophy as a science (eidetic and transcendental). (...) the project of transcendental science and knowledge is also connected with Husserl’s conception of transcen‐ dental reduction taken as a mode of revealing those constitutive achievements of consciousness which were covered in the natural attitude. In the paper, I focus on presenting the most im‐ portant points (epistemological, methodological, and transcendental) connected with Husserl’s evolution of phenomenology in the perspective of the project of science. (shrink)

Comentaba en el Prólogo a la 1ª edición que nos cuesta distinguir las técnicas de los métodos y aceptar que la buena investigación clínica es la que se realiza con método riguroso. Este método reposa en cuatro pilares: que la pregunta o cuestión formulada sea relevante, que esté enunciada de manera precisa y operativa, que sea abordada o respondida con el mejor medio disponible en cada circunstancia, y que evite redundancias o repeticiones de cuestiones que ya han sido examinadas por (...) otros investigadores. Añadía que es imprescindible una dosis de curiosidad y de entusiasmo por lo que se examina. Como se ha dicho con frecuencia, el ensayo clínico es, entre los métodos de investigación clínica, el "patrón oro", el que, gracias a su característica inherente (la distribución aleatoria), está sujeto a menores posibilidades de sesgos. Esta consideración no ha cambiado. Sin embargo, mayor validez interna del método no implica mayor relevancia de los resultados obtenidos. Actualmente es común examinar protocolos de ensayos clínicos bien diseñados, cuyo "único" problema es que pretenden evaluar aspectos de escaso interés farmacológico, terapéutico, epidemiológico o sanitario. ¿Qué interés tiene la evaluación del quinto fármaco de una serie en una indicación para la que ya hay cuatro análogos que le han precedido en su desarrollo? ¿Qué interés tiene la evaluación de un nuevo hipocolesterolemiante o de un nuevo fármaco para la osteoporosis si no se conocen, respectivamente, el impacto de la hipercolesterolemia como factor de riesgo de cardiopatía isquémica o la epidemiología de las fracturas en mujeres postmenopáusicas en nuestro medio? En relación con estos ejemplos, tendría mucho más interés conocer los determinantes epidemiológicos y la historia natural de la cardiopatía isquémica en nuestro medio y conocer la epidemiología de las fracturas "espontáneas" y su impacto sobre la demanda asistencial; para ello serían de mucha utilidad métodos de investigación cuya validez intrínseca podría ser considerada "subóptima" en comparación con el ensayo clínico. En los últimos años ha irrumpido con fuerza en numerosísimas publicaciones el concepto de la "medicina basada en pruebas". Esta moda refleja en parte la importancia que de manera creciente reguladores e industria farmacéutica han concedido a los ensayos clínicos: se ha alcanzado un consenso global sobre la necesidad de demostrar la "eficacia" de los nuevos medicamentos por medio de ensayos clínicos controlados. De este modo, los organismos reguladores y autoridades sanitarias exigen ensayos clínicos como uno de los elementos necesarios para obtener el registro de un nuevo medicamento. Como consecuencia, se realizan y publican muchos más ensayos clínicos que antaño, y actualmente se pueden encontrar ensayos que sustentan la eficacia de la mayoría de los medicamentos disponibles en indicaciones específicas. Si hace unos años bastaba con examinar si había ensayos clínicos que demostraran la eficacia de un determinado medicamento antes de adoptarlo como uno de los de uso común (o de incluirlo en el formulario de un hospital), en la actualidad estas decisiones son más complejas, y se basan sobre todo en una consideración atenta de los objetivos, los métodos y los resultados de cada ensayo o de otros estudios destinados a evaluar eficacia, seguridad, conveniencia o comodidad y coste. Un buen clínico debe saber a la vez leer críticamente las publicaciones científicas y producir información relevante. Leer críticamente significa evaluar la pertinencia de los problemas investigados, los métodos aplicados y la interpretación de los resultados obtenidos. Producir información relevante implica saber identificar los problemas que deben y pueden ser objeto de investigación, formularlos, y ser protagonista (generalmente como parte de un equipo) de la elaboración del plan de investigación. En los últimos años se han publicado varios textos similares al que tiene en sus manos, todos ellos de gran calidad. El presente no pretende ser el más exhaustivo, sino sobre todo interesar a los profesionales sanitarios en el apasionante campo de la investigación clínica, en su sentido más amplio, estimulando la autonomía del lector para investigar un problema o una situación, y para aprender a leer las publicaciones científicas clínicas. Su lectura debe contribuir a que términos como "doble ciego", "p<0,05", "casos y controles", etc. dejen de ser fetiches-misterios, para convertirse en herramientas conceptualmente sencillas, útiles para la evaluación de la actividad asistencial. Esta nueva edición está muy ampliada respecto a la anterior. Se han reorganizado las generalidades sobre los objetivos y métodos de la investigación clínica, se han ampliado algunos aspectos del ensayo clínico, como el análisis de subgrupos, los aspectos estadísticos y éticos y las publicaciones sobre ensayos clínicos, se han añadido cuatro nuevos capítulos, sobre efectividad y eficacia, metaanálisis, ensayos en un solo paciente y farmacoeconomía, y el Glosario ha sido revisado y ampliado (sobre todo con términos de farmacocinética, desarrollo preclínico de fármacos, estadística y biotecnología genética), e incluye casi 750 términos. Para su elaboración me he basado en numerosos textos y diccionarios,a aunque he reformulado la mayoría de las definiciones y he optado por añadir en ocasiones algún comentario personal a muchas de ellas. Carles Vallvé ha escrito el capítulo sobre Normas de Buena Práctica Clínica. Agradezco asimismo las precisones y comentarios de Eulalia Dalmau, Javier Jiménez, Josep Maria Castel y Xavier Vidal, así como los comentarios a versiones anteriores de Fernando Antezana y Jorleny Rojas. Eduard Diogène me sugirió la idea de la portada, El sueño de la razón produce monstruos, que Goya comentaba así: " La fantasía abandonada de la razón produce monstruos imposibles: unida con ella es madre de las artes y origen de sus marabillas" La 1ª edición de este libro, que fue promovida por Zeneca, tuvo una amplia difusión, en España y en América Latina. AstraZeneca me propuso preparar esta 2ª edición del mismo modo abierto que en ocasión de la primera; su actual Director Médico Ramón Estiarte me ha ayudado en la selección de términos para el Glosario. A él y al anterior Director Médico de Zeneca, Manuel Martín, agradezco su idea inicial, su estímulo y ayuda, y las facilidades que han dado para la difusión de este libro. Joan-Ramon Laporte. (shrink)