Contrary to what he expected, Primo Levi didn’t experience his life after being released from Auschwitz as cheerful and light-hearted. He – like many other survivors – was haunted by an obscure and solid anguish. It took some effort for him to discern the object or source of this anguish. He finally identified it as springing from a sense of shame or guilt in front of the drowned, that is, of those who were exterminated in the Lager. He could not (...) determine, however, whether his shame or guilt was at all rational. In this paper l examine Levi’s shame in light of what I regard as the dominant conception of practical deliberation, according to which principles and emotional detachment are central to our ability to deliberate appropriately. This conception underlies the role that John Rawls ascribes to the original position in the determination of the fundamental principles of justice. Deliberation in the original position is supposed to abstract away from any particular moral situations that one may actually have faced, since these are purely circumstantial elements to be discarded as both irrelevant and misleading for a proper deliberation on the principles of justice. In this paper, I intend both to make a case against the conception of practical deliberation on which Rawls’ original position relies and to vindicate the rationality of Levi’s shame, once some well-entrenched assumptions are brought to light and challenged. (shrink)

at seek to identify the necessary and sufficient conditions for a work to count as fiction. She argues that this goal cannot really be achieved; instead, she appeals to the notion of genre to distinguish between fiction and nonfiction. This notion is significantly more flex- ible, since it invites us to identify standard—but not necessary—and counter-standard features of works of fiction in light of our classificatory practices. More specifically, Friend argues that the genre of fiction has the genre of nonfiction—and (...) only that genre—as its con- trast class. I will refer to the particular way in which Friend elaborates this claim as the contrast view. I have, nevertheless, the impression that this view unnecessarily narrows down the array of perspectives and attitudes from which we can approach works of fiction. I will thus develop a line of reasoning to the effect that the contrast view should rather be construed as picking out a particular way of relating to works of fiction that lies at the end of a continuum defined by different degrees of reflectivity and estrangement. This implies that the contrast view is false as a general claim about how we experience works of fiction, even though this view may appropriately de- pict a specific way of approaching such works. (shrink)

Entiende Christine Korsgaard que sólo una vida gobernada por principios universales responde a nuestra condición de sujetos, pues, de otro modo, quedaríamos reducidos a un amasijo de impulsos inconexos. Quiere, no obstante, alejarse de la imagen del sujeto escindido entre razón y pasión y reivindica la necesidad de unificar cada una de las partes que lo constituyen. Tal unificación deberá descansar, según Korsgaard, en el respeto a principios morales de carácter universal, si bien confía en que una vida gobernada por (...) tales principios permita atender suficientemente los proyectos y compromisos con los que el sujeto se identifica y que constituyen su identidad práctica. En este escrito, trataré de mostrar que la propuesta de Korsgaard no acaba de alejarse de la concepción dividida del sujeto. Argumentaré, en este sentido, que las asimetrías que establece entre la identidad moral y otros tipos de identidades prácticas sólo pueden entenderse desde esa concepción escindida. (shrink)

In _Deaths in Venice_ Philip Kitcher explores the bearing that _Death in Venice_ by Thomas Mann may have on 'the oldest and deepest question of philosophy: _how to live_'. In this paper, I will distinguish two ways in which this question can be interpreted. One one reading, it amounts to the question 'how to lead a valuable or worthy life?', whereas on the other it involves a more elusive idea, namely, that a person may breath and walk and still be (...) dead in a relevant sense, that is, from the perspectivo in which being alive does not reduce to biological survival. In my view, Kitcher's reflection on Mann's novella relies on the first, more standard reading. I argue, though, that the being-alive interpretation sheds a more unified light on _Death in Venice_; in fact, I will conclude that the need to shift from one to another interpretation constitutes a fundamental concern in the novella. (shrink)

Marta Suria writes *Ella soy yo* as part of her response to the irruption of the memories of the sexual aggressions she had suffered since childhood. She is convinced that the way she narrates her experience will transform and liberate her. How is it at all possible that a certain kind of narrative may transform and li- berate us? In this paper, we will first describe the conception of the relationship between language and experience that lies behind this perplexity and, (...) secondly, we will sketch an alternative conception that will hopefully allow us to account for the transformative power of certain kinds of narratives. This alternative conception will hinge on the idea of expression and on the concept of aspect perception. For this purpose, we will firstly argue that language can be used not only to describe or evaluate our experience, but also to express it; we will, then, defend the view that linguistic or gestural expressions of our experiences not only announce or manifest them, but contribute to shaping and modulating them; finally, we will highlight the transformative, humanizing power of certain expressive uses of language. (shrink)

Yago es el mal incondicional\ sus acciones no pueden justificarse y, sin embargo, puede ser defendidas [T1]. Esta es la tesis que defiende Richard Raatzsch en *The Apologetics o f Evil. The Case o f Yago*. Su argumento descansa fundamentalmente en otras dos tesis, a saber: [T2] que no hay motivo alguno que dé cuenta de las acciones de Yago como un todo y [T3] que Yago es s uno de esos que mantienen su corazón atento solo a sí mismos. (...) Trataré de mostrar, sin embargo, que el argumento de Raatzsch en favor de [T1-T3] es inconsistente con su defensa de Yago, por lo que concluiré que Ratzsch no puede mantener coherentemente las tres tesis. Esta conclusión se verá, no obstante, complementada con una propuesta alternativa acerca de la naturaleza del mal incondicional en la que se subraya el papel de las experiencias corporales en la articulación de lo ético. (shrink)

The received view about rationalizing explanations divides our psychological status into two kinds: beliefs and desires. In *The Retrieval of Ethics*, Talbot Brewer makes a case against this view. In this paper, I examine our experience as readers of *The Castle* by Franz Kafka to support Brewer's critical program, that is, his challenge to the received view. I will argue, however, that a proper analysis of this experience poses a serious problem to Brewer's alternative approach, that is, to his attempt (...) to retrieve our agency thanks to a proper understanding of the role of the good in rationalizing explanations. (shrink)

Robert Dunn, David Finkelstein and Richard Moran have recently contributed to broadening the debate on self-knowledge within the analytic tradition. They raise questions concerning the sort of awareness that may have a healing effect in psychoanalytic therapy, and enhance the relevance to self-knowledge of a deliberative, and practically committed, attitude toward oneself. They reject, however, that self-observation could play a significant role in a strictly first-person attitude toward oneself, since they conceive of it as essentially detached and, in this respect, (...) similar to the kind of attitude that a third party might adopt. I will appeal to Simone Weil's distinction between two sorts obedience and to the contrast between two characters in *The Karamazov Brothers* to elucidate a kind of self-awareness that involves a kind of observation that is constitutively committed. This line of reasoning will also serve to elucidate a fundamental sort of self-knowledge that derives from the subject's capacity to acknowledge her own position within the ethical world and is closely associated to the goal of psychoanalytic therapy. (shrink)

This essay examine Samuel Beckett's *Trilogy to specify the conditions under which we could make sense of practical necessity. Among other things, I will show how Ajax' must is connected to Mol/oy's attempt to visit his mother and to the need to keep talking that both Molloy and the Unnamable share. I will conclude that their dislocated pursuit of certainty reveal - among other things - how the conditions under which practical necessity can be properly experienced have been extirpated from (...) our social and cultural context. Still, the fact that its vestiges nevertheless subsist provide some reason to regard practical necessity as a constitutive aspect of our agency. This will provide a particular sense in which the Unnamable may coherently claim: "I don't know, I'll never know, in the silence you don't know, you must go on, I can't go on, I will go on.". (shrink)

In this chapter, I focus on the experience of torture and, more specifically, on Jean Améry's account of it in his book *At the Mind's Limits*. There he claims that the loss of confidence in the world is the most devastating effect he experienced as a victim of torture. I thus explore what cosmopolitan aspiration may be revealed by this loss and also discuss whether it is to be discredited as an irrational reaction on the victim's side or instead as (...) proportional to the facts and, consequently, as relevant to the conditions under which a certain cosmopolitan aspiration could be achieved or, at least, favored. (shrink)

En *Racionalidad, acción y opacidad*, Fernando Broncano nos invita a poner en cuestión una ima- gen de la racionalidad y de la agencia que se sitúa en el centro de la cultura filosófica contemporánea. Es una imagen que nace con la modernidad y ocupa un lugar tan nuclear en nuestra cultura que se sostiene más allá de cualquier evidencia que podamos aportar en su contra. La tarea que emprende *Racionalidad, acción y opacidad* es subrayar los puntos ciegos de esa imagen, (...) cómo nos aleja de nuestras prácticas y experiencias, su incapacidad para dar cuenta de las mismas; o, dicho de otro modo, las dificultades de esa imagen para atender a las exigencias del equilibrio reflexivo que toda propuesta filosófica debe satisfacer. En este comentario, se elucidan varios aspectos de esa imagen y discute el análisis que de ellos propone Broncano. (shrink)

Relatar lo ocurrido como invención: una introducción a la filosofía de la ficción contemporánea ofrece al lector en castellano una magnífica oportunidad para familiarizarse con algunos aspectos centrales de la filosofía del lenguaje contemporánea y sus implicaciones para la teoría de la ficción. García-Carpintero recorre los argumentos fundamentales en favor y en contra de cada una de las posiciones relevantes, y nos propone finalmente un análisis alternativo de la norma de la ficción y una teoría neofregeana de los términos referenciales (...) que logra esquivar algunas objeciones tradicionales. Esta discusión incluye, no obstante, dos objeciones a su norma de la ficción: una se refiere a las formas de la conciencia que esa norma presupone y la otra a la naturaleza del interés que suscitan los proyectos imaginativos vinculados a las obras de ficción. (shrink)

In his paper “Obras de ficción, formas de conciencia y literatura”, Josep Corbí raises a few sharp objections to my distinction between fiction and non-fiction, as I formulate it in my recently published Relatar lo ocurrido como invención. In this response, I present first in a compact form such ideas, and then I try to answer to Corbí’s criticisms.

This book is the culmination of the COST Action CA15212 Citizen Science to Promote Creativity, Scientific Literacy, and Innovation throughout Europe. It represents the final stage of a shared journey taken over the last 4 years. During this relatively short period, our citizen science practices and perspectives have rapidly evolved. In this chapter we discuss what we have learnt about the recent past of citizen science and what we expect and hope for the future.

This paper examines the debate about the referential meaning of Kant’s concept of substance. In the Critique of Pure Reason and other works such as the Metaphysical Foundations of Natural Science, the category or concept of substance appears quite uncontroversially to have both a logical meaning (by which it means roughly ‘a thing that is the ultimate subject of predication’) and an objective meaning (by which it means roughly ‘a thing that is permanent’, or, equivalently, ‘a thing existing at all (...) times’). However, it is highly contested what kind of object, or objects, are supposed to meet, in experience, the criteria imposed by the conjunction of these two distinct meanings. I discuss two examples of the main interpretations to be found in the literature: Peter Strawson (2000), who contends that the reference of substance is only matter, and Claudia Jáuregui (2021), who also includes ordinary particular objects as substances. I scrutinize their fit with some of the textual evidence, primarily from the First Analogy of Experience, and finally reject Jáuregui’s interpretation as implying a kind of mereological essentialism about particular objects. Keywords: substance, meaning, matter, ordinary objects, First Analogy of Experience. (shrink)

La filosofía fue entre nosotros, durante largo tiempo, un “juego social”, en las últimas décadas se ha venido transformando en (pseudo)campo, y en la actualidad está expuesta a sucumbir a la heteronomía, decayendo a la degradada situación de “espacio de servicios”. Así la doctrina de Bourdieu esclarece el surgimiento, la situación actual, y en cierto modo también la peripecia futura de la filosofía en España. Y al mismo tiempo consigue explicar porque, en este preciso momento, es plausible el pesimista diagnóstico (...) de que el peligro de regresión a la heteronomía compromete la existencia del incipiente campo filosófico español. Simplemente ocurre que en las situaciones de crisis las percepciones de los agentes adquieren una relevancia de la que suelen carecer en etapas más apacibles. En los períodos de desilusión los agentes se vuelven lúcidos, en una palabra, porque entonces resulta más difícil “seguir el juego” que el campo les exige. Ya que tomar parte en dicho juego no es más, según Bourdieu, que una forma de ilusión. (shrink)

Thinking the Visual, Visualizing the Thought.A perceptual and Political Model of VisionMerleau-Ponty’s program of perceptivizing thought has depoliticizing effects that, though he does not recognize them, undermine his understanding of politics. These anti-political consequences, moreover, bring out the internal difficulties of his anti-intellectualist starting point. There are three areas in which Merleau-Ponty gave a thorough application, though with unequal success, of his perception-based model: the presentation of his own thought, in which his program of picturalization had a striking success; the (...) explanation of the historical process, in which his visualization model was only partly effective; and access to other people’s thought, in which his perceptivist views encountered an undeniable failure. Merleau-Ponty’s successive approaches to other people’s thought show, by two distinct paths, and beyond his own intentions, an unforeseen political defect. His perceptive model proves incompatible with his political ideas when it is applied in depth, and it thus breaks apart the cohesion of his thought. From a larger perspective, it disrupts reflective approaches to politics since it damages their conceptual bases. This article shows successively that Merleau-Ponty laid out a perceptive model of universal scope; that he applied it to several areas, including politics; that this model proves politically deficient when it serves to remove the autochthonous sources of sense; that these depoliticizing effects become more acute when Merleau-Ponty employs the perceptive model to elucidate other people’s thought; and that its frustration in this area not only devalues his political reflections, but also signals that the perceptive model simply prevents a “thinking of the political.”Pensare il visuale, visualizzare il pensiero.Un modello percettivo e politico della visioneIl programma di percettivizzazione del pensiero intrapreso da Merleau-Ponty comporta effetti spoliticizzanti che sconfessano nascostamente la sua comprensione della politica. Tali conseguenze antipolitiche mettono altresì in rilievo le difficoltà intrinseche alla sua posizione anti-intellettualista. Vi sono tre ambiti nei quali Merleau-Ponty, con diverso successo, ha applicato il suo modello percettivo : la presentazione del suo stesso pensiero, nella quale questo programma di pittoricizzazione incontra un successo trionfale; la chiarificazione del processo storico, dove tale modello “visualeˮ non è efficace che in parte; infine l’accesso al pensiero di altri autori, terreno sul quale questa prospettiva percettivista subisce uno scacco innegabile. Molti tentativi merleaupontiani di approcciare il pensiero di altri autori attestano in vario modo un imprevisto deficit politico. Il modello percettivo di Merleau-Ponty si rivela in altri termini incompatibile con le sue idee politiche, nel momento in cui viene applicato in profondità, e in ultima analisi mette a dura prova la coerenza del suo pensiero. In una prospettiva più ampia, esso ostacola un approccio riflessivo alla politica poiché ne degrada le stesse basi concettuali. Il nostro articolo mostra quindi che Merleau-Ponty ha articolato un modello percettivo di portata universale; che l’ha applicato a svariati ambiti d’indagine, tra cui la politica; che quel modello si rivela deficitario quando viene utilizzato per attingere a specifiche fonti di senso; che tali effetti spoliticizzanti si acuiscono nel momento in cui Merleau-Ponty adotta il modello percettivo per illuminare il pensiero di altri autori; che, per concludere, la sua incongruenza con questo peculiare ambito di riflessione non solo impoverisce le sue riflessioni politiche, ma attesta che in linea generale il modello percettivo sbarra la strada a un qualsiasi «pensiero del politico». (shrink)

This article asks how the costs and benefits of operating a monetary union should be distributed amongst its more and less competitive members, taking as an example the operation of the European Monetary Union (EMU or Eurozone). Drawing on existing domestic and transnational justice debates, I resist both a purely procedural and a purely distributive view. The former assumes treaties against a fair background can make any distribution fair and disregards how individual citizens are likely to fare depending on how (...) a monetary union is organized. The latter requires justice amongst Eurozone co-citizens, and it neglects the value of member state’s choices and attitudes towards risk. Instead, I defend a view of the EMU as an association of free self-determining states. I also argue that a variety of factors are relevant to this problem, including the need to protect less competitive states from ‘domination’, or inappropriate forms of control by their co-members, and to protect citizens from various forms of deprivation even if their own governments are willing to expose them to the relevant risks. This article asks how the costs and benefits of operating a monetary union should be distributed amongst its more and less competitive members, taking as an example the operation of the European Monetary Union (EMU or Eurozone). Drawing on existing domestic and transnational justice debates, I resist both a purely procedural and a purely distributive view. The former assumes treaties against a fair background can make any distribution fair and disregards how individual citizens are likely to fare depending on how a monetary union is organized. The latter requires justice amongst Eurozone co-citizens, and it neglects the value of member state’s choices and attitudes towards risk. Instead, I defend a view of the EMU as an association of free self-determining states. I also argue that a variety of factors are relevant to this problem, including the need to protect less competitive states from ‘domination’, or inappropriate forms of control by their co-members, and to protect citizens from various forms of deprivation even if their own governments are willing to expose them to the relevant risks. (shrink)

This paper studies five approaches on the future of alterity that awaits ideas and doctrines. According to these predictions, embedded in texts by Weber, Meinecke, Butterfield, Merleau-Ponty and Koselleck, the coming forms of thinking shall endure the same destiny affecting the ideas of the past because they will evolve without relying on historical sameness. The future of Western thought, in short, is bound to an unpredictable “destiny of otherness”. These claims, taken together, outline a redirection of the genealogical untangling to (...) the future. While they persist on linking present phenomena to realities deemed historically “other”, they also foresee that this fate of alterity will prevail in future times, an enlargement of scope that results in a symmetrically expanded genealogy. This universalized “discourse of historical otherness” makes evident that genealogy, in addition to its involvement with past vicissitudes of ideas and beliefs, is also bound to explore their future emmeshing with alterity. Its “forward-looking inflection” will proscribe historiographic prolepsis, contending that the destiny of otherness awaiting ideas and doctrines excludes any surmise about the meaning they will be given in the future. (shrink)

In the last third of the 20th century, the Bielefeld School of social history, headed by Hans- Ulrich Wehler and Jürgen Kocka, rose to prominence. It had contrasting concerns: the focus on structures and processes of development sidelined intentional action and coexisted with a political rewriting of the past that indicted the interests and decisions of dominant elites in Germany from 1870 to 1933. History was viewed, oddly enough, as retrospective politics. This article analyses the main aporiae implied by both (...) the School’s programme and its scholarly output. How did a structuralist historiography contrive backward-looking political denunciations? Is our time entitled to judge and accuse the past? Notwithstanding the weight of structures and processes, were there real alternatives for the historical agents? Did systemic causality grant elbowroom to intentional action? What chances were then missed and why? Overall, the surmise that there were always choices clashes with received narratives of inevitability. (shrink)

Cognitive abilities cannot be measured directly. What we can measure is individual variation in task performance. In this paper, we first make the case for why we should be interested in mapping individual differences in task performance on to particular cognitive abilities: we suggest that it is crucial for examining the causes and consequences of variation both within and between species. As a case study, we examine whether multiple measures of inhibitory control for non-human animals do indeed produce correlated task (...) performance; however, no clear pattern emerges that would support the notion of a common cognitive ability underpinning individual differences in performance. We advocate a psychometric approach involving a three-step programme to make theoretical and empirical progress: first, we need tasks that reveal signature limits in performance. Second, we need to assess the reliability of individual differences in task performance. Third, multi-trait multi-method test batteries will be instrumental in validating cognitive abilities. Together, these steps will help us to establish what varies between individuals that could impact their fitness and ultimately shape the course of the evolution of animal minds. Finally, we propose executive functions, including working memory, inhibitory control and attentional shifting, as a sensible starting point for this endeavour. (shrink)

The Global Financial Crisis of 2007–2009 exacerbated two distinct concerns about the independence of central banks: a concern about legitimacy and a concern about economic justice. This paper explores the legitimacy of independent central banks from the perspective of these two concerns, by presenting two distinct models of central banking and their different claims to political legitimacy and distributive justice. I argue primarily that we should avoid construing central bank independence in binary terms, such that central banks either are, or (...) are not, independent. I will argue that we should instead construe central bank independence in scalar terms, so that independence admits of degree, thus allowing us to develop an account of independence in which central banks can retain it to the extent necessary for economic efficiency, while meeting reasonable concerns regarding democratic legitimacy and economic justice. (shrink)

Orang-utans played a communication game in two studies testing their ability to produce and comprehend requestive pointing. While the ‘communicator’ could see but not obtain hidden food, the ‘donor’ could release the food to the communicator, but could not see its location for herself. They could coordinate successfully if the communicator pointed to the food, and if the donor comprehended his communicative goal and responded pro-socially. In Study 1, one orang-utan pointed regularly and accurately for peers. However, they responded only (...) rarely. In Study 2, a human experimenter played the communicator’s role in three conditions, testing the apes’ comprehension of points of different heights and different degrees of ostension. There was no effect of condition. However, across conditions one donor performed well individually, and as a group orang-utans’ comprehension performance tended towards significance. We explain this on the grounds that comprehension required inferences that they found difficult – but not impossible. The finding has valuable implications for our thinking about the development of pointing in phylogeny. (shrink)

Philosophers have distinguished at least three different interpretations of Rawls’s difference principle. This principle claims that social and economic inequalities are to be arranged so that they are to the greatest benefit of the least advantaged. My aim in this paper is to show that according to the most attractive and plausible interpretation of that principle, which I call the reciprocity view, Rawls’s difference principle allows us to limit economic growth in order to preserve nature and protect the interests of (...) future generations, while still meeting the demands of justice concerning the least advantaged members of society. (shrink)

This Insight examines the stance the EU should adopt towards the Russian invasion of Ukraine on the basis of the political thought of Immanuel Kant, Thomas Hobbes, and Niccolò Machiavelli. Taking as its starting point Josep Borrell’s comment that “we are too much Kantians and not enough Hobbesians” at the 2022 EU Ambassadors’ Conference, this Insight offers a revisionist interpretation of both Kant and Hobbes while suggesting Machiavelli as a third possible inspiration for EU external action. Although he is (...) often portrayed as a proto-“realist” intent on increasing state power, Hobbes in reality favours stability above all else and would therefore presumably not support a more “aggressive” foreign policy. Kant, on the other hand, has traditionally been seen as more of a philosophical idealist, but his political philosophy in fact supports a more assertive conduct by states in their external relations. Both of these philosophers are thus quite different from how Borrell portrays them. The Insight also introduces the perspective of a third thinker, Machiavelli, whose philosophy suggests that the EU should adopt a pragmatic diplomatic strategy, forging alliances, supplying Ukraine with weapons, and maintaining strong ties with allies. (shrink)

To reject skepticism and lay the foundation for the certainty of knowledge, Kant raised the question of how synthetic a priori proposition is possible. In his solution, the new content of knowledge comes from the syntheses of experience a posteriori, and the universal necessity of knowledge is guaranteed by it’s a priority. Under the influence of Kant, the concept of a priori and necessity has long been regarded as coextensive. But Saul Kripke believes that this will confuse different philosophical fields: (...) a priori is an epistemological concept, which involves the way or means of acquiring knowledge, and necessity is a metaphysical concept, which involves the possible ways or states of the world. The key point is that, on Kripke, there is no necessary connection between these two fields. He raised some famous examples of the necessary a posteriori. More remarkably, in his explanation of necessary a posteriori, although he did not clearly propose the distinction between epistemic possibility and metaphysical possibility, he had laid the foundation for this distinction. Furthermore, on Manuel Garcia-Carpintero and Josep Macia, when Kripke talks about necessary a posteriori by appealing to two relevant expressions, what he proposed can be taken as kind of ‘blueprint for 2-D accounts’. (Manuel Garcia-Carpintero and Josep Macia, 2006, p.2) There are different forms of two-dimensionalism in semantics. I will focus on David Chalmers’s epistemic version and Scott Soames’ criticism. With the framework of possible world semantics established by Kripke and others, David Chalmers’ epistemic two-dimensionalism deals with the relationship between epistemic and metaphysical modalities from a quite different perspective, and then gives an elegant definition to necessary a posteriori and other modal concepts. Scott Soames criticized two-dimensionalism based on Kripke's modal realism and essentialism, and developed Kripke's account of necessary a posteriori. But according to Chalmers, Soames also uses a two-dimensional system himself to analyze cases of the necessary a posteriori. In the first two part of this paper I will briefly introduce the epistemic two-dimensionalism and specify the similarities between Kripke-Soames and Chalmers when they interpret necessary a posteriori. In the third part I turn to their difference by the analysis of relationship between epistemic possibility and metaphysical possibility which is the key issue for illuminating necessary a posteriori. (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)

The best and the worst of Spain. Texts from Unamuno, Lucas Mallada, Rafael Salillas, Josep Plà.