The use of placebo controls in clinical trials remains controversial. Ethical analysis and international ethical guidance permit the use of placebo controls in randomized trials when scientifically indicated in four cases: (1) when there is no proven effective treatment for the condition under study; (2) when withholding treatment poses negligible risks to participants; (3) when there are compelling methodological reasons for using placebo, and withholding treatment does not pose a risk of serious harm to participants; and, more (...) controversially, (4) when there are compelling methodological reasons for using placebo, and the research is intended to develop interventions that can be implemented in the population from which trial participants are drawn, and the trial does not require participants to forgo treatment they would otherwise receive. The concept of methodological reasons is essential to assessing the ethics of placebo controls in these controversial last two cases. This article sets out key considerations relevant to considering whether methodological reasons for a placebo control are compelling. (shrink)

Placebo-trials on HIV-infected pregnant women in developing countries like Thailand and Uganda have provoked recent controversy. Such experiments aim to find a treatment that will cut the rate of vertical transmission more efficiently than existing treatments like zidovudine. This scenario is first stated as generally as possible, before three ethical principles found in the Belmont Report, itself a sharpening of the Helsinki Declaration, are stated. These three principles are the Principle of Utility, the Principle of Autonomy and the Principle (...) of Justice. These are taken as voices of moral imperative. But although each has intuitive appeal, it can be shown that there are possible scenarios in which they give conflicting prescriptions. To achieve consistency, one must be subordinate to the others. The voice of utility is taken as subordinate to those of justice and autonomy and it is shown that given plausible assumptions about the level of poverty and education in the developing country targeted, the experiment is ruled morally wrong in the name of both justice and autonomy. Moreover, it is argued that no justification can be found for the inclusion of a placebo group, when strictly defined. By contrast, a ‘no- treatment’ control arm might be justified, but only when the demands of autonomy are satisfied, demands that are more stringent than they might appear. A utilitarian defence of the experiment is examined, namely that the would-be participants are in a no-loss situation, and it is shown that this defence is seriously flawed. Finally, it is concluded that there is no justification for amending the Declaration of Helsinki. (shrink)

In this paper, Isuggest that placebo effects, as we know them today, should be understood as experimental phenomena, low-level regularities whose causal structure is grasped through particular experimental designs with little theoretical guidance. Focusing on placebo interventions with needles for pain reduction -one of the few placebo regularities that seems to arise in meta-analytical studies- I discuss the extent to which it is possible to decompose the different factors at play through more fine-grained randomized clinical trials. My (...) sceptical argument is twofold. On the one hand, I argue that experiments alone are not enough to standardize interventions, and that it is necessary to include theories. On the other hand, I argue that the social interactions that seem to be part of placebo effects are difficult, if not impossible, to blind. Therefore, the measurement biases arising from the participants’ reactivity to the experimental setup cannot be controlled for. Further decomposition of placebo effects requires a theoretical account of the existing experimental regularities that may guide further tests. (shrink)

Control interventions (often called “sham,” “placebo,” or “attention controls”) are essential for studying the efficacy or mechanism of physical, psychological, and self-management interventions in clinical trials. This article presents core recommendations for designing, conducting, and reporting control interventions to establish a quality standard in nonpharmacological intervention research. A framework of additional considerations supports researchers’ decision making in this context. We also provide a reporting checklist for control interventions to enhance research transparency, usefulness, and rigour.

Some placebo-controlled trials can continue ethically after a candidate vaccine is found to be safe and efficacious.

Eyal Shahar’s essay review [1] of James Penston’s remarkable book [2] seems more inspired playful academic provocation than review or essay, expressing dramatic views of impossible validity. The account given of modern biostatistical causation reveals the slide from science into the intellectual confusion and non-science RCTs have created: “…. the purpose of medical research is to estimate the magnitude of the effect of a causal contrast, for example the probability ratio of a binary outcome …” But Shahar’s world is simultaneously (...) not probabilistic, but of absolute uncertainty: “We should have no confidence in any type of evidence ….. We should have no confidence at all”. Shahar’s "Causal contrast" is attractive. It seems to make sense, but bypasses in two words the means of establishing causation by the scientific method. This phrase assumes a numeric statistically significant “contrast” is causal rather than a potential correlation requiring further investigation. The concept of “causal contrast” is a slippery slope from sense into biostatistical non-science. This can be illustrated with an hypothetical RCT where 100% of interventions exhibit a posited treatment effect and 0% of placebo controls. Internal validity is seemingly quite reasonably assumed satisfied (common-sense dictating the likelihood of an awesome magnificent fraud, bias or plain error of the magnitude required is infinitesimal). Scientific method appears satisfied. The RCT demonstrates: (1) strict regularity of outcome in the presence of posited cause; (2) the absence of outcome in its absence and (3) an intervention (experiment) showing the direction of causation is from posited cause to posited effect. Now travel further down the slope from science. Assume 50% of interventions and 0% of controls are positive. We compromise scientific method, but justify this by assuming a large subgroup which we say surely must on these figures be exhibiting the posited treatment effect. But what of 10% of interventions and 9% of placebo controls exhibiting the posited treatment effect? Our biostatistician says the 1% “causal contrast” is statistically significant. But we have: (1) minimal evidence of regularity; (2) the posited outcome irrespective of presence of posited cause and (3) our intervention is at the highest equivocal in demonstrating any form of causation. This is not science. It is, however, where biostatistics has unthinkingly taken us, as Penston has shown comprehensively [2]. We, the audience of published medical research, are now for the 10% / 9% example well down the slope from science. An unattractive hypothesis results requiring numerous assumptions similar to these:- "There is a 'contrast' which is ‘causal’, albeit the method employed is not scientific. An effect of the intervention has been observed in a very small subgroup. This subgroup is susceptible to treatment. The similar number of placebo controls exhibiting the outcome sought is irrelevant, because the 1% difference between intervention and controls is statistically significant. The statistical analysis is valid and reliable. The RCT’s internal validity is sufficiently satisfied. No funding or bias or fraud has affected the results or their analysis.” As Penston notes: “Confirming and refuting the results of research is crucial to science …. But … there’s no way of testing the results of any particular large-scale RCT or epidemiological study. Each study … is left hanging in the air, unsupported.” It gets worse. To identify a rare serious adverse reaction of a frequency of 1:10,000 can require a trial of 200,000 or larger split between controls and interventions. This is not done. But for every 100 who prospectively benefit from the intervention, 9,900 also receive it. And for every 100 benefiting one person (who likely gains no benefit) will suffer a serious unidentified adverse reaction. This is also without taking account of more common adverse reactions whether serious or otherwise. References [1] Shahar, E. (2011) Research and medicine: human conjectures at every turn. International Journal of Person Centered Medicine 1 (2), 250-253. [2] Penston, J. (2010). stats.con: How we’ve been fooled by statistics-based research in medicine. London: The London Press, UK. (shrink)

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

The concepts of placebos and placebo effects refer to extremely diverse phenomena. I recommend dissolving the concepts of placebos and placebo effects into loosely related groups of specific mechanisms, including (potentially among others) expectation-fulfillment, classical conditioning, and attentional-somatic feedback loops. If this approach is on the right track, it has three main implications for the ethics of informed consent. First, because of the expectation-fulfillment mechanism, the process of informing cannot be considered independently from the potential effects of treatment. (...) Obtaining informed consent influences the effects of treatment. This provides support for the authorized concealment and authorized deception paradigms, and perhaps even for outright deceptive placebo use. Second, doctors may easily fail to consider the potential benefits of conditioning, leading them to misjudge the trade-off between beneficence and autonomy. Third, how attentional-somatic feedback loops play out depends not only on the content of the informing process but also on its framing. This suggests a role for libertarian paternalism in clinical practice. (shrink)

Several authors have recently argued that psychotherapy, as it is commonly practiced, is deceptive and undermines patients’ ability to give informed consent to treatment. This ‘deception’ claim is based on the findings that some, and possibly most, of the ameliorative effects in psychotherapeutic interventions are mediated by therapeutic common factors shared by successful treatments, rather than because of theory-specific techniques. These findings have led to claims that psychotherapy is, at least partly, likely a placebo, and that practitioners of psychotherapy (...) have a duty to ‘go open’ to patients about the role of common factors in therapy ; to not ‘go open’ is supposed to unjustly restrict patients’ autonomy. This paper makes two related arguments against the ‘go open’ claim. While therapies ought to provide patients with sufficient information to make informed treatment decisions, informed consent does not require that practitioners ‘go open’ about therapeutic common factors in psychotherapy, and clarity about the mechanisms of change in psychotherapy shows us that the common-factors findings are consistent with, rather than undermining of, the truth of many theory-specific forms of psychotherapy; psychotherapy, as it is commonly practiced, is not deceptive and is not a placebo. The call to ‘go open’ should be resisted and may have serious detrimental effects on patients via the dissemination of a false view about how therapy works. (shrink)

Objectives -/- Surveys in various countries suggest 17% to 80% of doctors prescribe ‘placebos’ in routine practice, but prevalence of placebo use in UK primary care is unknown. Methods -/- We administered a web-based questionnaire to a representative sample of UK general practitioners. Following surveys conducted in other countries we divided placebos into ‘pure’ and ‘impure’. ‘Impure’ placebos are interventions with clear efficacy for certain conditions but are prescribed for ailments where their efficacy is unknown, such as antibiotics for (...) suspected viral infections. ‘Pure’ placebos are interventions such as sugar pills or saline injections without direct pharmacologically active ingredients for the condition being treated. We initiated the survey in April 2012. Two reminders were sent and electronic data collection closed after 4 weeks. Results -/- We surveyed 1715 general practitioners and 783 (46%) completed our questionnaire. Our respondents were similar to those of all registered UK doctors suggesting our results are generalizable. 12% (95% CI 10 to 15) of respondents used pure placebos while 97% (95% CI 96 to 98) used impure placebos at least once in their career. 1% of respondents used pure placebos, and 77% (95% CI 74 to 79) used impure placebos at least once per week. Most (66% for pure, 84% for impure) respondents stated placebos were ethical in some circumstances. Conclusion and implications -/- Placebo use is common in primary care but questions remain about their benefits, harms, costs, and whether they can be delivered ethically. Further research is required to investigate ethically acceptable and cost-effective placebo interventions. (shrink)

It seems that we can be directly accountable for our reasons-responsive attitudes—e.g., our beliefs, desires, and intentions. Yet, we rarely, if ever, have volitional control over such attitudes, volitional control being the sort of control that we exert over our intentional actions. This presents a trilemma: (Horn 1) deny that we can be directly accountable for our reasons-responsive attitudes, (Horn 2) deny that φ’s being under our control is necessary for our being directly accountable for φ-ing, (...) or (Horn 3) deny that the relevant sort of control is volitional control. This paper argues that we should take Horn 3. (shrink)

In this paper, I take it for granted both that there are two types of blameworthiness—accountability blameworthiness and attributability blameworthiness—and that avoidability is necessary only for the former. My task, then, is to explain why avoidability is necessary for accountability blameworthiness but not for attributability blameworthiness. I argue that what explains this is both the fact that these two types of blameworthiness make different sorts of reactive attitudes fitting and that only one of these two types of attitudes requires having (...) been able to refrain from φ-ing in order for them to be fitting. (shrink)

Living organisms act as integrated wholes to maintain themselves. Individual actions can each be explained by characterizing the mechanisms that perform the activity. But these alone do not explain how various activities are coordinated and performed versatilely. We argue that this depends on a specific type of mechanism, a control mechanism. We develop an account of control by examining several extensively studied control mechanisms operative in the bacterium E. coli. On our analysis, what distinguishes a control (...) mechanism from other mechanisms is that it relies on measuring one or more variables, which results in setting constraints in the control mechanism that determine its action on flexible constraints in other mechanisms. In the most basic arrangement, the measurement process directly determines the action of the control mechanism, but in more complex arrangements signals mediate between measurements and effectors. This opens the possibility of multiple responses to the same measurement and responses based on multiple measurements. It also allows crosstalk, resulting in networks of control mechanisms. Such networks integrate the behaviors of the organism but also present a challenge in tailoring responses to particular measurements. We discuss how integrated activity can still result in differential, versatile, responses. (shrink)

Mere capacity views hold that agents who can intervene in an unfolding movement are performing an agentially controlled action, regardless of whether they do intervene. I introduce a simple argument to show that the noncausal explanation offered by mere capacity views fails to explain both control and action. In cases where bodily subsystems, rather than the agent, generate control over a movement, agents can often intervene to override non-agential control. Yet, contrary to what capacity views suggest, in (...) these cases, this capacity to intervene does not amount to agential control or action. I illustrate this with a case study of how passive breathing, a mere behavior, is misclassified by mere capacity views. I end by revisiting the central alternative to mere capacity views: causal control views. Advances in our understanding of how agents exert control over unfolding movements indicate that the nature of control is characterized by ubiquitous, small-scale causal interventions. (shrink)

Philosophical discussion on control has largely centred around control over our actions and beliefs. Yet this overlooks the question of whether we also have control over the reasons for which we act and believe. To date, the overriding assumption appears to be that we do not, and with seemingly good reason. We cannot choose to act for a reason and acting-for-a-reason is not itself something we do. While some have challenged this in the case of reasons for (...) action, these claims seem especially untenable regarding believing for a reason. And extending the scope of control in this way also faces the threat of regress. In the face of this orthodoxy, the present paper argues that we do in fact have control over both believing and acting for a particular reason. It also starts to develop an account of the way in which this would be possible. Given the broad importance of understanding control and agency, this paper bears on a number of topics in epistemology, the philosophy of mind, and ethics. (shrink)

Invention of artificial general intelligence is predicted to cause a shift in the trajectory of human civilization. In order to reap the benefits and avoid pitfalls of such powerful technology it is important to be able to control it. However, possibility of controlling artificial general intelligence and its more advanced version, superintelligence, has not been formally established. In this paper, we present arguments as well as supporting evidence from multiple domains indicating that advanced AI can’t be fully controlled. Consequences (...) of uncontrollability of AI are discussed with respect to future of humanity and research on AI, and AI safety and security. This paper can serve as a comprehensive reference for the topic of uncontrollability. (shrink)

Current hypothesis claims that language plays a significant role in regulating the placebo effect and begins by discussing the concept of the placebo effect and its potential impact on clinical trials and medical treatments. The paper describes the findings of a study on the Spanish language and its potential relationship in affecting the placebo effect through the known "Hispanic paradox". The paper goes on to discuss the Sapir-Whorf hypothesis and its potential implications for the relationship between language, (...) thought, and the placebo effect. We suggest that the way in which information is communicated to patients, including the choice of language and the specific words and phrases used, may play a role in the effectiveness of the placebo effect. We make further investigation and advise on how a new language model with logical rules may interpret the language - placebo effect in Non-euclidean formalism. -/- The paper proposes that further research could be conducted to investigate the relationship between language and the placebo effect, with the aim of developing more effective methods for predicting and regulating the placebo effect in clinical trials. (shrink)

We sometimes fail unwittingly to do things that we ought to do. And we are, from time to time, culpable for these unwitting omissions. We provide an outline of a theory of responsibility for unwitting omissions. We emphasize two distinctive ideas: (i) many unwitting omissions can be understood as failures of appropriate vigilance, and; (ii) the sort of self-control implicated in these failures of appropriate vigilance is valuable. We argue that the norms that govern vigilance and the value of (...) self-control explain culpability for unwitting omissions. (shrink)

Many extant theories of placebo focus on their causal structure wherein placebo effects are those that originate from select features of the therapy (e.g., client expectations or “incidental” features like size and shape). Although such accounts can distinguish placebos from standard medical treatments, they cannot distinguish placebos from everyday occurrences, for example, when positive feedback improves our performance on a task. Providing a social-epistemological account of a treatment context can rule out such occurrences, and furthermore reveal a new (...) way to distinguish clinical placebos from standard medical treatments. (shrink)

Recent work in cognitive modelling has found that most of the data that has been cited as evidence for the dual-process theory (DPT) of reasoning is best explained by non-linear, “monotonic” one-process models (Stephens et al., 2018, 2019). In this paper, I consider an important caveat of this research: it uses models that are committed to unrealistic assumptions about how effectively task conditions can isolate Type-1 and Type-2 reasoning. To avoid this caveat, I develop a coordinated theoretical, experimental, and modelling (...) strategy to better test DPT. First, I propose that Type-1 and Type-2 reasoning are defined as reasoning that precedes and follows metacognitive control, respectively. Second, I argue that reasoning that precedes and follows metacognitive control can be effectively isolated using debiasing paradigms that manipulate metacognitive heuristics (e.g., processing fluency) to prevent or trigger metacognitive control, respectively. Third, I argue that monotonic modelling can allow us to decisively test DPT only when we use them to analyse data from this particular kind of debiasing paradigm. (shrink)

This chapter focuses on the experimental practices and reasoning strategies employed in nineteenth century investigations on the causal origin of the phenomenon of Brownian movement. It argues that there was an extensive and sophisticated experimental work done on the phenomenon throughout the nineteenth century. Investigators followed as rigorously as possible the methodological standards of their time to make causal claims and advance causal explanations of Brownian movement. Two major methodological strategies were employed. The first was the experimental strategy of varying (...) the circumstances. Suspected causal factors were varied and the resulting effect on Brownian movement was studied. The main goal of this strategy was the identification of difference-making factors, i.e., factors having a causal influence on the phenomenon. The second was the so-called method of hypothesis. Rather than relying exclusively on the ability of experiments to identify difference-making factors, its proponents tried to show how the independently developed tenets of the new kinetic-molecular conception of matter provided a plausible causal explanation of Brownian movement. Each one of these methodological strategies had its distinctive practices and notions of control. None of these strategies could, on its own, establish molecular motion as the cause of Brownian movement. It was only the fruitful combination of the two strategies and of their accompanying practices and notions of control that led, at the end of the nineteenth century, to the recognition of molecular motion as the most probable cause of Brownian movement. (shrink)

The extensive involvement of nonconscious processes in human behaviour has led some to suggest that consciousness is much less important for the control of action than we might think. In this article I push against this trend, developing an understanding of conscious control that is sensitive to our best models of overt action control. Further, I assess the cogency of various zombie challenges—challenges that seek to demote the importance of conscious control for human agency. I argue (...) that though nonconscious contributions to action control are evidently robust, these challenges are overblown. (shrink)

It has been argued that the explanation of self-control requires positing special motivational powers. Some think that we need will-power as an irreducible mental faculty; others that we need to think of the active self as a dedicated and depletable pool of psychic energy or – in today more respectable terminology – mental resources; finally, there is the idea that self-control requires postulating a deep division between reason and passion – a deliberative and an emotional motivational system. This (...) essay argues that no such special motivational powers are necessary. Yet, at the same time, self-control does powerfully illustrate the importance of a feature of the mind. What it illustrates, I argue, is the importance of the mental activity of attention in the control of all action. It is by appeal to this mental activity that we can dispense with special motivational powers. If we think of Humeanism as the view that there is fundamentally only one kind of motivational system and that all action is based in that system, then this essay contributes to a defense of Humeanism. On the other hand, the essay also shows that any model of agency in terms of only beliefs and desires, motivational and representational states, or preferences and credences is incomplete. A different conception of Humeanism as the view that every mental state is either motivational, representational, or a combination of them, is false. (shrink)

Self-control is integral to successful human agency. Without it we cannot extend our agency across time and secure central social, moral, and personal goods. But self-control is not a unitary capacity. In the first part of this paper we provide a taxonomy of self-control and trace its connections to agency and the self. In part two, we turn our attention to the external conditions that support successful agency and the exercise of self-control. We argue that what (...) we call moral security is a critical foundation for agency. Parts three and four explore what happens to agency when moral security is lacking, as in the case of those subject to racism, and those living in poverty. The disadvantages suffered by those who are poor, in a racial minority or other oppressed group, or suffering mental illness or addiction, are often attributed to a lack of individual self-control or personal responsibility. In particular, members of these groups are often seen as irresponsibly focused on short-term pleasures over long-term good, a view underwritten by particular psychological theories of self-control. We explore how narratives about racism and poverty undermine moral security, and limit and distort the possibility of synchronic and diachronic self-control. Where moral security is undermined, the connection between self-control and diachronic goods often fails to obtain and agency contracts accordingly. We close with some preliminary reflections on the implications for responsibility. (shrink)

Judgments of blame for others are typically sensitive to what an agent knows and desires. However, when people act negligently, they do not know what they are doing and do not desire the outcomes of their negligence. How, then, do people attribute blame for negligent wrongdoing? We propose that people attribute blame for negligent wrongdoing based on perceived mental control, or the degree to which an agent guides their thoughts and attention over time. To acquire information about others’ mental (...) control, people self-project their own perceived mental control to anchor third-personal judgments about mental control and concomitant responsibility for negligent wrongdoing. In four experiments (N = 841), we tested whether perceptions of mental control drive third-personal judgments of blame for negligent wrongdoing. Study 1 showed that the ease with which people can counterfactually imagine an individual being non-negligent mediated the relationship between judgments of control and blame. Studies 2a and 2b indicated that perceived mental control has a strong effect on judgments of blame for negligent wrongdoing and that first-personal judgments of mental control are moderately correlated with third-personal judgments of blame for negligent wrongdoing. Finally, we used an autobiographical memory manipulation in Study 3 to make personal episodes of forgetfulness salient. Participants for whom past personal episodes of forgetfulness were made salient judged negligent wrongdoers less harshly compared to a control group for whom past episodes of negligence were not salient. Collectively, these findings suggest that first-personal judgments of mental control drive third-personal judgments of blame for negligent wrongdoing and indicate a novel role for counterfactual thinking in the attribution of responsibility. (shrink)

In this paper, I argue that deceptive placebo use can be morally permissible, on the grounds that the deception involved in the prescription of deceptive placebos can differ in kind to the sorts of deception that undermine personal autonomy. In order to argue this, I shall first delineate two accounts of why deception is inimical to autonomy. On these accounts, deception is understood to be inimical to the deceived agent’s autonomy because it either involves subjugating the deceived agent’s will (...) to another’s authority or because it precludes the agent from acting effectively in pursuit of their ends. I shall argue that providing an agent with false beliefs is not inimical to their autonomy if they are only able to effectively pursue their autonomously chosen ends by virtue of holding those particular false beliefs. Finally, I show that deceptive placebo use need only involve this latter sort of deception. (shrink)

Tom Dougherty argues that culpably deceiving another person into sex is seriously wrong no matter what the content about which she is deceived. We argue that his explanation of why deception invalidates consent has extremely implausible implications. Though we reject Dougherty’s explanation, we defend his verdict about deception and consent to sex. We argue that he goes awry by conflating the disclosure requirement for consent and the understanding requirement. When these are distinguished, we can identify how deceptive disclosure invalidates consent. (...) This alternative explanation also allows for a response to Neil Manson’s recent criticisms of Dougherty’s argument. (shrink)

There are a number of competing psychological accounts of the placebo effect, and much of the recent debate centers on the relative importance of classical conditioning and conscious beliefs. In this paper, I discuss apparent problems with these accounts and with?disjunctive? accounts that deny that placebo effects can be given a unified psychological explanation. The fact that some placebo effects seem to be mediated by cognitive states with content that is consciously inaccessible and inferentially isolated from a (...) subject's beliefs motivates an account of the placebo effect in terms of subdoxastic cognitive states. I propose that aliefs, subdoxastic cognitive states that are associative, automatic, and arational, can provide a unified psychological account of the placebo effect. This account also has the potential to illuminate interesting connections to other psychological phenomena. (shrink)

We advance an account that grounds cognition, specifically decision-making, in an activity all organisms as autonomous systems must perform to keep themselves viable—controlling their production mechanisms. Production mechanisms, as we characterize them, perform activities such as procuring resources from their environment, putting these resources to use to construct and repair the organism's body and moving through the environment. Given the variable nature of the environment and the continual degradation of the organism, these production mechanisms must be regulated by control (...) mechanisms that select when a production is required and how it should be carried out. To operate on production mechanisms, control mechanisms need to procure information through measurement processes and evaluate possible actions. They are making decisions. In all organisms, these decisions are made by multiple different control mechanisms that are organized not hierarchically but heterarchically. In many cases, they employ internal models of features of the environment with which the organism must deal. Cognition, in the form of decision-making, is thus fundamental to living systems which must control their production mechanisms. (shrink)

Reactivity, or the phenomenon by which subjects tend to modify their behavior in virtue of their being studied upon, is often cited as one of the most important difficulties involved in social scientific experiments, and yet, there is to date a persistent conceptual muddle when dealing with the many dimensions of reactivity. This paper offers a conceptual framework for reactivity that draws on an interventionist approach to causality. The framework allows us to offer an unambiguous definition of reactivity and distinguishes (...) it from placebo effects. Further, it allows us to distinguish between benign and malignant forms of the phenomenon, depending on whether reactivity constitutes a danger to the validity of the causal inferences drawn from experimental data. (shrink)

Placebos are often used by clinicians, usually deceptively and with little rationale or evidence of benefit, making their use ethically problematic. In contrast with their typical current use, a provocative line of research suggests that placebos can be intentionally exploited to extend analgesic therapeutic effects. Is it possible to extend the effects of drug treatments by interspersing placebos? We reviewed a database of placebo studies, searching for studies that indicate that placebos given after repeated administration of active treatments acquire (...) medication-like effects. We found a total of 22studies in both animals and humans hinting of evidence that placebos may work as a sort of dose extender of active painkillers. Wherever effective in relieving clinical pain, such placebo use would offer several advantages. First, extending the effects of a painkiller through the use of placebos may reduce total drug intake and side effects. Second, dose-extending placebos may decrease patient dependence. Third, using placebos along with active medication, for part of the course of treatment, should limit dose escalation and lower costs. Importantly, provided that nondisclosure is pre-authorized in the informed consent process and that robust evidence indicates therapeutic benefit comparable to that of standard full-dose therapeutic regimens, introducing dose-extending placebos into the clinical arsenal should be considered. This novel prospect of placebo use has the potential to change our general thinking about painkiller treatments, the typical regimens of painkiller applications, and the ways in which treatments are evaluated. (shrink)

Anorexia Nervosa (AN) is a complex disorder characterised by self-starvation, an act of self-destruction. It is often described as a disorder marked by paradoxes and, despite extensive research attention, is still not well understood. Much AN research focuses upon the distorted body image that individuals with AN supposedly experience. However, based upon reports from individuals describing their own experience of AN, I argue that their bodily experience is much more complex than this focus might lead us to believe. Such research (...) often presents an overly cognitive understanding of bodily experience in AN, underplaying the affective, felt experience of individuals with AN, as well as descriptions of empowerment, strength and control reported in the early stages of AN. This paper seeks to enrich our understanding of bodily experience in AN as it progresses throughout the various stages of the disorder. I show how the classical phenomenological distinction between the body-as-subject and the body-as-object, as well as Leder’s conception of the visceral body, can inform our understanding of bodily experience in AN. I suggest that the project of self-starvation is an attempt to overcome the noisy demands of the visceral body, which are experienced as threatening the body-as-subject, through a process of objectifying the body-as-object. By cashing out AN as a project of radical bodily control that, tragically, comes to control the individual, we can capture important aspects of the bodily experience of AN and the temporal progression of the disorder. -/- . (shrink)

Plausibly, agents act freely iff their actions are responses to reasons. But what sort of relationship between reason and action is required for the action to count as a response? The overwhelmingly dominant answer to this question is modalist. It holds that responses are actions that share a modally robust or secure relationship with the relevant reasons. This thesis offers a new alternative answer. It argues that responses are actions that can be explained by reasons in the right way. This (...) explanationist answer comes apart from the modalist answer. For it holds that actions are responses to reasons if they are explained by those reasons even if they don’t share a modally robust relationship. Explanationism thus offers a novel way of vindicating the intuition that alternative possibilities don’t matter to responding to reasons and (consequently) free agency. The key dialectical position the thesis develops is that both modalism and explanationism constitute attempts to capture he core type of relationship encoded by the notion of a response. Responses to reasons, at core, involve a non-accidental relationship between reason and action. We can either understand non-accidentality as a modal phenomenon – as a modally robust tracking between two facts. Or we can understand non-accidentality as an explanatory phenomenon – as a special explanatory relationship between two facts. According to my rival explanationist proposal, two facts share a non-accidental relationship iff we can give a unified explanation of why both obtain. Unified explanations are explanations of why [p&q] that cannot be decomposed into two (or more) separate independent explanations of p and of q. Consequently, according to explanationism about responding to reasons, actions are responses to reasons iff those reasons offer a rational explanation of the action that cannot be decomposed into separate independent components. (shrink)

Using placebos in day-to-day practice is an ethical problem. This paper summarises the available epidemiological evidence to support this difficult decision. Based on these data we propose to differentiate between placebo and “knowledge framing”. While the use of placebo should be confined to experimental settings in clinical trials, knowledge framing — which is only conceptually different from placebo — is a desired, expected and necessary component of any doctor-patient encounter. Examples from daily practice demonstrate both, the need (...) to investigate the effects of knowledge framing and its impact on ethical, medical, economical and legal decisions. (shrink)

Self-control, the capacity to resist temptations and pursue longer-term goals over immediate gratifications, is crucial in determining the overall shape of our lives, and thereby in our ability to shape our identities. As it turns out, this capacity is intimately linked with our ability to control the direction of our attention. This raises the worry that perhaps social media are making us more easily distracted people, and therefore less able to exercise self-control. Is this so? And is (...) it necessarily a bad thing? This paper analyzes the nature of attention, its vices and virtues, and what currently available evidence has to say about the effects of social media on attention and self-control. The pattern that seems to be emerging is that, although there is an association between higher use of social media and lower attentional control, we do not yet know whether it is social media use that makes people more distracted, or whether those who use social media the most do so because they are more easily distracted. Either way, the rise of the ‘Web 2.0’ does raise questions about whether the virtues of attention will change in the future, and whether this will bring with it a transformation in the way we shape our selves. (shrink)

This paper discusses the idea that the concept of privacy should be understood in terms of control. Three different attempts to spell out this idea will be critically discussed. The conclusion will be that the Source Control View on privacy is the most promising version of the idea that privacy is to be understood in terms of control.

This paper empirically raises and examines the question of ‘conceptual control’: To what extent are competent thinkers able to reason properly with new senses of words? This question is crucial for conceptual engineering. This prominently discussed philosophical project seeks to improve our representational devices to help us reason better. It frequently involves giving new senses to familiar words, through normative explanations. Such efforts enhance, rather than reduce, our ability to reason properly, only if competent language users are able to (...) abide by the relevant explanations, in language comprehension and verbal reasoning. This paper examines to what extent we have such ‘conceptual control’ in reasoning with new senses. The paper draws on psycholinguistic findings about polysemy processing to render this question empirically tractable and builds on recent findings from experimental philosophy to address it. The paper identifies a philosophically important gap in thinkers’ control over the key process of stereotypical enrichment and discusses how conceptual engineers can use empirical methods to work around this gap in conceptual control. The paper thus empirically demonstrates the urgency of the question of conceptual control and explains how experimental philosophy can empirically address the question, to render conceptual engineering feasible as an ameliorative enterprise. (shrink)

Control consciousness is the awareness or experience of seeming to be in control of one’s actions. One view, which I will be arguing against in the present paper, is that control consciousness is a form of sensory consciousness. In such a view, control consciousness is exhausted by sensory elements such as tactile and proprioceptive information. An opposing view, which I will be arguing for, is that sensory elements cannot be the whole story and must be supplemented (...) by direct contributions of nonsensory, motor elements. More specifically, I will be arguing for the view that the neural basis of control consciousness is constituted by states of recurrent activation in relatively intermediate levels of the motor hierarchy. (shrink)

One of the main obstacles to the realization of intentions for future actions and to the successful pursuit of long-term goals is lack of self-control. But, what does it mean to engage in self-controlled behaviour? On a motivational construal of self-control, self-control involves resisting our competing temptations, impulses, and urges in order to do what we deem to be best. The conflict we face is between our better judgments or intentions and “hot” motivational forces that drive or (...) compel us to act in opposing ways. In contrast, on an executive construal of self-control, the emphasis is not on overcoming temptation, but on overriding or inhibiting “cold” automatically triggered routines and habits that are at odds with what we intend to do. Our general aim in this chapter is to contribute to the development of an overarching theory of self-control by exploring ways in which these two apparently competing frameworks can be reconciled. We propose that self-control is best understood as a hybrid set of skills. We draw on recent work on expert motor skill to highlight important ways in which experts differ from novices in the capacities they deploy and the ways in which they deploy them. We consider analogies (and disanalogies) between the domain of sports expertise and the domain of self-control. We end by considering how such a hybrid approach can help us reconcile a motivational and an executive approach to self-control. (shrink)

Ontologies formally represent reality in a way that limits ambiguity and facilitates automated reasoning and data fusion, but is often daunting to the non-technical user. Thus, many researchers have endeavored to hide the formal syntax and semantics of ontologies behind the constructs of Controlled Natural Languages (CNLs), which retain the formal properties of ontologies while simultaneously presenting that information in a comprehensible natural language format. In this paper, we build upon previous work in this field by evaluating prospects of implementing (...) International Technology Alliance Controlled English (ITACE) as a middleware for ontology editing. We also discuss at length a prototype of a natural language conversational interface application designed to facilitate ontology editing via the formulation of CNL constructs. (shrink)

abstract Is it permissible for a doctor or nurse to knowingly administer a placebo in a clinical setting? There is certainly something suspicious about it: placebos are typically said to be ‘sham’ treatments, with no ‘active’ properties and so giving a placebo is usually thought to involve tricking or deceiving the patient who expects a genuine treatment. Nonetheless, some physicians have recently suggested that placebo treatments are sometimes the best way to help their patients and can be (...) administered in an honest way. These physicians conclude that placebo treatments are a perfectly acceptable, and ethically unproblematic, mode of treatment. While I grant the common idea that placebos are deceptive is correct, I argue that widespread misunderstandings concerning why this is so has led proponents of placebo treatments to respond to the charge of deception in a way that misses the mark entirely. My goal in this paper, then, is to develop a precise conception of what makes something a placebo, which in turn will clarify the central charge concerning the ethics of placebo treatment, viz. that it is deceptive. (shrink)

Researchers often claim that self-control is a skill. It is also often stated that self-control exertions are intentional actions. However, no account has yet been proposed of the skillful agency that makes self-control exertion possible, so our understanding of self-control remains incomplete. Here I propose the skill model of self-control, which accounts for skillful agency by tackling the guidance problem: how can agents transform their abstract and coarse-grained intentions into the highly context-sensitive, fine-grained control (...) processes required to select, revise and correct strategies during self-control exertion? The skill model borrows conceptual tools from ‘hierarchical models’ recently developed in the context of motor skills, and asserts that self-control crucially involves the ability to manage the implementation and monitoring of regulatory strategies as the self-control exercise unfolds. Skilled agents are able do this by means of flexible practical reasoning: a fast, context-sensitive type of deliberation that incorporates non-propositional representations into the formation and revision of the mixed-format intentions that structure self-control exertion. The literatures on implementation intentions and motivation framing offer corroborating evidence for the theory. As a surprising result, the skill of self-control that allows agents to overcome the contrary motivations they experience is self-effacing: instead of continuously honing this skill, expert agents replace it with a different one, which minimizes or prevents contrary motivations from arising in the first place. Thus, the more expert you are at self-control, the less likely you are to use it. (shrink)

Actions that are intended to produce harmful consequences can fail to achieve their desired effects in numerous ways. We refer to action sequences in which harmful intentions are thwarted as deviant causal chains. The culpable control model of blame (CCM)is a useful tool for predicting and explaining the attributions that observers make of the actors whose harmful intentions go awry. In this paper, we describe six types of deviant causal chains; those in which: an actor’s attempt is obviated by (...) the intervention of another person or the environment; the intended effects could not have been produced regardless of the actor’s behavior; other causes diminish the actor’s causal role; the actor brings about foreseen but undesired consequences as a result of pursuing his or her focal goal; the focal action produces a chain of increasingly remote causal events; and the actor derives unforeseen benefits from his or her nefarious actions. A basic assumption of the CCM in these cases is that attributions for the participants’ actions will depend on positive and negative evaluations of their intentions and behaviors. We describe empirical findings that are consistent with this assumption, and predict other findings for causal deviance phenomena that have not yet been investigated empirically. (shrink)

Causal selection has to do with the distinction we make between background conditions and “the” true cause or causes of some outcome of interest. A longstanding consensus in philosophy views causal selection as lacking any objective rationale and as guided, instead, by arbitrary, pragmatic, and non-scientific considerations. I argue against this position in the context of causal selection for disease traits. In this domain, causes are selected on the basis of the type of causal control they exhibit over a (...) disease of interest. My analysis clarifies the principled rationale that guides this selection and how it involves both pragmatic and objective considerations, which have been overlooked in the extant literature. (shrink)

I hope to show that, although belief is subject to two quite robust forms of agency, "believing at will" is impossible; one cannot believe in the way one ordinarily acts. Further, the same is true of intention: although intention is subject to two quite robust forms of agency, the features of belief that render believing less than voluntary are present for intention, as well. It turns out, perhaps surprisingly, that you can no more intend at will than believe at will.

In this paper, a solenoid based linearly movable armature system is designed using robust control theory in order to improve the performance of the system. Reference track method is the best performance analysis for position control systems. Among the robust controllers, H infinity mixedsensitivity and Mixed H 2 /H∞ with Regional Pole Placement Controllers are used to improve the performance of the system. Comparison of the proposed controllers for tracking a reference displacement signals (step and sine wave) and (...) a promising simulation result have been obtained. (shrink)

The Shape of Agency offers interlinked explanations of the basic building blocks of agency, as well as its exemplary instances. The first part offers accounts of a collection of related phenomena that have long troubled philosophers of action: control over behaviour, non-deviant causation, and intentional action. These accounts build on earlier work in the causalist tradition, and undermine the claims made by many that causalism cannot offer a satisfying account of non-deviant causation, and therefore fails as an account of (...) intentional action. The second part turns to modes of agentive excellence—ways that agents display quality of form—providing a novel account of skill, including an account of the ways that agents display more or less skill. Shepherd discusses the role of knowledge in skill, and concludes that while knowledge is often important, it is inessential. This leads to a discussion of the way that knowledge of action and knowledge of how to act informs action execution. Knowledgeable action includes a unique epistemic underpinning: in knowledgeable action, the agent has authoritative knowledge of what she is doing and how she is doing it when and because she is poised to control her action by way of practical reasoning. (shrink)

It is tempting to think (though many deny) that epistemic agents exercise a distinctive kind of control over their belief‐like attitudes. My aim here is to sketch a “bottom‐up” model of epistemic agency, one that draws on an analogous model of practical agency, according to which an agent's conditional beliefs are reasons‐responsive planning states that initiate and sustain mental behavior so as to render controlled.

Mere capacity views hold that agents who can intervene in an unfolding movement are performing an agentially controlled action, regardless of whether they do intervene. I introduce a simple argument to show that the noncausal explanation offered by mere capacity views fails to explain both control and action. In cases where bodily subsystems, rather than the agent, generate control over a movement, agents can often intervene to override non-agential control. Yet, contrary to what capacity views suggest, in (...) these cases, this capacity to intervene does not amount to agential control or action. I illustrate this with a case study of how passive breathing, a mere behavior, is misclassified by mere capacity views. I end by revisiting the central alternative to mere capacity views: causal control views. Advances in our understanding of how agents exert control over unfolding movements indicate that the nature of control is characterized by ubiquitous, small-scale causal interventions. (shrink)