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)

Is there a response, which is not accounted for by regression to the mean, natural history, the Hawthorne effect?The term placebo comes to us from the Latin for "I shall please," indicating that the phenomenon known as the "placebo effect" or "placebo response" has been familiar to medical practitioners for a number of centuries, at least. As we reached the mid-20th century and randomized controlled trials became a central feature of medical research, the use of controls and (...) blinding in those trials allowed for the isolation of the placebo effect in ways that made it much clearer that there... (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)

Philosophical debates about how best to explain emotion or placebo are debates about how best to characterise and explain the distinctive form of human responsiveness to the world that is the object of interest for each of those domains of inquiry. In emotion research, the cognitive theory of emotion faces several intractable problems. I discuss two of these: the problem of epistemic deficit and the problem of recalcitrant emotions. Cognitive explanations in Placebo Studies, such as response-expectancy and belief-based (...) explanations, also face the problem of epistemic deficit in addition to the problem of logically self-destructive true belief. While such considerations might motivate a retreat to affect, this brings its own problems. I argue that it is a particular version of cognitivism, representational cognitivism (Rep-Cog), that generates the paradoxes we encounter in emotion and placebo research. I propose that turning to nonrepresentational accounts of cognition will dissolve these paradoxes. As I move toward conclusion, I propose drawing on the ethnomethodological tradition to respecify human responsiveness to loci of significance in the lifeworld by undertaking ethnographies of members’ own situated methods for making intelligible and accountable their attitudinal and nonattitudinal responsiveness to loci of significance in their environment. (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)

The placebo effect has puzzled scientists for centuries. Philosopher Dien Ho argues that we now know how it works, and that this should transform our understanding of the relationship between mind and body. We must stop thinking of improvements in health due to placebo as somehow less real than those due to other medicines: there can no longer be a clean distinction between ill-health that’s “all in the head” and ill-health that involves a malfunctioning body. Ho argues that (...) our improved understanding of placebos means that doctors should now harness their power in treatment, especially since research shows that they can be effective even when patients are told that they’re taking a placebo. (shrink)

One of the central problems in the philosophy of action is to spell out the distinction between action and what merely happens, e.g., a wink versus an eye twitch. This essay proposes a theory of action offering an account of this distinction. The central claim of the theory is that action is movement that is controlled by the mover, where movement is understood capaciously and control is characterized by a trio of conditions consisting of an aim condition, a modal (...) condition, and an explanatory condition. Importantly, being controlled is shown to be a determinable property of movements, and its determination dimensions are isolated. Paired with the claim that action is movement that is controlled by the mover, this account of control as a determinable illuminates the diversity within the category of action. (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)

Perceptual-control theory offers a physically reductive way to account for teleology or goal-directedness, ranging from the initial emergence of life, to creatures capable of regulating their own consciousness. This broad framework motivates key aspects of the perceptual-control model including the flexibility of behaviour, the hierarchy of aims or values, and the links between control and affective states. In this way, perceptual control theory integrates the psychological constants of representation, evaluation, and action.

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)

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)

Consider the following patient: a 40-year-old man who has had back pain that radiates down his left leg, on and off for 2 months. He performs his normal activities and does not have any “red flag”...

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)

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)

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)

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)

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.

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)

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)

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)

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)

Following maze research in animal behavior studies through the twentieth century, I explore “control” as an extended historical process involving the successive stabilization or removal of bits and scraps of the world to arrive at the pure form of a phenomenon of interest. Early behaviorist investigation of maze learning aimed to strip environmental cues from maze design to study context-free learning. Exemplifying this tendency is the famous 1907 “Kerplunk” experiment of Watson and Carr, in which they concluded that rats (...) could ultimately learn a maze as one long bodily response unspooling in a successive series of actions, rather than basing their movement through the maze on external sensory stimuli. Supporting this context-free research program was a conceptual understanding of learning as something singular and general. With later, more ecological, accounts of animal behavior, however, it was argued that these early control practices had nullified the rich interrelation between organism and environment that makes advanced learning possible. The result was a deflated and distorted understanding of animal learning. Researchers had, in short, controlled away the phenomenon. This case highlights the tension between the object of inquiry and the object of control, and illustrates how novelty emerges in reinterpreting as central to the phenomenon of interest that which was previously merely interference. (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.

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)

This paper introduces a comprehensive theoretical framework that integrates quantum mechanics and metaphysical philosophy to investigate the intricate relationship between cosmic order and governance. In an effort to transcend the traditional divide between science and philosophy, this study establishes its foundations in mathematical formalism and empirical analogies, thereby mitigating the risk of philosophical overreach often associated with theoretical physics. The proposed framework reimagines quarks as fundamental nodes within a cosmic information network, governed by the principles of quantum chromodynamics (QCD) and (...) non-local coherence, offering a novel perspective on the interconnectedness of physical phenomena. Central to this exploration is the development of a Nash equilibrium model, which balances deterministic constants (α), probabilistic variables (β), and stochastic noise (γ), drawing inspiration from quantum indeterminacy and theological notions of free will. Furthermore, the study fosters interdisciplinary dialogue by bridging ancient and modern philosophical paradigms—such as Platonic Logos, Penrose’s twistor theory, and Quranic qadar —through carefully constructed thought experiments and analogies, ensuring a clear distinction between empirical observations and metaphysical interpretations. The research concludes by proposing future experimental directions, including collider tests and quantum sensor arrays, aimed at grounding the Cosmic Control Panel model in empirically verifiable science. By challenging reductionist paradigms while upholding theoretical humility, this study lays the groundwork for a rigorous and testable interdisciplinary framework, paving the way for deeper insights into the harmonious interplay between cosmic determinism and human agency. (shrink)

1: Placebo effect sometimes plausibly has powerful effects. 2: Buddhism philosophy holds that every living animal is sentient, and has a consciousness and killing them is bad for the killer and freeing them is good somehow. Consciousness may involve some aspects of quantum mechanism as Roger Penrose’s Orch OR' theory of consciousness pointed out. -/- 3: Although previous studies show that there is no “demonstrable effects of distant intercessory prayer. Anecdotal cases of a special kind of Buddhist activity of (...) freeing captive animals in huge amount seem to have powerful therapeutic effects on severe and terminal patients. We want test it experimentally. 4: The cunning point that exceeds previous stuies is, it’s reasonable to consider there may be collective and superpositional effects of this activity due to the likely quantum mechanism of consciousness, and it may play as a sort of magnifying glass that shows a discernible placebo effect. -/- 5:We recruit a considerable number of patients that are terminally ill and the doctors said they can not help them anymore and have double-blind experiments of the above idea.The statistics may show some anomalous distribution. Ethical concerns shall take into consideration. (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)

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)

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)

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)

Recent studies have explored the effectiveness of open-label placebos for a variety of conditions, including chronic pain, cancer-related fatigue and irritable bowel syndrome. OLPs are thought to sidestep traditional ethical worries about placebos because they do not involve deception: with an OLP, patients or subjects are told outright that they are not given an active substance. As deception is framed as the primary hurdle to ethical placebo use, the door is ostensibly opened to ethical studies of OLPs. In this (...) article, I suggest that even though OLPs seemingly do not involve deception, there are other ethical considerations in their clinical investigation and subsequent use. Research ethics often focusses on informed consent—of which, deception and honesty are a piece—as a means to justify research practices with human subjects. Yet, it is but one of the ethical considerations that should be taken into account. With research into placebo effects in particular, I argue that the history of clinical placebo use grounds special considerations for OLP research that go beyond respect for the autonomy of individual patients through informed consent and encompass structural concerns about the type of patient for whom a placebo has historically been thought appropriate. (shrink)

Control is typically accepted as a necessary condition for moral responsibility. Thus, humans are morally responsible for their actions only if we can realise the right kind of control. Are there good reasons to think that humans can psychologically realise control? This paper is an attempt to address this question by establishing choice and agenthood as separate but interconnected aspects of control. I consider two challenges to the claim that humans can realise the kind of (...) class='Hi'>control required for moral responsibility. First, an empirical challenge from cognitive neuroscience provides a familiar way to argue against the realisation of the choice aspect by human psychology. Second, a more formidable conceptual challenge to the aspect of agenthood presents us with scepticism about the kind of explanations that psychology can provide. The second challenge suggests that, in psychological accounts of choice, the agent disappears. Drawing on recent empirical models of cognitive control and philosophical accounts of agency, I conclude that the psychological explanation of choice is consistent with the aspect of agenthood being realised by human psychology. (shrink)

Artificial agents create significant moral opportunities and challenges. Over the last two decades, discourse has largely focused on the concept of a ‘responsibility gap.’ We argue that this concept is incoherent, misguided, and diverts attention from the core issue of ‘control gaps.’ Control gaps arise when there is a discrepancy between the causal control an agent exercises and the moral control it should possess or emulate. Such gaps present moral risks, often leading to harm or ethical (...) violations. We propose a second-order ‘duty of moral control’ that mandates closing these gaps to reduce risks within acceptable moral limits. Our analysis encompasses both autonomous machines and collective agents, acknowledging their similarities and key differences in constitution and moral status. We suggest four methods to close control gaps: ensuring artificial agents attain moral agency, providing meaningful human control, implementing safety engineering, and employing social control. These methods aim to responsibly integrate artificial agents into society. We conclude that a realistic approach, which addresses the practical problems posed by control gaps, is essential. This approach provides solutions to manage the risks posed by artificial agents while maintaining acceptable moral standards, ensuring we responsibly harness their potential and address the ethical challenges they present. (shrink)

Necessarily, if S lacks the ability to exercise control, S is not an agent. If S is not an agent, S cannot act intentionally, responsibly, or rationally, nor can S possess or exercise free will. In spite of the obvious importance of control, however, no general account of control exists. In this paper I reflect on the nature of control itself. I develop accounts of control ’s exercise and control ’s possession that illuminate what (...) it is for degrees of control —that is, the degree of control an agent possesses or exercises in a given circumstance—to vary. Finally, I demonstrate the usefulness of the account on offer by showing how it generates a solution to a long-standing problem for causalist theories of action, namely, the problem of deviant causation. (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)

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)

From a European perspective the US debate about gun control is puzzling because we have no such debate: It seems obvious to us that dangerous weapons need tight control and that ‘guns’ fall under that category. I suggest that this difference occurs due to different habits that generate different attitudes and support this explanation with an analogy to the habits about knives. I conclude that it is plausible that individual knife-people or gun-people do not want tight regulatory legislation—but (...) tight knife and gun legislation is morally obligatory anyway. We need to give up our habits for the greater good. (shrink)

Akratic actions are often being thought to instantiate a paradigmatic self-control failure. . If we suppose that akrasia is opposed to self-control, the question is how akratic actions could be free and intentional. After all, it would seem that it is only if an action manifests self-control that it can count as free. My plan is to explore the relation between akrasia and self-control. The first section presents what I shall call the standard conception, according to (...) which akrasia and self-control are contraries, and introduces the puzzle that this conception raises. The second section turns to the arguments for and against the possibility of free and intentional akratic actions. The third section questions the claim that akratic actions are necessarily opposed to actions manifesting self-control. (shrink)

The transferability problem—whether the results of an experiment will transfer to a treatment population—affects not only Randomized Controlled Trials but any type of study. The problem for any given type of study can also, potentially, be addressed to some degree through many different types of study. The transferability problem for a given RCT can be investigated further through another RCT, but the variables to use in the further experiment must be discovered. This suggests we could do better on the epistemological (...) problem of transferability by promoting, in the repeated process of formulating public health guidelines, feedback loops of information from the implementation setting back to researchers who are defining new studies. (shrink)

What is self-control and how does the concept of self-control relate to the notion of will-power? A widespread philosophical opinion has been that the notion of will-power does not add anything beyond what can be said using other motivational notions, such as strength of desire and intention. One exception is Richard Holton who, inspired by recent research in social psychology, has argued that will-power is a separate faculty needed for persisting in one's resolutions, what he calls 'strength of (...) will'. However, he distinguishes strength of will from self-control. In this paper I argue that will-power is essential also to a certain form of self-control. I support this claim by arguments showing that the traditional philosophical accounts of self-control run into difficulties because they pay insufficient attention to will-power as an independent source of motivation. (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)