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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The success of precision medicine depends on obtaining large amounts of information about at-risk populations. However, getting consent is often difficult. Why? In this commentary I point to the differentials in social status involved. These differentials are inevitable once personal information is surrendered, but are particularly intense when the studied populations are socioeconomically or socioculturally disadvantaged and/or ethnically stigmatized groups. I suggest how the deep distrust of the latter groups can be partially justified as a lack of confidence that (...) their core values or interests will sufficiently be taken into account. Hence, the ethical challenge here lies not in avoiding status differentials, but in dealing with them appropriately. Scientists should not assume trust from others but adopt a norm of “demonstrating trustworthiness”. (shrink)

Even in the increasingly individualized American medical system, advocates of 'personalized medicine' claim that healthcare isn't individualized enough. With the additional glamour of new biotechnologies such as genetic testing and pharmacogenetics behind it, 'Me Medicine'-- personalized or stratified medicine-- appears to its advocates as the inevitable and desirable way of the future. Drawing on an extensive evidence base, this book examines whether these claims are justified. It goes on to examine an alternative tradition rooted in communitarian ideals, (...) that of the common good as a goal in medicine. (shrink)

Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue (...) that draws both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. (shrink)

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

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

In this paper, I argue that the concept of normality in medical research and clinical practice is inextricable from the concept of ambiguity. I make this argument in the context of Edmund Pellegrino's call for a renewed reflection on medicine’s basic concepts and by drawing on work in critical disability studies concerning Deafness and body integrity identity disorder. If medical practitioners and philosophers of medicine wish to improve their understanding of the meaning of medicine as well as (...) its concrete practice, I contend that they should take seriously the import and centrality of ambiguity for biomedicine. (shrink)

The issue of how to incorporate the individual's first‐hand experience of illness into broader medical understanding is a major question in medical theory and practice. In a philosophical context, phenomenology, with its emphasis on the subject's perception of phenomena as the basis for knowledge and its questioning of naturalism, seems an obvious candidate for addressing these issues. This is a review of current phenomenological approaches to medicine, looking at what has motivated this philosophical approach, the main problems it faces (...) and suggesting how it might become a useful philosophical tool within medicine, with its own individual, but interrelated, contribution to make to current medical debates. After the general background, there is a brief summary of phenomenological ideas and their current usage in a medical context. Next is a critique of four key claims within current phenomenological medical works, concerning both the role phenomenology plays and the supposedly clear divide between phenomenology and other approaches. There are significant problems within these claims, largely because they overlook the complexity of the questions they consider. Finally, there is some more in‐depth examination of phenomenology itself and the true complexity of phenomenological debate concerning subjectivity. The aim is to show that it will be both more productive and truer to phenomenology itself, if we use phenomenology as a philosophical method for explicating and gaining deeper understanding of complex and fundamental problems, which are central to medicine, rather than as providing simple, but flawed solutions. (shrink)

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

The present text is the revised and corrected English translation of the book published in German by the Lang Verlag, Bern 2008. Unfortunately the text still has some minor flaws (especially in the Index Locorum) but they do not concern the main thesis or the arguments. It will still be the final version, especially considering my age. It is among the most widespread and the least questioned convictions that in Metaphysics Lambda Aristotle presents a theology which has its basis in (...) a metaphysics of substance. Doubts about theological interpretation are beginning to stir in a growing number of publications, but nevertheless the majority of research literature, compendiums and histories of philosophy argues within this frame. A closer look at the facts reveals that this conviction has no basis in the text. Quite the contrary it is based on a reception with theological interests. It arised over centuries, starting from Patristic times and the Middle Ages; it was influenced by Neoplatonic texts as the Liber de Causis or the Theologia Aristotelis, texts for a long time considered as original Aristotelian books. And, if you read not translations but the Greek text, you see that the word 'god' occurs much less than in a theological book should be. In some translations we find more occurences of that word, and especially in French, Italian, English translations some words as le Bien, l'Intelligence etc. are written with capitals to inticate that it is about god. To make it even more clear, we read often the term 'First Mover' or 'Unmoved Mover' as an other name for god, but this expression is never used by Aristotle. So the reader has the impression that Aristotle speaks continuously about god. In addition, in the present book you will find arguments which clean up with the outdated concept of substance in the Aristotelian text, a concept which was developed for quite other problems than Aristotle had, namely theolgical ones. And, if there is no substance, there is no corresponding metaphysics of substance and no theology or onto-theology. If substance, metyphysics, theology play no role in Metaphysics Lambda, what else is its content and aim? That is not so difficult to say because Aristotle says it sufficiently clear in his first sentence, περὶ οὐσίας ἡ θεωρία: our inquiry is about being; its aim is to develop the Frage nach dem Sein and to state a speculative answer: being is noesis, Sein ist Gewahren. (shrink)

ABSTRACT: Abstract Most modern knowledge is not science. The physical sciences have successfully validated theories to infer they can be used universally to predict in previously unexperienced circumstances. According to the conventional conception of science such inferences are falsified by a single irregular outcome. And verification is by the scientific method which requires strict regularity of outcome and establishes cause and effect. -/- Medicine, medical research and many “soft” sciences are concerned with individual people in complex heterogeneous populations. These (...) populations cannot be tested to demonstrate strict regularity of outcome in every individual. Neither randomised controlled trials nor observational studies in medicine are science in the conventional conception. Establishing and using medical and other “soft science” theories cannot be scientific. It requires conceptually different means: requiring expert judgement applying all available evidence in the relevant available factual matrix. -/- The practice of medicine is observational. Prediction of outcomes for the individual requires professional expertise applying available medical knowledge and evidence. Expertise in any profession can only be acquired through experience. Prior cases are the fundament of knowledge and expertise in medicine. Case histories, studies and series can provide knowledge of extremely high reliability applicable to establishing reliable general theories and falsifying others. Their collation, study and analysis should be a priority in medicine. Their devaluation as evidence, the failure to apply their lessons, the devaluation of expert professional judgement and the attempt to emulate the scientific method are all historic errors in the theory and practice of modern medicine. (shrink)

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

In the last decade alone, a growing body of preliminary evidence suggests that classic psychedelics (CPs) can rapidly and durably ameliorate symptoms and cognitive deficits associated with depression. However, the mechanisms by which CPs work in the brain are not well understood. Rodent translational research, in which experimental findings from rodents are translated to humans, is fundamental in achieving this goal. This chapter focuses on a representative subset of human and rodent studies investigating CPs for depression, including the various (...) lines of research that have been initiated to understand how they work. Our aim is to show that in addition to epistemic challenges that scientists face in translating findings from rodents to humans, there is also mismatch between experimental approaches used to investigate CPs in humans and rodents. We thus show current experimental practices are not conducive to mechanistic discovery. We end with a set of positive proposals to expedite the drive to translate CPs into effective treatments for depression. -/- Keywords: classic psychedelics, psychiatry, clinical trials, collaboration, extrapolation, major depressive disorder, open science, philosophy of science, rodent models, scientific practice, translation, validity . (shrink)

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

This paper considers the issue of translation failure between theories from the perspective of a modified causal theory of reference. It is argued that translation failure between theories is in fact a consequence of such a modified causal theory of reference. The paper attempts to show what is right about the incommensurability thesis from the perspective of such a theory of reference. Since relations of co-reference may obtain between theories in the absence of translation, incomparability of content does not follow (...) from failure of translation. (shrink)

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

In this paper, I offer one example of conceptual change. Specifically, I contend that the discovery that viruses could cause cancer represents an excellent example of branch jumping, one of Thagard’s nine forms of conceptual change. Prior to about 1960, cancer was generally regarded as a degenerative, chronic, non-infectious disease. Cancer causation was therefore usually held to be a gradual process of accumulating cellular damage, caused by relatively non-specific component causes, acting over long periods of time. Viral infections, on the (...) other hand, were generally understood to be acute processes, whereby single, specific and necessary causal agents acted alone to produce disease. However, during the 1960s and 1970s, a number of cancers were discovered to have an infectious aetiology. Of particular note were two—Burkitt’s lymphoma and cervical cancer—which I will discuss in detail later in this piece. Together, these discoveries led, in the short term, to a tentative aetiological reclassification of some types of cancer as infectious diseases and, in the longer term, to a full-blown reclassification of cancer as an aetiological disease branch in its own right. This process of reclassification forms the empirical basis for my concluding remarks on the influence of classification upon causation in medicine. Through this, I aim to demonstrate that conceptual change, far from being a purely abstract concern of the philosopher of science, is of substantial import to scientific practitioners. (shrink)

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

Many neurodegenerative and neuropsychiatric diseases and other brain disorders are accompanied by impairments in high-level cognitive functions including memory, attention, motivation, and decision-making. Despite several decades of extensive research, neuroscience is little closer to discovering new treatments. Key impediments include the absence of validated and robust cognitive assessment tools for facilitating translation from animal models to humans. In this review, we describe a state-of-the-art platform poised to overcome these impediments and improve the success of translational research, the Mouse (...) class='Hi'>Translational Research Accelerator Platform (MouseTRAP), which is centered on the touchscreen cognitive testing system for rodents. It integrates touchscreen-based tests of high-level cognitive assessment with state-of-the art neurotechnology to record and manipulate molecular and circuit level activity in vivo in animal models during human-relevant cognitive performance. The platform also is integrated with two Open Science platforms designed to facilitate knowledge and data-sharing practices within the rodent touchscreen community, touchscreencognition and mousebytes. Touchscreencognition includes the Wall, showcasing touchscreen news and publications, the Forum, for community discussion, and Training, which includes courses, videos, SOPs, and symposia. To get started, interested researchers simply create user accounts. We describe the origins of the touchscreen testing system, the novel lines of research it has facilitated, and its increasingly widespread use in translational research, which is attributable in part to knowledge-sharing efforts over the past decade. We then identify the unique features of MouseTRAP that stand to potentially revolutionize translational research, and describe new initiatives to partner with similar platforms such as McGill’s M3 platform. (shrink)

This is a volume of twelve essays concerning the fundamental tension in personalised medicine between individual choice and the common good.

Part of a symposium devoted to ‘Prediction, Understanding, and Medicine’, in which Alex Broadbent argues that the nature of medicine is determined by its competences, i.e., which things it can do well. He argues that, although medicine cannot cure well, it can do a good job of enabling people not only to understand states of the human organism and of what has caused them, but also to predict future states of it. From this Broadbent concludes that (...) class='Hi'>medicine is (at least in part) essentially a practice of understanding and predicting, not curing. In reply to this bold position, I mount two major criticisms. First, I maintain that the reasons Broadbent gives for doubting that medicine can cure provide comparable reason for doubting that medicine can provide an understanding; roughly, the best explanation of why medicine cannot reliably cure is that we still lack much understanding of health and disease. Second, I object to the claim that a practice is medical only if it facilitates understanding and prediction. Although Broadbent has brought to light certain desirable purposes of medicine that are under-appreciated, my conclusion is that he has not yet provided enough reason to think that understanding and prediction are essential to it. Instead of supposing that medicine has an essence, in fact, I suggest that its nature is best understood in terms of a property cluster. (shrink)

As opposed to a ‘one size fits all’ approach, precision medicine uses relevant biological, medical, behavioural and environmental information about a person to further personalize their healthcare. This could mean better prediction of someone’s disease risk and more effective diagnosis and treatment if they have a condition. Big data allows for far more precision and tailoring than was ever before possible by linking together diverse datasets to reveal hitherto-unknown correlations and causal pathways. But it also raises ethical issues relating (...) to the balancing of interests, viability of anonymization, familial and group implications, as well as genetic discrimination. This article analyses these issues in light of the values of public benefit, justice, harm minimization, transparency, engagement and reflexivity and applies the deliberative balancing approach found in theEthical Framework for Big Data in Health and Research to a case study on clinical genomic data sharing. Please refer to that article for an explanation of how this framework is to be used, including a full explanation of the key values involved and the balancing approach used in the case study at the end. Our discussion is meant to be of use to those involved in the practice as well as governance and oversight of precision medicine to address ethical concerns that arise in a coherent and systematic manner. (shrink)

Through this contribution I aim to explore the horizons and limits of digital medicine in light of an embodied approach to the issue of care. I will sketch the historical background of digital medicine and show the contemporary status of this interdisciplinary field, as well as its applications and outcomes. Then, I will address a critique of the computational theory of mind (CTM) upon which many contemporary mental health apps are designed. This approach to the mind is inscribed (...) into the modern trend of neuromania, which conceives the embodied, living human being as a mere series of data analyses and algorithms, with the brain as the seat of the person. Drawing on continental philosophy and classical phenomenology I will develop a notion of health conceived as a moral enterprise, showing how wellbeing and vitality are not reducible to a product made by technologies or doctors, but rather they are the results of an embodied encounter. As such, empathy and person-centered care cannot be achieved by digital medicine. They are the result of a journey into the regions of recognition, embodied presence and the aliveness constituting the person. Finally, I will show how the issue of care cannot be separated from an embodied encounter between people, especially in case of dementia. (shrink)

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

According to the philosophical tradition, translation is successful when one has substituted words and sentences from one language with those from another by cross-linguistic synonymy. Moreover, according to the orthodox view, the meaning of expressions and sentences of languages are determined by their basic or systematic role in a language. This makes translating normative and evaluative discourse puzzling for two reasons. First, as languages are syntactically and semantically different because of their peculiar cultural and historical influences, and as values and (...) norms differ across cultures, it is unlikely that languages will have synonymous evaluative and normative expressions. If translation is only successful by cross-linguistic synonymy, it would seem that we will not be able to translate the value theoretic claims of persons from radically different cultures. But it is with such persons that dialogue on evaluative matters is imperative, to resolve ethical and axiological differences that could be the root of conflict. Second, as the orthodox account of meaning renders it linguistically relative, it is unlikely that expressions across languages will be cross-linguistically synonymous. Thus, on the Orthodox account of translation, translation is indeterminate (as W.V.O. Quine has argued) or impossible (as Jacques Derrida has argued). In this dissertation I argue for a novel theory of meaning and translation based on innovations in the translation studies literature and my prior work in cross cultural research, which I call Text-Type Semantics or TTS. TTS explains how translation is successful while affirming radical cultural and linguistic diversity. It treats disciplinary concerns as the neutral criteria to calibrate translation. On the basis of TTS I argue that we need what I call the “Quasi-Indexical” account of thick and thin concepts (or QI) to translate normative and evaluative discourse. I argue that QI and TTS succeed where competing accounts in the moral semantics literature (such as Non-Analytic Naturalism and Expressivism) fail. The argument also shows that the relativization of truth (in philosophy and beyond) to languages and cultures is mistaken. (shrink)

If one had to identify the biggest change within the philosophical tradition in the twenty-first century, it would certainly be the rapid rise of experimental philosophy to address differences in intuitions about concepts. It is, therefore, surprising that the philosophy of medicine has so far not drawn on the tools of experimental philosophy in the context of a particular conceptual debate that has overshadowed all others in the field: the long-standing dispute between so-called naturalists and normativists about the concepts (...) of health and disease. In this paper, I defend and advocate the use of empirical methods to inform and advance this and other debates within the philosophy of medicine. (shrink)

David Tomasi presents new, groundbreaking research on the science and application of Mind-Body Medicine strategies to improve clinical outcomes in inpatient psychiatry settings. Much more than a list of therapeutic recommendations, this book is a thorough description of how Mind-Body Medicine can be successfully applied, from a therapeutic as well as from an organizational, cost-effective analysis viewpoint, to the full spectrum of psychiatric treatments. Furthermore, this study examines the role of multidisciplinary and interdisciplinary treatment teams, with a special (...) focus on the profession and the role of psychotherapists and group therapists, thereby providing solid scientific evidence of the benefits of patient-provider therapeutic alliances. In this sense, this book serves as a guide for professionals and institutions both in the private and the public sphere, to learn effective treatment and management strategies. About the Author Psychotherapist, Researcher, and Philosopher Dr. David Låg Tomasi is the author of Medical Philosophy (ibidem, 2016) and the co-author of Positive Patient Response to a Structured Exercise Program Delivered in Inpatient Psychiatry (Global Advances in Health and Medicine, 2019), the most-read research item from the University of Vermont (Researchgate, 2019). A member of several national and international Academies of Sciences, Dr. Tomasi works in the Inpatient Psychiatry Unit at the UVM Medical Center, and teaches at the University of Vermont and the Community College of Vermont. ---- Ibidem / Columbia University Press. (shrink)

According to one influential view, something which we might have reason to think is a language, is not proven to be such until it has been translated. I will try to show, to the contrary, that it is necessary to appeal to factors which are independent of translation in order to establish that it is indeed a language which has been translated in the first place. If this is right, it follows that proof of languagehood, so far from depending on (...) translation, is in fact logically prior to translation. (shrink)

In “Conceptual Differences Between Children and Adults,” Susan Carey discusses phlogiston theory in order to defend the view that there can be non-translatability between scientific languages. I present an objection to her defence.