Who Moved My Cheese? showed readers how to adapt to change. Fish! helped raise flagging morale. Execution guided readers to overcome the inability to get things done. QBQ! The Question Behind the Question , already a phenomenon in its self-published edition, addresses the most important issue in business and society today: personal accountability. The lack of personal accountability has resulted in an epidemic of blame, complaining, and procrastination. No organization-or individual-can achieve goals, compete in the marketplace, fulfill a vision, or (...) develop people and teams without personal accountability. The solution involves an entirely new approach. We can no longer ask, "Who dropped the ball?" "Why can't they do their work properly?" or "Why do we have to go through all these changes?" Instead, every individual has to ask the question behind the question: "How can I improve this situation?" "What can I contribute?" or "How can I make a difference?" Succinct, insightful, and practical, QBQ! The Question Behind the Question provides a method for putting personal accountability into daily action, which can bring astonishing results: problems get solved, barriers come down, service improves, teamwork grows, and people adapt to change. (shrink)
The 'Art of Life' is John Stuart Mill's name for his account of practical reason. In this volume, eleven leading scholars elucidate this fundamental, but widely neglected, element of Mill's thought. Mill divides the Art of Life into three 'departments': 'Morality, Prudence or Policy, and Æsthetics'. In the volume's first section, Rex Martin, David Weinstein, Ben Eggleston, and Dale E. Miller investigate the relation between the departments of morality and prudence. Their papers ask whether Mill is a rule (...) utilitarian and, if so, whether his practical philosophy must be incoherent. The second section contains papers by Jonathan Riley and Wendy Donner, who explore the relation between the departments of morality and aesthetics. They discuss issues ranging from supererogation to aesthetic pleasure and humanity's relationship with nature. -/- The papers in the third section consider the Art of Life's axiological first principle, the principle of utility. Elijah Millgram contends that Mill's own life refutes his claim that the Art of Life has a single axiological first principle. Philip Kitcher maintains that Mill has a dynamic axiology requiring us to continually refine our conception of the good. In the final section, three papers address what it means to put the Art of Life into practice. Robert Haraldsson locates an 'Art of Ethics' in On Liberty that is in tension with the Art of Life. Nadia Urbinati plumbs the classical roots of Mill's view of the good life. Finally, Colin Heydt develops Mill's suggestion that we regard our own lives as works of art. (shrink)
Franklin G. Miller and colleagues have stimulated renewed interest in research ethics through their work criticizing clinical equipoise. Over three years and some twenty articles, they have also worked to articulate a positive alternative view on norms governing the conduct of clinical research. Shared presuppositions underlie the positive and critical dimensions of Miller and colleagues' work. However, recognizing that constructive contributions to the field ought to enjoy priority, we presently scrutinize the constructive dimension of their work. We argue (...) that it is wanting in several respects. (shrink)
Despite growing scientific interest in the placebo effect and increasing understanding of neurobiological mechanisms (Finniss et al. 2010), theoretical conceptualization of the placebo effect remains primitive (Miller, Colloca, and Kaptchuk 2009). Mechanistic research on this phenomenon appears largely free-floating, with little guidance by any systematic theoretical paradigm. A partial explanation is the pervasive conceptual confusion that characterizes thinking about the placebo effect. The philosopher of science Adolf Grunbaum noted that "the medical and psychiatric literature on placebos and their effects (...) is conceptually bewildering, to the point of being a veritable Tower of Babel" (Grunbaum 1994, p. 286). .. (shrink)
The Monstrosity of Christ provides an exchange between the Slovenian theorist Slavoj Žižek and the British theologian John Milbank. Both authors argue that Christianity is the religion of ‘absolute truth,’ but provide very different accounts of this. Milbank argues that Christianity is true insofar as only the incarnation of Christ mediates the paradoxical metaphysical participation of the finite within the infinite. Žižek argues that the crucifixion of Christ constitutes the death of God, demonstrating that there is no providential or (...) transcendent reality supervening on human history. This realization constitutes the universal truth of Christianity. (shrink)
G. A. Cohen incisively argued that our judgments of social justice should fit our convictions about how to interact with others in our personal lives. Ironically, the ordinary morality of cooperation invoked in his last book undermines his favored principle of equality, and supports John Rawls' reliance on a relevantly impartial choice promoting appropriate fundamental interests as a basis for distributive standards. His further objections to Rawls' account of distributive justice neglect the role of social relations in establishing the (...) proper scope of that impartiality and the moral force of Rawls' taxonomy of non-ideal societies. In contrast, the powerful evocation of goods of community at the end of Cohen's last book points to a genuine inadequacy. Conscientious fellow-citizens must take account of the impact of their political choices on options for sharing and caring. In finding a proper balance between these goods and competing individualist concerns, the original position is of too little use to sustain Rawls' assessment of his conception of justice as complete. In the face of our strong moral convictions about how to live together, both Cohen's luck egalitarianism and Rawls' barriers between aspirations to community and political choice must give way. (shrink)
: This paper presents a method of moral problem solving in clinical practice that is inspired by the philosophy of John Dewey. This method, called "clinical pragmatism," integrates clinical and ethical decision making. Clinical pragmatism focuses on the interpersonal processes of assessment and consensus formation as well as the ethical analysis of relevant moral considerations. The steps in this method are delineated and then illustrated through a detailed case study. The implications of clinical pragmatism for the use of principles (...) in moral problem solving are discussed. (shrink)
The Federalist, written by “Publius” (Alexander Hamilton, John Jay, and James Madison) in 1787-1788 in defense of the proposed constitution of the United States, endorses a fundamental principle of political legitimacy: namely, “it is the reason of the public alone, that ought to control and regulate the government.” This essay argues that this principle—the rule of reason—may be traced back to Plato. Part I of the essay seeks to show that Plato's Statesman offers a clearer understanding of the rule (...) of reason than his more famous Republic, and it also indicates how this principle gave rise to the ideal of constitutionalism, which was adopted and reformulated by Aristotle, Polybius, and Cicero, as well as moderns including Locke and Montesquieu. Part II argues that The Federalist agrees with Plato when it argues that popular sovereignty must be tempered by the rule of reason. A proper distance should be maintained between the people and the actual exercise of power in order that political decisions be based on reason rather than passion. The people must therefore act through a federal system divided between national government and state governments, and these governments must themselves possess separated powers which control each other by means of checks and balances. Indeed, federalism itself may be viewed as a modern counterpart of Plato's “art of weaving,” which unites naturally disparate and opposed parts of the city-state into a concordant whole. In declaring, “If men were angels, no government would be necessary,” The Federalist concedes that politics is the art of the possible. But statesmanship is not an exercise in pragmatism devoid of principles. Here “Publius” shares Plato's vision of politics as a “second sailing,” that is, an attempt to approximate the ideal of rational governance as far as possible in ordinary politics. Footnotesa This paper was originally presented at a meeting of the Symposium on Political Thought at Bowling Green State University. I am very grateful to the participants for their helpful suggestions, including Peter Celello, Albert Dzur, Neil Englehart, Jefferson Holcomb, David Jackson, Melissa Miller, Terrence Watson, and Adam White. I also received valuable criticisms from David Keyt, Ellen Frankel Paul, and the other contributors to this volume. (shrink)
In this book polymath William Ian Miller probes one of the dirty little secrets of humanity: that we are all faking it much more than anyone would care to admit. He writes with wit and wisdom about the vain anxiety of being exposed as frauds in our professions, cads in our loves, and hypocrites to our creeds. He finds, however, that we are more than mere fools for wanting so badly to look good to ourselves and others. Sometimes, when (...) we are faking it, our vanity leads to virtue, and we actually achieve something worthy of esteem and praise William Ian Miller is the Thomas G. Long Professor of Law at the University of Michigan Law School. He has also taught at Harvard, Yale, Chicago, and the Universities of Bergen and Tel Aviv. His previous books include The Mystery of Courage (Harvard University Press, 2000) and The Anantomy of Disgust (Harvard University Press, 1997). (shrink)
Floridi and Sanders, seminal work, “On the morality of artificial agents” has catalyzed attention around the moral status of computer systems that perform tasks for humans, effectively acting as “artificial agents.” Floridi and Sanders argue that the class of entities considered moral agents can be expanded to include computers if we adopt the appropriate level of abstraction. In this paper we argue that the move to distinguish levels of abstraction is far from decisive on this issue. We also argue that (...) adopting certain levels of abstraction out of context can be dangerous when the level of abstraction obscures the humans who constitute computer systems. We arrive at this critique of Floridi and Sanders by examining the debate over the moral status of computer systems using the notion of interpretive flexibility. We frame the debate as a struggle over the meaning and significance of computer systems that behave independently, and not as a debate about the ‘true’ status of autonomous systems. Our analysis leads to the conclusion that while levels of abstraction are useful for particular purposes, when it comes to agency and responsibility, computer systems should be conceptualized and identified in ways that keep them tethered to the humans who create and deploy them. (shrink)
It has been demonstrated that death certificates do not accurately record the actual cause of death in up to one-fourth of cases, as determined from subsequent autopsy findings. The purpose of this study was to explore the use of natural language autopsy data bases as an automated quality assurance mechanism. We translated the account of the major process leading to death, or the primary diagnosis, from all 45,564 narrative autopsy reports obtained at The Johns Hopkins Hospital between May 28, 1889, (...) and June 30, 1987, into the hierarchical system of Medical Subject Heading (MeSH) titles. We obtained a total of 125,772 MeSH title translations, 1,563 of them distinct (average 2.8 per case), ranging in frequency from 6,029 occurrences of LUNG to 1 occurrence apiece of 357 MeSH titles. The natural-language-to-MeSH translations showed expected trends over the past century: fewer infectious diseases; more cardiovascular and neoplastic disease among adults; and more respiratory diseases and congenital malformations in the pediatric age group. The greater availability of autopsy documents in electronic form should increase the value of this resource for quality assurance. (shrink)
This paper examines workplace surveillance and monitoring. It is argued that privacy is a moral right, and while such surveillance and monitoring can be justified in some circumstances, there is a presumption against the infringement of privacy. An account of privacy precedes consideration of various arguments frequently given for the surveillance and monitoring of employees, arguments which look at the benefits, or supposed benefits, to employees as well as to employers. The paper examines the general monitoring of work, and the (...) monitoring of email, listservers and the World Wide Web. It is argued that many of the common justifications given for this surveillance and monitoring do not stand up to close scrutiny. (shrink)
Conventional medical ethics and the law draw a bright line distinguishing the permitted practice of withdrawing life-sustaining treatment from the forbidden practice of active euthanasia by means of a lethal injection. When clinicians justifiably withdraw life-sustaining treatment, they allow patients to die but do not cause, intend, or have moral responsibility for, the patient's death. In contrast, physicians unjustifiably kill patients whenever they intentionally administer a lethal dose of medication. We argue that the differential moral assessment of these two practices (...) is based on a series of moral fictions – motivated false beliefs that erroneously characterize withdrawing life-sustaining treatment in order to bring accepted end-of-life practices in line with the prevailing moral norm that doctors must never kill patients. When these moral fictions are exposed, it becomes apparent that conventional medical ethics relating to end-of-life decisions is radically mistaken. (shrink)
Despite strong growth in scientific investigation of the placebo effect, understanding of this phenomenon remains deeply confused. We investigate critically seven common conceptual distinctions that impede clear understanding of the placebo effect: (1) verum/placebo, (2) active/inactive, (3) signal/noise, (4) specific/nonspecific, (5) objective/subjective, (6) disease/illness, and (7) intervention/context. We argue that some of these should be eliminated entirely, whereas others must be used with caution to avoid bias. Clearing away the conceptual underbrush is needed to lay down a path to understanding (...) and harnessing placebo effects in clinical medicine. (shrink)
The leading ethical position on placebo-controlled clinical trials is that whenever proven effective treatment exists for a given condition, it is unethical to test a new treatment for that condition against placebo. Invoking the principle of clinical equipoise, opponents of placebo-controlled trials in the face of proven effective treatment argue that they (1) violate the therapeutic obligation of physicians to offer optimal medical care and (2) lack both scientific and clinical merit. We contend that both of these arguments are mistaken. (...) Clinical equipoise provides erroneous ethical guidance in the case of placebo-controlled trials, because it ignores the ethically relevant distinction between clinical trials and treatment in the context of clinical medicine and the methodological limitations of active-controlled trials. Placebo controls are ethically justifiable when they are supported by sound methodological considerations and their use does not expose research participants to excessive risks of harm. (shrink)
: Bioethicists have failed to understand the pervasively paternalistic character of research ethics. Not only is the overall structure of research review and regulation paternalistic in some sense; even the way informed consent is sought may imply paternalism. Paternalism has limits, however. Getting clear on the paternalism of research ethics may mean some kinds of prohibited research should be reassessed.
What makes an act of killing morally wrong is not that the act causes loss of life or consciousness but rather that the act causes loss of all remaining abilities. This account implies that it is not even pro tanto morally wrong to kill patients who are universally and irreversibly disabled, because they have no abilities to lose. Applied to vital organ transplantation, this account undermines the dead donor rule and shows how current practices are compatible with morality.
The doctrine of clinical equipoise is appealing because it appears to permit physicians to maintain their therapeutic obligation to offer optimal medical care to patients while conducting randomized controlled trials (RCTs). The appearance, however, is deceptive. In this article we argue that clinical equipoise is defective and incoherent in multiple ways. First, it conflates the sound methodological principle that RCTs should begin with an honest null hypothesis with the questionable ethical norm that participants in these trials should never be randomized (...) to an intervention known to be inferior to standard treatment. Second, the claim that RCTs preserve the therapeutic obligation of physicians misrepresents the patient-centered orientation of medical care. Third, the appeal to clinical equipoise as a basic principle of risk-benefit assessment for RCTs is incoherent. Finally, the difficulties with clinical equipoise cannot be resolved by viewing it as a presumptive principle subject to exceptions. In the final sections of the article, we elaborate on the non-exploitation framework for the ethics clinical research and indicate issues that warrant further inquiry. (shrink)
Traditionally, biomedical research has been devoted to improvement in the understanding and treatment or prevention of disease. Building on the knowledge generated by the long history of disease-oriented research, the next few decades will witness an explosion of biomedical enhancements to make people faster, stronger, smarter, less forgetful, happier, prettier, and live longer (Turner et al. 2003; Vastag 2004; Rose 2002). As with other biomedical interventions, research to assess the safety and efficacy of these enhancements in humans should be conducted (...) before their introduction into clinical practice.1 However, various concerns regarding the ethics of enhancement research could be raised. Those who .. (shrink)
Transplantation of vital organs has been premised ethically and legally on "the dead donor rule" (DDR)—the requirement that donors are determined to be dead before these organs are procured. Nevertheless, scholars have argued cogently that donors of vital organs, including those diagnosed as "brain dead" and those declared dead according to cardiopulmonary criteria, are not in fact dead at the time that vital organs are being procured. In this article, we challenge the normative rationale for the DDR by rejecting the (...) underlying premise that it is necessarily wrong for physicians to cause the death of patients and the claim that abandoning this rule would exploit vulnerable patients. We contend that it is ethical to procure vital organs from living patients sustained on life support prior to treatment withdrawal, provided that there is valid consent for both withdrawing treatment and organ donation. However, the conservatism of medical ethics and practical concerns make it doubtful that the DDR will be abandoned in the near future. This leaves the current practice of organ transplantation based on the "moral fiction" that donors are dead when vital organs are procured. (shrink)
Prevailing ethical thinking about informed consent to clinical research is characterized by theoretical confidence and practical disquiet. On the one hand, bioethicists are confident that informed consent is a fundamental norm. And, for the most part, they are confident that what makes consent to research valid is that it constitutes an autonomous authorization by the research participant. On the other hand, bioethicists are uneasy about the quality of consent in practice. One major source of this disquiet is substantial evidence of (...) the “therapeutic misconception”—the tendency of patient-subjects in clinical trials to confuse participating in research with receiving personalized medical care. This .. (shrink)
: Medical research is widely thought to have a fundamentally therapeutic orientation, in spite of the fact that clinical research is thought to be ethically distinct from medical care. We need an entirely new conception of clinical research ethics—one that looks to science instead of the doctor-patient relationship.
Bioethics is a hybrid discipline. As a theoretical enterprise it stands for untrammeled inquiry and argument. Yet it aims to influence medical practice and policy. In this article we explore tensions between these two dimensions of bioethics and examine the merits and perils of a “Socratic” approach to bioethics that challenges “the conventional wisdom.”.
A basic question of medical ethics is whether the norms governing medical practice should be understood as the application of principles and rules of the common morality to medicine or whether some of these norms are internal or proper to medicine. In this article we describe and defend an evolutionary perspective on the internal morality of medicine that is defined in terms of the goals of clinical medicine and a set of duties that constrain medical practice in pursuit of these (...) goals. This perspective is developed by means of a critical examination of the essentialist conception of the internal morality of medicine advocated by Edmund Pellegrino and the critique of internal morality approaches by Robert Veatch and Tom Beauchamp. (shrink)
: Catholic teaching has no moral difficulties with research on stem cells derived from adult stem cells or fetal cord blood. The ethical problem comes with embryonic stem cells since their genesis involves the destruction of a human embryo. However, there seems to be significant promise of health benefits from such research. Although Catholic teaching does not permit any destruction of human embryos, the question remains whether researchers in a Catholic institution, or any researchers opposed to destruction of human embryos, (...) could participate in research on cultured embryonic stem cells, or whether a Catholic institution could use any therapy that ultimately results from such research. This position paper examines how such research could be conducted legitimately in a Catholic institution by using an ethical analysis involving a narrative context, the nature of the moral act, and the principle of material cooperation, along with references to significant ethical assessments. It also offers tentative guidelines that could be used by a Catholic institution in implementing such research. (shrink)
Pragmatism is a distinctive approach to clinical research ethics that can guide bioethicists and members of institutional review boards (IRBs) as they struggle to balance the competing values of promoting medical research and protecting human subjects participating in it. After defining our understanding of pragmatism in the setting of clinical research ethics, we show how a pragmatic approach can provide guidance not only for the day-to-day functioning of the IRB, but also for evaluation of policy standards, such as the one (...) that addresses acceptable risks for healthy children in clinical research trials. We also show how pragmatic considerations might influence the debate about the use of deception in clinical research. Finally, we show how a pragmatic approach, by regarding the promotion of human research and the protection of human subjects as equally important values, helps to break down the false dichotomy between science and ethics in clinical research. (shrink)
We use a result due to Rolin, Speissegger, and Wilkie to show that definable sets in certain o-minimal structures admit definable parameterizations by mild maps. We then use this parameterization to prove a result on the density of rational points on curves defined by restricted Pfaffian functions.
This article reports four subliminal perception experiments using the relationship between confidence and accuracy to assess awareness. Subjects discriminated among stimuli and indicated their confidence in each discrimination response. Subjects were classified as being aware of the stimuli if their confidence judgments predicted accuracy and as being unaware if they did not. In the first experiment, confidence predicted accuracy even at stimulus durations so brief that subjects claimed to be performing at chance. This finding indicates that subjects's claims that they (...) are ''just guessing'' should not be accepted as sufficient evidence that they are completely unaware of the stimuli. Experiments 2-4 tested directly for subliminal perception by comparing the minimum exposure duration needed for better than chance discrimination performance against the minimum needed for confidence to predict accuracy. The latter durations were slightly but significantly longer, suggesting that under certain circumstances people can make perceptual discriminations even though the information that was used to make those discriminations is not consciously available. (shrink)
Some ethical issues facing contemporary medicine cannot be fully understood without addressing medicine's internal morality. Medicine as a profession is characterized by certain moral goals and morally acceptable means for achieving those goals. The list of appropriate goals and means allows some medical actions to be classified as clear violations of the internal morality, and others as borderline or controversial cases. Replies are available for common objections, including the superfluity of internal morality for ethical analysis, the argument that internal morality (...) is merely an apology for medicine's traditional power and authority, and the claim that there is no single, "core" internal morality. The value of addressing the internal morality of medicine may be illustrated by a detailed investigation of ethical issues posed by managed care. Managed care poses some fundamental challenges for medicine's internal morality, but also calls for thoughtful reflection and reconsideration of some traditionally held moral views on patient fidelity in particular. (shrink)
Surgical clinical trials have seldom used a “sham” or placebo surgical procedure as a control, owing to ethical concerns. Recently, several ethical commentators have argued that sham surgery is either inherently or presumptively unethical. In this article I contend that these arguments are mistaken, and that there are no sound ethical reasons for an absolute prohibition of sham surgery in clinical trials. Reflecting on three cases of sham surgery, especially on the recently reported results of a sham-controlled trial of arthroscopic (...) surgery for arthritis of the knee, I present an ethical analysis that focuses on the methodological rationale for use of sham surgery, risk-benefit assessment, and informed consent. (shrink)
: The "difference position" holds that clinical research and therapeutic medical practice are sufficiently distinct activities to require different ethical rules and principles. The "similarity position" holds instead that clinical investigators ought to be bound by the same fundamental principles that govern therapeutic medicine—specifically, a duty to provide the optimal therapeutic benefit to each patient or subject. Some defenders of the similarity position defend it because of the overlap between the role of attending physician and the role of investigator in (...) a research trial. This overlap is maximal when the same physician occupies both roles with respect to a particular patient-subject. We address the ethical tensions inherent in that role conflict and argue that the tensions are real but manageable. The difference position provides a sound ethical framework within which to manage those tensions, while the similarity position is unsatisfactory because it seeks to deny the existence of the tensions. (shrink)
: Recent controversial decisions to terminate several large clinical trials have called attention to the need for developing a sound ethical framework to determine when trials should be stopped in light of emerging efficacy data. Currently, the fundamental rationale for stopping trials early is based on the principle that equipoise has been disturbed. We present an analysis of the ethical and practical problems with the "equipoise disturbed" position and describe an alternative ethical framework based on the principle of nonexploitation. This (...) framework acknowledges the need for balancing the dual ethical obligations of clinical research, the protection of human subjects and the generation of new medical knowledge. Based on this framework, we put forward a proposal to make early stopping guidelines more stringent under specified conditions. The temporary withholding of apparent benefits in certain circumstances is justified by achieving a fair contract with the research participants, one that protects them from undue harm and exploitation while reducing the many uncertainties surrounding new investigational treatments that arise when trials are stopped prematurely. (shrink)
: The "therapeutic misconception," described by Paul Appelbaum and colleagues more than 20 years ago, refers to the tendency of participants in clinical trials to confuse the design and conduct of research with personalized medical care. Although the "therapeutic misconception" has become a term of art in research ethics, little systematic attention has been devoted to the ethical significance of this phenomenon. This article examines critically the way in which Appelbaum and colleagues formulate what is at stake in the therapeutic (...) misconception, paying particular attention to assumptions and implications that clinical trial participation disadvantages research participants as compared with receiving standard medical care. After clarifying the ethical significance of the therapeutic misconception with respect to the decision making of patients, we offer policy recommendations for obtaining informed consent to participation in clinical trials. (shrink)
This book challenges fundamental doctrines of established medical ethics. It is argued that the routine practice of stopping life support technology causes the death of patients and that donors of vital organs (hearts, liver, lungs, and both kidneys) are not really dead at the time that their organs are removed for life-saving transplantation. Although these practices are ethically legitimate, they are not compatible with traditional medical ethics: they conflict with the norms that doctors must not intentionally cause the death of (...) their patients and that vital organs can be obtained only from dead donors. The aim of this book is to undertake an ethical examination that aims to honestly face the reality of medical practices at the end of life. This involves exposing the misconception that stopping life support merely allows patients to die from their medical conditions, that there is an ethical bright line separating withdrawal of life support from active euthanasia, and that determination of death of hospitalized patients prior to vital organ donation is consistent with the established biological conception of death. A novel ethical justification is required for procuring vital organs from still-living donors. It is contended that in the context of plans to withdraw life support, donors of vital organs are not harmed or wronged by organ procurement prior to death, provided that valid consent is obtained for stopping treatment and organ donation. In view of serious practical difficulties in facing the truth regarding organ donation, an alternative pragmatic account is developed for justifying current practices that relies on the concept of transparent legal fictions. In sum, it is the thesis of this book that to preserve the legitimacy of end-of-life practices, we need to reconstruct medical ethics. (shrink)
*The opinions expressed are the views of the author and do not necessarily reflect the policy of the National Institutes of Health, the Public Health Service, or the U.S. Department of Health and Human Services.
In the past, hypothesis testing in medicine has employed the paradigm of the repeatable experiment. In statistical hypothesis testing, an unbiased sample is drawn from a larger source population, and a calculated statistic is compared to a preassigned critical region, on the assumption that the comparison could be repeated an indefinite number of times. However, repeated experiments often cannot be performed on human beings, due to ethical or economic constraints. We describe a new paradigm for hypothesis testing which uses only (...) rearrangements of data present within the observed data set. The token swap test, based on this new paradigm, is applied to three data sets from cardiovascular pathology, and computational experiments suggest that the token swap test satisfies the Neyman Pearson condition. (shrink)