In this 2002 J.F. Lewis Award-winning monograph, Gunther Stent traces the origins and development of the paradoxes of free will in this well-crafted ...

When people engage in conversation, they tailor their utterances to their conversational partners, whether these partners are other humans or computational systems. This tailoring, or adaptation to the partner takes place in all facets of human language use, and is based on a mental model or a user model of the conversational partner. Such adaptation has been shown to improve listeners' comprehension, their satisfaction with an interactive system, the efficiency with which they execute conversational tasks, and the likelihood of achieving (...) higher level goals such as changing the listener's beliefs and attitudes. We focus on one aspect of adaptation, namely the tailoring of the content of dialogue system utterances for the higher level processes of persuasion, argumentation and advice‐giving. Our hypothesis is that algorithms that adapt content for these processes, according to a user model, will improve the usability, efficiency, and effectiveness of dialogue systems. We describe a multimodal dialogue system and algorithms for adaptive content selection based on multi‐attribute decision theory. We demonstrate experimentally the improved efficacy of system responses through the use of user models to both tailor the content of system utterances and to manipulate their conciseness. (shrink)

I was surprised to note the critical tone of the discussion which my friend Leonard B. Meyer recently devoted in these pages to an article on the relation of art and science that I wrote for a popular scientific magazine. For I had believed all the while that in my article I was merely presenting to a general scientific audience a watered-down version of what I thought were Meyer's own views. Evidently I was mistaken in that belief, though I have (...) been unable to fathom just where I went wrong in interpreting Meyer's earlier writings, which, more than any other source, are the provenance of my ideas about the nature of art. Gunther S. Stent, professor of molecular biology at the University of California, Berkeley, is the author of Molecular Biology of Bacterial Viruses, Phage and the Origin of Molecular Biology, Molecular Genetics: An Introductory Narrative, The Coming of the Golden Age: A View of the End of Progress, and many important scientific papers. In Concerning the Sciences, the Arts—AND the Humanities" , Leonard B. Meyer took issue with views expressed by Professor Stent in "Prematurity and Uniqueness in Scientific Discovery," published in Scientific American. (shrink)

The monist approach to the ancient mind-body problem styled "neurophilosophy" put forward recently by Patricia Smith Churchland on the basis of latter-day advances in the neurosciences is philosophically inadequate because it does not deal with the ethical dimension of the mind. Keywords: brain, complementarity, free will, mind-body problem, neuroscience, reductionism CiteULike Connotea Del.icio.us What's this?

When people engage in conversation, they tailor their utterances to their conversational partners, whether these partners are other humans or computational systems. This tailoring, or adaptation to the partner takes place in all facets of human language use, and is based on a mental model or a user model of the conversational partner. Such adaptation has been shown to improve listeners' comprehension, their satisfaction with an interactive system, the efficiency with which they execute conversational tasks, and the likelihood of achieving (...) higher level goals such as changing the listener's beliefs and attitudes. We focus on one aspect of adaptation, namely the tailoring of the content of dialogue system utterances for the higher level processes of persuasion, argumentation and advice-giving. Our hypothesis is that algorithms that adapt content for these processes, according to a user model, will improve the usability, efficiency, and effectiveness of dialogue systems. We describe a multimodal dialogue system and algorithms for adaptive content selection based on multi-attribute decision theory. We demonstrate experimentally the improved efficacy of system responses through the use of user models to both tailor the content of system utterances and to manipulate their conciseness. (shrink)

For medical interventions there is a gap between what clinical scientific research has established as likely to carry clinical benefit and what the National Institute for Clinical Excellence (NICE) has judged as cost-effective. This gap is the affordability gap. It is created by a value judgement made by NICE and affirmed by the Secretary of State for Health. This value judgement operates to affect other value judgements made in actual clinical situations where at least one choice of treatment falls into (...) the affordability gap. This paper considers how the creation of this affordability gap impacts upon actual clinical decisions. It explores these issues in the context of the choice between a drug-eluting stent and a bare metal stent for elective coronary angioplasty. It also argues that the option of an NHS procedure with a top-up fee to cover the cost of the affordability gap is a genuine one; that this option could improve clinical outcomes; that it is morally acceptable; and that the rules that prevent the utilization of this option should be relaxed. (shrink)

This text reconsiders the philosophizing into the future of mankind and futurology done by molecular biologist Gunther Stent in *The Coming of the Golden Age* in the light of Raymond Ruyer's critical notice published in the aftermath of the publication of Stent's book in French translation. For Ruyer, it is an occasion to revisit his own take on what he called in his last work a "theology of the opposition between the organic and the rational," and to restate (...) in a new light his conclusions concerning Cournot's suggestion as to the becoming of social relationships in a context of management of complexity of association. It is argued here that both Stent and Ruyer share a common thermodynamic, informational, and also surprisingly Nietzschean ascendency in judging of the possible outcomes for the human race. (shrink)

"In preparing this remarkable book, Ernest Hook persuaded an eminent group of scientists, historians, sociologists and philosophers to focus on the problem: why are some discoveries rejected at a particular time but later seen to be valid? The interaction of these experts did not produce agreement on 'prematurity' in science but something more valuable: a collection of fascinating papers, many of them based on new research and analysis, which sometimes forced the author to revise a previously-held opinion. The book should (...) be enthusiastically welcomed by all readers who are interested in how science works."—Stephen G. Brush, co-author of Physics, The Human Adventure: From copernicus to Einstein and Beyond "Prematurity and Scientific Discovery contains interesting and insightful papers by numerous well-known scientists and scholars. It will be of wide interest, not only to science studies scholars but also to working scientists and to science-literate general readers."—Thomas Nickles, editor of Scientific Discovery, Logic, and Rationality. (shrink)

Doubly robust (DR) estimators are an important class of statistics derived from a theory of semiparametric efficiency. They have become a popular tool in causal inference, including applications to dynamic treatment regimes. The doubly robust estimators for the mean response to a dynamic treatment regime may be conceived through the augmented inverse probability weighted (AIPW) estimating function, defined as the sum of the inverse probability weighted (IPW) estimating function and an augmentation term. The IPW estimating function of the causal estimand (...) via marginal structural model is defined as the complete-case score function for those subjects whose treatment sequence is consistent with the dynamic regime in question divided by the probability of observing the treatment sequence given the subject's treatment and covariate histories. The augmentation term is derived by projecting the IPW estimating function onto the nuisance tangent space and has mean-zero under the truth. The IPW estimator of the causal estimand is consistent if (i) the treatment assignment mechanism is correctly modeled and the AIPW estimator is consistent if either (i) is true or (ii) nested functions of intermediate and final outcomes are correctly modeled.Hence, the AIPW estimator is doubly robust and, moreover, the AIPW is semiparametric efficient if both (i) and (ii) are true simultaneously. Unfortunately, DR estimators can be inferior when either (i) or (ii) is true and the other false. In this case, the misspecified parts of the model can have a detrimental effect on the variance of the DR estimator. We propose an improved DR estimator of causal estimand in dynamic treatment regimes through a technique originally developed by [4] which aims to mitigate the ill-effects of model misspecification through a constrained optimization.In addition to solving a doubly robust system of equations, the improved DR estimator simultaneously minimizes the asymptotic variance of the estimator under a correctly specified treatment assignment mechanism but misspecification of intermediate and final outcome models. We illustrate the desirable operating characteristics of the estimator through Monte Carlo studies and apply the methods to data from a randomized study of integrilin therapy for patients undergoing coronary stent implantation. The methods proposed here are new and may be used to further improve personalized medicine, in general. (shrink)

The Israel Colloquium for the History, Philosophy and Sociology of Science presents before you its third volume of proceedings. The philosophy section of the volume has three main foci: the scientific explanation (Hempel and Ben-Menachem, Elster and Dascal); realism in science (Cohen and Zemach) and its implications for the problem of universals (Armstrong and Bar-Elli); and the question of demarcation: the dividing line between science and philosophy (KrUger), as well as the cognitive limits of science (Stent). There is no (...) neat separation in this volume between essays on the history of science and those on the sociology of science, and perhaps properly so. Thus, Lenoir's contribution is a clear example of the way the two disciplines combine and interrelate. Joseph Ben-David's comment on this lecture was among the last things he wrote, knowing full well that his days were numbered. Reading his contribution imparts a strong sense of loss, the loss of a great sociologist and a wise man. Not only history, however, but also historiography is a subject for reflection in this volume (Freudenthal and Kerszberg). And, finally, a couple of articles convey the sense of fascination with science as a story (Heilbron, Hughes). We have by now come to expect from the investigations reported in the Israel Colloquium series not surface unity of theme and method, but rather an underlying common commitment and zest for the scientific enterprise at its best. The third volume hopes to join the first two in footing this bill. (shrink)

PHOTO ID 121339257© Designer491| Dreamstime.com ABSTRACT When physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be apparent conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters future physicians’ commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. We use an ethical dilemma that was presented to a group of third-year medical students to examine how ethics education might be causing (...) them to give undue deference to autonomy, thereby undermining their commitment to beneficence. INTRODUCTION The right of patients to choose which treatments they prefer is rooted in today’s social mores and taught as a principle of medical ethics as respect for autonomy. Yet, when physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be a conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters a commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. I. An Ethical Dilemma The impetus for this paper arose when students who were completing their third clinical year discussed a real-life ethical dilemma. A middle-aged man developed a pulmonary hemorrhage while on blood thinners for a recently placed coronary stent. The bleeding was felt to be reversible, but the patient needed immediate intubation or he would die. The cardiologist was told that the patient previously expressed to other physicians that he never wanted to be intubated. However, the cardiologist made the decision to intubate the patient anyway, and the patient eventually recovered.[1] Students were asked if they believed that the cardiologist had acted ethically. Their overwhelming response was, “No, the patient should have been allowed to die.” We looked into how students applied ethical reasoning to conclude that this outcome was ethically preferred. To explore how the third-year clinical experience might have formed the students’ judgment, we presented the same case to students who were just beginning their third year. Their responses were essentially uniform in recommending intubation. While there is likely more than one reasonable view in this case, we agree with the physician and the younger medical students that intubation was the ethically appropriate decision and will present an argument for it. But first, we explain the reasoning behind the more advanced medical students’ decision to choose patient autonomy at the expense of beneficence. II. Medical Ethics Education and the Priority of Autonomy Beauchamp and Childress’s Principles of Biomedical Ethics, first published in 1979 and now in its 8th edition, is a significant part of the formal ethics education in medical school.[2] Students learn an ethical decision-making approach based on respect for four ethical principles: autonomy, beneficence, nonmaleficence, and justice. While Beauchamp and Childress officially afford no prima facie superiority to any principle, the importance of respect for patient autonomy has increased through the editions of their book. For example, early editions of their book opposed the legalization of physician-assisted death compared to recent editions that defended it.[3] As another example, Beauchamp and Childress make paternalism harder to justify by adding an autonomy-protecting condition to the list of conditions for acceptable paternalism.[4] Authority, they contend, need not conflict with autonomy—provided the authority is autonomously chosen.[5] “The main requirement,” they write, “is to respect a particular patient’s or subject’s autonomous choices, whatever they may be.[6] In the principlism of Beauchamp and Childress, autonomy now seems to have a kind of default priority.[7] However, the bioethics discourse has strong counternarratives, noting some movement to elevate the role of beneficence and to respect the input of stakeholders, including the family and the healthcare team. Ethics education achieves particular relevance in the third clinical year when students become embedded in the care of patients and learn from what has been called the informal curriculum. They observe how attending physicians approach day-to-day ethical problems at the patient’s bedside. In this context, students observe the importance of informed consent for serious treatments or invasive procedures, a practice that highlights the principle of patient autonomy. In both the formal and informal curriculum, medical students observe how, in the words of Paul Wolpe, “patient autonomy has become the central and most powerful principle in ethical decision-making in American medicine.”[8] In short, students appear to learn a deference for patient autonomy. This curricular shift in favor of autonomy coincides with legal developments that protect patients’ rights and decision-making with respect to their healthcare choices. The priority of autonomy in medicine benefits patients by reflecting their choices and, in some cases, their fundamental liberty. III. The Practice of Medicine and the Commitment to Beneficence There are many critiques of the dominant place that autonomy has in biomedical ethics,[9] especially considering that autonomy seems to be biased toward individualistic, Western, and somewhat American culture-driven values.[10] In addition, many bioethical dilemmas are cast as a conflict between autonomy and beneficence. Our point is that medical students bring to their study of medicine a commitment to beneficence that seems to be suppressed by practical ethics education. We think this commitment is rationally defensible and should be nurtured. It is striking that young medical students have a pre-reflective commitment to beneficence at all. For, as we mentioned, it is not just medicine but Western culture generally that prioritizes autonomy in settling ethical dilemmas. In wanting to act for the good of others (rather than simply agreeing to what others want), physicians are already swimming somewhat against the cultural tide.[11] However, doing so makes sense, given the nature of medicine and the profession of healing. When prospective medical students are asked why they wish to become physicians, the usual answer is some variation on caring for the sick and preventing disease. It is unlikely that a reason to become a physician is to respect a patient’s autonomy. It would be easy to dismiss medical students’ commitment to beneficence as a mere intuition and contrary to a more reasoned and deliberative approach. Beauchamp and Childress seem to minimize the value of physician intuition, stating that justifications for certain procedures are “…supported by good reasons. They need not rest merely in intuition or feeling.”[12] Henry Richardson writes that “situational or perceptive intuition…leaves the reasons for decision unarticulated.”[13] We think this is a crude and rather thin way of understanding intuition. Some bioethicists have defended intuition as essential to the practice of medicine and not something opposed to reason.[14] In the case we describe, we believe the ethical justifications s for the patient’s intubation are fundamentally sound: the patient did not have a “do not intubate” order written in the chart, the emergency intubation had not been foreseen, so the patient did not have the opportunity to consent to or reject intubation; the patient had consented to the treatment for his cardiac disease so his consent for intubation could have been assumed;[15] and the consequences of respecting his autonomy did not justify allowing him to die.[16] While it is possible to have more than one reasonable view on this case, we think the case for beneficence is strong and certainly should not be dismissed out of hand. We do not deny that if a patient makes a clearly documented, well-informed decision to forgo intubation that this decision ought to be respected by the physician (even if the physician disagrees with the patient’s decision). But, in this situation, as in many others in the practice of medicine, the patient’s real wishes and preferences are not well-articulated in advance. There are many cases where a physician acts based on what she believes the patient, or the surrogate, would want, sometimes in situations that do not allow much time for reflection. An example might be resuscitation of a newborn at the borderline of viability. In their ethics education, beneficence would mean acting first to save a life. If the patient or surrogate makes an informed decision to the contrary, a beneficent physician respects that autonomous decision. In the case presented, the patient expressed gratitude to the cardiologist when extubated. But what if he had expressed anger at the physician for violating his autonomy? There are those who could argue that not only was intubation ethically wrong but that the cardiologist put himself in legal jeopardy by his actions (especially if there had been a written refusal applicable to the specific situation). In the example we use, we point out that the cardiologist may not have escaped a lawsuit if the patient had died without intubation. His family, when hearing the circumstances, may have sued for failure to act and dereliction of the cardiologist’s duty to save him. Beyond a potential legal challenge for either action or inaction, there is an overriding ethical question the cardiologist had to address: what course would be most satisfying to his conscience? Would he rather allow a patient to die for fear of recrimination, or act to save his life, regardless of the personal consequences? In the absence of real knowledge about the patient’s considered wishes, it is most reasonable to err on the side of promoting patient well-being. A physician’s commitment to beneficence is not necessarily a way of undermining a patient’s autonomy. In acting for the patient's good, physicians are also acting on what it is reasonable to believe a patient (or most patients, perhaps) would want, which is obviously connected to what a patient does want. Pellegrino and Thomasma argue that beneficence includes respect for a patient’s autonomy since “the best interests of the patient are intimately linked with their preferences.”[17] Instead of conceptualizing ethical dilemmas in medicine as conflicts between autonomy and beneficence, it is possible that medical schools could teach students that truly practicing beneficence is a way of valuing patient autonomy, especially when the patient’s wishes are not specific to the situation and are not clearly expressed. CONCLUSION It is important for students and practicing physicians to understand the principle of respect for patient autonomy in a pluralistic society that demands personal self-determination. However, the role of the physician as a beneficent healer should not be diminished by this respect for autonomy. Respecting a patient’s autonomy is grounded in and manifested by physician beneficence.[18] That is, seeking what is good for the patient can only be good if it respects their personhood and dignity. We propose that a commitment to beneficence, incipient in young medical students, should be developed over time with their other clinical reasoning skills. Such a commitment need not be sacrificed on the altar of patient autonomy. Beneficence needs greater relative moral weight with students as they proceed in their ethics education. - [1] S. Jauhar, “When Doctors Need to Lie,” New York Times, February 22, 2014, https://www.nytimes.com/2014/02/23/opinion/sunday/when-doctors-need-to-lie.html. [2] T. L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019). [3] Louise A. Mitchell, “Major Changes in Principles of Biomedical Ethics,” The National Catholic Bioethics Quarterly 14, no. 3 (2014): 459–75, https://doi.org/10.5840/ncbq20141438. [4] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019), 238. [5] Beauchamp and Childress, 103. [6] Beauchamp and Childress, p. 108. [7] For other accounts that prioritize autonomy, see e.g. Allen E. Buchanan and Dan W. Brock, Deciding for Others: The Ethics of Surrogate Decision Making (Cambridge University Press, 1989), 38–39; R Gillon, “Ethics Needs Principles—Four Can Encompass the Rest—and Respect for Autonomy Should Be ‘First among Equals,’” Journal of Medical Ethics 29, no. 5 (October 2003): 307–12, https://doi.org/10.1136/jme.29.5.307. For examples of critiques of these accounts, see footnote 9. [8] P. R. Wolpe, “The Triumph of Autonomy in American Bioethics: A Sociological View,” in Bioethics and Society: Constructing the Ethical Enterprise, p. 43. [9] V. A. Entwistle et al., “Supporting Patient Autonomy: The Importance of Clinician-Patient Relationships,” Journal of General Internal Medicine 25, no. 7 (July 2010): 741–45; C. Foster, Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law, 1st ed. (Oxford ; Hart Publishing, 2009); O. O’Neill, Autonomy and Trust in Bioethics, The Gifford Lectures, University of Edinburgh 2001 (Cambridge, UK: Cambridge University Press, 2002). [10] P. Marshall and B. Koenig, “Accounting for Culture in a Globalized Bioethics,” The Journal of Law, Medicine & Ethics: A Journal of the American Society of Law, Medicine & Ethics 32, no. 2 (2004): 252–66; R. Fan, “Self-Determination vs. Family-Determination: Two Incommensurable Principles of Autonomy,” Bioethics 11, no. 3–4 (1997): 309–22. [11] Arguments stressing the importance of beneficence, as ours does here, certainly approach paternalistic arguments. We set aside the complex issue of paternalism for purposes of this paper and simply note that the principle of beneficence as such does not say anything specifically about acting against the patient’s will. In the case study that focuses this paper, we do not believe the patient’s will or wishes were clearly indicated. [12] Beauchamp and Childress, Principles of Biomedical Ethics, p. 20, see note 2 above. [13] H. S. Richardson, “Specifying, Balancing, and Interpreting Bioethical Principles,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 25, no. 3 (January 1, 2000): 285–307, p. 287. [14] H. D. Braude, Intuition in Medicine a Philosophical Defense of Clinical Reasoning (Chicago ; University of Chicago Press, 2012). [15] R. Kukla, “Conscientious Autonomy: Displacing Decisions in Health Care,” The Hastings Center Report 35, no. 2 (2005): 34–44. [16] M. Schermer, The Different Faces of Autonomy: Patient Autonomy in Ethical Theory and Hospital Practice, vol. 13, Library of Ethics and Applied Philosophy (Dordrecht: Springer Netherlands, 2002). [17] E. D. Pellegrino and D. C. Thomasma, For the Patient’s Good - the Restoration of Beneficence in Health Care (New York, NY: Oxford University Press, 1988), p. 29. [18] Pellegrino and Thomasma, For the Patient’s Good. 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In December 2004, at the age of 91, my father was told that his congestive heart failure had worsened and that his kidneys were functioning poorly. At best, the prognosis was that he had perhaps another year; at 86, my father had had a succession of three heart attacks before having surgery to place a stent in his coronary artery. The cardiologist who treated him then said he would get five or six good years from the stent, for (...) which my father was grateful. Now, he believed that his time had come, and he wanted to see his grandchildren one last time.My family and I quickly made arrangements to travel 1,200 miles to make this last visit. We arrived late in the evening, and my mother answered the doorbell with the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Care of the terminal patient:Are we on the same page?Lauren WancataIn surgical training a “service” or care team consists of sick patients admitted to the hospital and the medical team caring for the patient. Each service consists of an attending physician, a chief resident, a senior resident and junior residents structured as a hierarchy. The chief was gone for the week. As a senior trainee I would be the (...) acting chief—a role I had assumed many times before this month. To prepare for the week of his absence, I read through each patient’s chart, and the chief and I discussed each patient—diagnosis, procedures, and plans.One was a 41–year–old male with cancer—he was young, but a patient like him was not uncommon at my institution. He originally came in through the emergency department with abdominal pain and difficulty with urination. His admitting medical team started the work–up for his symptoms—blood tests, a CAT scan, and consults to other physician services with specialized knowledge. He eventually underwent endoscopy with biopsies of his stomach and placement of stents into his ureter and kidney for his urinary issues. With return of the biopsies, he had a diagnosis—cancer. He required additional procedures, including the placement of stents into his bile ducts, as they, like his ureter, had become affected by the cancer. The next step was staging the cancer to determine his treatment options. Our surgical service was consulted for a diagnostic laparoscopy with washing—we would take a look inside his abdomen with a camera and obtain a fluid sample to be sent to the pathologist for review, the standard of care for this type of cancer. When the camera was placed nodules were seen—a sample of the nodules and the fluid were sent to a pathologist and determined to be positive for cancer: metastatic disease, stage IV. A special feeding tube was placed into his small intestine to aid in nutritional support, as he had already lost a significant amount of weight, and improving his nutrition would be imperative for any further treatments. Following this operation, oversight of his day–to–day care was taken on by our surgical service, and he had been under our care for a period of time before I rotated onto the service for the month.What was the plan for his care in the hospital, and what was his–long–term plan? His cancer could not be surgically removed due to the extent of its spread within his body. He had recently undergone another CAT scan due to an elevation in his white blood cell count (this elevation was a sign of possible infection) and a thoracentesis, a procedure to remove some of the fluid that was collecting around his lungs. Nephrologists (kidney specialist) had been consulted due to his declining kidney function. Throughout the days, his tube feeds, his source of nutrition, would often be turned off due to bloating and feeling full.Each morning, I rounded with our team, and we would see how he was doing. We would discuss how his night went, and make a plan for the day. He was a man of few words, but his wife was always at his bedside, to support him, listen to updates and keep tract of his progress. She had worked at the hospital and had seen a wide range of patients. She would ask about his kidney function, his tube feeds, and his labs. But, she never asked about his prognosis. I would leave his room each day with the unnerving feeling that the patient, family members and care team were not on the same page. Yes, we all wanted him to get better and to leave the hospital. [End Page 28] But, was he really going to get better? What defined better? Did the patient and his family really know the extent of his disease and his prognosis?Towards the end of my week as chief, I started to ask if they had any other questions. It had been a few weeks since his operation. Was there anything that they wanted to discuss or ask me about? At the... (shrink)

Medical science brings innovations in patient care at an astounding pace today - new chemotherapeutic agents, coated stents, and minimally invasive surgery are just few recent examples. For physicians, though, the specter of malpractice liability can overshadow the marvel of practicing in this era. Many physicians are working in a volatile liability environment; they face spiraling costs for malpractice insurance, have difficulties purchasing liability coverage at any price, and see record payouts in a growing number of claims against their colleagues. (...) The American Medical Association has declared that at least 20 states are currently in a malpractice “crisis,” with another 24 states showing early signs of an impending crisis.There have been two comparable periods of instability in the last thirty years, but these predecessor crises differ from the current one in important ways. First, while physicians mainly experienced dwindling options for obtaining coverage in the mid-1970s and exorbitant prices in the mid-1980s, the current crisis appears to have elements of both availability and affordability. (shrink)

Medical science brings innovations in patient care at an astounding pace today - new chemotherapeutic agents, coated stents, and minimally invasive surgery are just few recent examples. For physicians, though, the specter of malpractice liability can overshadow the marvel of practicing in this era. Many physicians are working in a volatile liability environment; they face spiraling costs for malpractice insurance, have difficulties purchasing liability coverage at any price, and see record payouts in a growing number of claims against their colleagues. (...) The American Medical Association has declared that at least 20 states are currently in a malpractice “crisis,” with another 24 states showing early signs of an impending crisis.There have been two comparable periods of instability in the last thirty years, but these predecessor crises differ from the current one in important ways. First, while physicians mainly experienced dwindling options for obtaining coverage in the mid-1970s and exorbitant prices in the mid-1980s, the current crisis appears to have elements of both availability and affordability. (shrink)

Given a strong family history of early heart attacks, the future has always been an iffy proposition. Miraculously, I have bypassed the early off-ramps and find myself approaching 80, stents in place, considering the very real but previously unimaginable possibility of still more. But what kind of more? With dopamine on the wane and no longer supercharged by the push and shove of unbridled ambition and pride, bigger and grander are out of the question. Tired clichés poke through the widening (...) cracks in my thinking to become uninvited bulletins of compromise and consolation. Be grateful. Relax, reminisce, enjoy sunsets, learn the backyard birds’ names, maybe even sing to them, and count blessings. (shrink)

Nanomedicine is yielding new and improved treatments and diagnostics for a range of diseases and disorders. Nanomedicine applications incorporate materials and components with nanoscale dimensions where novel physiochemical properties emerge as a result of size-dependent phenomena and high surface-to-mass ratio. Nanotherapeutics and in vivo nanodiagnostics are a subset of nanomedicine products that enter the human body. These include drugs, biological products, implantable medical devices, and combination products that are designed to function in the body in ways unachievable at larger scales. (...) Nanotherapeutics andin vivonanodiagnostics incorporate materials that are engineered at the nanoscale to express novel properties that are medicinally useful. These nanomedicine applications can also contain nanomaterials that are biologically active, producing interactions that depend on biological triggers. Examples include nanoscale formulations of insoluble drugs to improve bioavailability and pharmacokinetics, drugs encapsulated in hollow nanoparticles with the ability to target and cross cellular and tissue membranes and to release their payload at a specific time or location, imaging agents that demonstrate novel optical properties to aid in locating micrometastases, and antimicrobial and drug-eluting components or coatings of implantable medical devices such as stents. (shrink)

Like a number of other writers, [Gunther S.] Stent contends that in essential ways science and art are comparable. As he puts it: "Both the arts and the sciences are activities that endeavor to discover and communicate truths about the world" . Although one cannot but sympathize with the desire to bring the so-called Two Cultures together, a viable and enduring union will not be achieved by ignoring or glossing over important differences. Using the behavior of scientists, artists, and (...) laymen as empirical evidence, the first part of this essay will argue that Stent's union is a shotgun marriage, not one made in heaven, and that his attempt to wed different disciplinary species results not in fecund insight but barren misconception. In the second part, I will suggest that this misunderstanding arises because, like many scientists Stent fails even to recognize the existence of the humanist - that is, the theorist and critic of the arts. Yet the humanities must be included, and areas of inquiry within them differentiated, if diverse disciplines are to be related to one another in a coherent and consistent way. Leonard B. Meyer's most recent book is Explaining Music: Essays and Explanations. He is also the author of Emotion and Meaning in Music, The Rhythmic Structure of Music , and Music, The Arts, and Ideas, awarded the Laing Prize in 1969. See also: "Against Literary Darwinism" by Jonathan Kramnick in Vol. 38, No. 2. (shrink)

The nature and status of cultural evolution and its connection with biological evolution are controversial in part because of Richard Dawkin’s suggestion that the scientific study of culture should include “memetics,” an analog of genetics in which genes are replaced by “memes”—the hypothetical units of cultural evolution. Memetics takes different forms; I focus on its minimal form, which claims merely that natural selection shapes to some extent the evolution of some aspects of culture. Advocates and critics of memetics disagree about (...) the scientific status of memetics, but they agree that memetics must face the following fundamental problems. Problem 1: Cultural evolution differs too much from biological evolution. Problem 2: Culture is too complex. Problem 3: Memes are too difficult to identify and track. Problem 4: Memetics produces only trivial results. This paper examines these problems in the context of a minimal memetic analysis in one specific context: patented inventions. Technology is a special subset of culture, and patented inventions are a special subset of technology—not least because there is a detailed written record of every patent. I describe four recent empirical results on technological innovation derived from memetic analysis of the patent record. Result 1: Inkjet printing, PCR, and stents are key drivers of technological innovation. Result 2: Patent genealogies are tangled and incestuous. Result 3: Door-opening innovations drive the evolution of technology. Result 4: The evolving content of the drivers of innovation confirms the importance of inkjet printing, PCR, and stents, among other inventions. These results show that minimal memetics can provide a novel and illuminating analysis the evolution of patented technology. Furthermore, this memetic analysis can answer all of the main problems with memetics. Problem 1 can be dismissed because culture and biology can be quite disanalogous, provided that natural selection still operates in both. Problem 2 is a mirage, because memetic analysis of the patented inventions is consistent with the full richness and complexity of the evolution of technology. Problem 3 is easy to solve, because the patent record makes it trivial to identify and track patents and their key traits through lineages. Problem 4 can be fully answered only after memetic analysis becomes widespread, but the results reviewed here shows that minimal memetics does yield scientific results that are nontrivial and interesting. (shrink)

The title The End of Science? asks not whether science itself is about to end or even to wane, but whether people will stop claiming that science knows nature as it is. Science, it suggests, may know nature only as the scientist sees it. Or the title suggests that, in knowing nature, scientists to some extent create nature. No one bothers to ask philosophers or theologians, poets, or politicians, workers or bosses whether they know the world as it is. It (...) is common knowledge that the world for which they speak has been affected already by their description of that world. Will not the same fate strike scientists now? Has it not already? This is the basic issue that the six distinguished contributors address. They include Sandra Harding, Sheldon Lee Glashow, Ian Hacking, Mary Hesse, Gerald Holton, and Gunther S. Stent. Co-published with the Nobel Conference. (shrink)

In the Transcendental Aesthetic (TA), Kant is typically held to make negative assertations about “things in themselves,” namely that they are not spatial or temporal. These negative assertions stand behind the “neglected alternative” problem for Kant’s transcendental idealism. According to this problem, Kant may be entitled to assert that spatio-temporality is a subjective element of our cognition, but he cannot rule out that it may also be a feature of the objective world. In this paper, I show in a new (...) way how Kant’s view (focusing on his conclusions about space) is not subject to this objection, by showing that he does not make the denial about mind-independent reality that he is typically held to make. The argument develops consequences of a new reading of Kant’s expression “an sich selbst” (‘in itself’; ‘in themselves’). I argue that “an sich selbst” or “per se” has a special, judgment-level role, so that this expression does not form new noun-terms adjectivally. It follows that the conceptual unit of Kant’s “Conclusions” in the TA is simply “things” (Dinge), since “things in themselves” is not a nominal expression; Kant adopts the Wolffian ontological use of “thing” as the basic kind-term for any existent. The arguments that things per se are not in space are arguments that space cannot be a necessary property or relations of things as a kind. I show that this does not involve the positive claim about mind-independent reality that inspires the neglected alternative objection. (shrink)

The philosophy of historical sciences investigates their distinct objects of study, epistemic challenges, and methodological solutions. Rethinking astronomy in this light offers a contribution. First, the methodology of historical sciences adds to a more adequate description of how astronomers study and utilize token events. Second, astronomy faces a typical difficulty in identifying traces of some past events and has developed a delicate solution. This enriches the idea of trace and suggests a methodology that relies on iterations between data-driven approaches and (...) theory-driven approaches, together with the cross-validation between multiple relevant historical events or datasets. (shrink)

Logic has pride of place in mathematics and its 20th century offshoot, computer science. Modern symbolic logic was developed, in part, as a way to provide a formal framework for mathematics: Frege, Peano, Whitehead and Russell, as well as Hilbert developed systems of logic to formalize mathematics. These systems were meant to serve either as themselves foundational, or at least as formal analogs of mathematical reasoning amenable to mathematical study, e.g., in Hilbert’s consistency program. Similar efforts continue, but have been (...) expanded by the development of sophisticated methods to study the properties of such systems using proof and model theory. In parallel with this evolution of logical formalisms as tools for articulating mathematical theories (broadly speaking), much progress has been made in the quest for a mechanization of logical inference and the investigation of its theoretical limits, culminating recently in the development of new foundational frameworks for mathematics with sophisticated computer-assisted proof systems. In addition, logical formalisms developed by logicians in mathematical and philosophical contexts have proved immensely useful in describing theories and systems of interest to computer scientists, and to some degree, vice versa. Three examples of the influence of logic in computer science are automated reasoning, computer verification, and type systems for programming languages. (shrink)