Evidence that placebo acupuncture is an effective treatment for chronic pain presents a puzzle: how do placebo needles appearing to patients to penetrate the body, but instead sitting on the skin’s surface in the manner of a tactile stimulus, evoke a healing response? Previous accounts of ritual touch healing in which patients often described enhanced touch sensations suggest an embodied healing mechanism. In this qualitative study, we asked a subset of patients in a singleblind randomized trial in irritable bowel syndrome (...) to describe their treatment experiences while undergoing placebo treament. Analysis focused on patients’ unprompted descriptions of any enhanced touch sensations and any significance patients assigned to the sensations. We found in 5/6 cases, patients associated sensations including “warmth” and “tingling” with treatment efficacy. The conclusion offers a “neurophenomenological” account of the placebo effect by considering dynamic effects of attentional filtering on early sensory cortices, possibly underlying the phenomenology of placebo acupuncture. (shrink)
Psychopathy refers to a range of complex behaviors and personality traits, including callousness and antisocial behavior, typically studied in criminal populations. Recent studies have used self-reports to examine psychopathic traits among noncriminal samples. The goal of the current study was to examine the underlying factor structure of the Self-Report of Psychopathy Scale–Short Form (SRP-SF) across complementary samples and examine the impact of gender on factor structure. We examined the structure of the SRP-SF among 2,554 young adults from three undergraduate samples (...) and a high-risk young adult sample. Using confirmatory factor analysis, a four-correlated factor model and a four-bifactor model showed good fit to the data. Evidence of weak invariance was found for both models across gender. These findings highlight that the SRP-SF is a useful measure of low-level psychopathic traits in noncriminal samples, although the underlying factor structure may not fully translate across men and women. (shrink)
Part of the baths regulations preserved on a bronze plaque, engraved more or less identically on each side, from the copper mine at Vipasca, Lusitania. The manager is to wash, clean and grease the waterheating vats once a month. Such vats, as mentioned by Vitruvius in his discussion of public baths , were three in number: aena supra hypocausim tria sunt componenda. They were sizeable articles: Propertius seems to see himself tortured in one: Veneris torrebar aeno. The greasing was to (...) keep aerugo, copper rust, at bay; for this purpose Cato in general recommends amurca, lees of olive oil: ahena omnia amurca unguito…et aerugo non erit molesta; and also for greasing axles amurca axem unguito. For bronze tablets exposed to the weather such as the numerous public records on temple walls and the like Pliny recommends olive oil: aera…robiginem celerius trahunt…nisi oleo perunguantur. The phrase e recenti which occurs in both versions of the text is unexampled, and the CIL editors suggest that it means ex integro, afresh. However I am inclined to think that the engraver had a faulty copy in front of him and we should read adipe recenti. (shrink)
G. E. Moore's ‘A Defence of Common Sense’ has generated the kind of interest and contrariety which often accompany what is new, provocative, and even important in philosophy. Moore himself reportedly agreed with Wittgenstein's estimate that this was his best article, while C. D. Broad has lamented its very great but largely unfortunate influence. Although the essay inspired Wittgenstein to explore the basis of Moore's claim to know many propositions of common sense to be true, A. J. Ayer judges its (...) enduring value to lie in provoking a more sophisticated conception of the very type of metaphysics which disputes any such unqualified claim of certainty. (shrink)
The thesis of this article is that there has never been any ground for the controversy between the doctrine of free will and determinism, that it is based upon a misapprehension, that the two assertions are entirely consistent, that one of them strictly implies the other, that they have been opposed only because of our natural want of the analytical imagination. In so saying I do not tamper with the meaning of either phrase. That would be unpardonable. I mean free (...) will in the natural and usual sense, in the fullest, the most absolute sense in which for the purposes of the personal and moral life the term is ever employed. I mean it as implying responsibility, merit and demerit, guilt and desert. I mean it as implying, after an act has been performed, that one " could have done otherwise " than one did. I mean it as conveying these things also, not in any subtly modified sense but in exactly the sense in which we conceive them in life and in law and in ethics. These two doctrines have been opposed because we have not realised that free will can be analysed without being destroyed, and that determinism is merely a feature of the analysis of it. And if we are tempted to take refuge in the thought of an "ultimate ", an "innermost" liberty that eludes the analysis, then we have implied a deterministic basis and constitution for this liberty as well. For such a basis and constitution lie in the idea of liberty. -/- The thesis is not, like that of Green or Bradley, that the contending opinions are reconciled if we adopt a certain metaphysic of the ego, as that it is timeless, and identifies itself with a desire by a " timeless act". This is to say that the two are irreconcilable, as they are popularly supposed to be, except by a theory that delivers us from the conflict by taking us out of time. Our view on the contrary is that from the natural and temporal point of view itself there never was any need of a reconciliation but only of a comprehension of the meaning of terms. (The metaphysical nature of the self and its identity through time is a problem for all who confront memory, anticipation, etc.; it has no peculiar difficulties arising from the present problem.) -/- I am not maintaining that determinism is true; only that it is true insofar as we have free will. That we are free in willing is, broadly speaking, a fact of experience. That broad fact is more assured than any philosophical analysis. It is therefore surer than the deterministic analysis of it, entirely adequate as that in the end appears to be. But it is not here affirmed that there are no small exceptions, no slight undetermined swervings, no ingredient of absolute chance. All that is here said is that such absence of determination, if and so far as it exists, is no gain to freedom, but sheer loss of it; no advantage to the moral life, but blank subtraction from it. -- When I speak below of "the indeterminist" I mean the libertarian indeterminist, that is, him who believes in free will and holds that it involves indetermination. (shrink)
This study represents an improvement in the ethics scales inventory published in a 1988 Journal of Business Ethics article. The article presents the distillation and validation process whereby the original 33 item inventory was reduced to eight items. These eight items comprise the following ethical dimensions: a moral equity dimension, a relativism dimension, and a contractualism dimension. The multidimensional ethics scale demonstrates significant predictive ability.
Corporate social responsibility is a recognised and common part of business activity. Some of the regularly cited motives behind CSR are employee morale, recruitment and retention, with employees acknowledged as a key organisational stakeholder. Despite the significance of employees in relation to CSR, relatively few studies have examined their engagement with CSR and the impediments relevant to this engagement. This exploratory case study-based research addresses this paucity of attention, drawing on one to one interviews and observation in a large UK (...) energy company. A diversity of engagement was found, ranging from employees who exhibited detachment from the CSR activities within the company, to those who were fully engaged with the CSR activities, and to others who were content with their own personal, but not organisational, engagement with CSR. A number of organisational context impediments, including poor communication, a perceived weak and low visibility of CSR culture, and lack of strategic alignment of CSR to business and personal objectives, served to explain this diversity of employee engagement. Social exchange theory is applied to help explore the volition that individual employees have towards their engagement with CSR activities, and to consider the implications of an implicit social, rather than explicit economic, contract between an organisation and its employees in their engagement with CSR. (shrink)
This is a comprehensive study of the English word 'or', and the logical operators variously proposed to present its meaning. Although there are indisputably disjunctive uses of or in English, it is a mistake to suppose that logical disjunction represents its core meaning. 'Or' is descended from the Anglo-Saxon word meaning second, a form which survives in such expressions as "every other day." Its disjunctive uses arise through metalinguistic applications of an intermediate adverbial meaning which is conjunctive rather than disjunctive (...) in character. These conjunctive uses have puzzled philosophers and logicians, and have been discussed extensively under such headings as "free choice permission." This study examines the textbook myths that have clouded our understanding of how or and other "logical" vocabulary comes to have something approaching its logical meaning in natural languages. It considers the various historical conceptions of disjunction and its place in logic from the Stoics to the present day. (shrink)
No one is excused from doing what he ought to do merely because he is unwilling to do it. But what if others are unwilling to play their necessary role in some joint venture that you all ought to undertake: might that excuse you from doing what you yourself ought to do as part of that? It would, if you were genuinely willing to play your necessary part if they were. But the unwillingness of everyone involved cannot reciprocally serve to (...) excuse one another from doing what they ought to do. (shrink)
This essay explores the role of informal logicand its application in the context of currentdebates regarding evidence-based medicine. This aim is achieved through a discussion ofthe goals and objectives of evidence-basedmedicine and a review of the criticisms raisedagainst evidence-based medicine. Thecontributions to informal logic by StephenToulmin and Douglas Walton are explicated andtheir relevance for evidence-based medicine isdiscussed in relation to a common clinicalscenario: hypertension management. This essayconcludes with a discussion on the relationshipbetween clinical reasoning, rationality, andevidence. It is argued that (...) informal logic hasthe virtue of bringing explicitness to the roleof evidence in clinical reasoning, and bringssensitivity to understanding the role ofdialogical context in the need for evidence inclinical decision making. (shrink)
Did Plato abandon, or sharply modify, the Theory of Forms in later life? In the _Phaedo, Symposium, _and _Republic_ it is generally agreed that Plato held that universals exist. But in Parmenides, he subjected that theory to criticism. If the criticism were valid, and Plato knew so, then the _Parmenides_ marks a turning point in his thought. If, however, Plato became aware that there are radical differences in the logical behaviour of concepts, and the later dialogues are a record of (...) his attempt to analyse those differences, then Plato’s thought can be said to have moved in a new and vitally important direction after the _Parmenides_. _Studies in Plato’s Metaphysics_ brings together twenty essays by leading philosophers from the UK and the USA reflecting upon this important issue and upon the questions arising from it. (shrink)
The Ebola epidemic in Western Africa has highlighted issues related to weak health systems, the politics of drug and vaccine development and the need for transparent and ethical criteria for use of scarce local and global resources during public health emergency. In this paper we explore two key themes. First, we argue that independent of any use of experimental drugs or vaccine interventions, simultaneous implementation of proven public health principles, community engagement and culturally sensitive communication are critical as these measures (...) represent the most cost-effective and fair utilization of available resources. Second, we attempt to clarify the ethical issues related to use of scarce experimental drugs or vaccines and explore in detail the most critical ethical question related to Ebola drug or vaccine distribution in the current outbreak: who among those infected or at risk should be prioritized to receive any new experimental drugs or vaccines? We conclude that healthcare workers should be prioritised for these experimental interventions, for a variety of reasons. (shrink)
Evidence based medicine has been a topic of considerable controversy in medical and health care circles over its short lifetime, because of the claims made by its exponents about the criteria used to assess the evidence for or against the effectiveness of medical interventions. The central epistemological debates underpinning the debates about evidence based medicine are reviewed by this paper, and some areas are suggested where further work remains to be done. In particular, further work is needed on the theory (...) of evidence and inference; causation and correlation; clinical judgment and collective knowledge; the structure of medical theory; and the nature of clinical effectiveness. (shrink)
Background: Patient autonomy has been promoted as the most important principle to guide difficult clinical decisions. To examine whether practising physicians indeed value patient autonomy above other considerations, physicians were asked to weight patient autonomy against three other criteria that often influence doctors’ decisions. Associations between physicians’ religious characteristics and their weighting of the criteria were also examined. Methods: Mailed survey in 2007 of a stratified random sample of 1000 US primary care physicians, selected from the American Medical Association masterfile. (...) Physicians were asked how much weight should be given to the following: (1) the patient’s expressed wishes and values, (2) the physician’s own judgment about what is in the patient’s best interest, (3) standards and recommendations from professional medical bodies and (4) moral guidelines from religious traditions. Results: Response rate 51% (446/879). Half of physicians (55%) gave the patient’s expressed wishes and values “the highest possible weight”. In comparative analysis, 40% gave patient wishes more weight than the other three factors, and 13% ranked patient wishes behind some other factor. Religious doctors tended to give less weight to the patient’s expressed wishes. For example, 47% of doctors with high intrinsic religious motivation gave patient wishes the “highest possible weight”, versus 67% of those with low (OR 0.5; 95% CI 0.3 to 0.8). Conclusions: Doctors believe patient wishes and values are important, but other considerations are often equally or more important. This suggests that patient autonomy does not guide physicians’ decisions as much as is often recommended in the ethics literature. (shrink)
As health care embraces the tenets of evidence-based medicine it is important to ask questions about how evidence is produced and interpreted. This essay explores normative dimensions of evidence production, particularly around issues of setting the tolerable level of uncertainty of results. Four specific aspects are explored: what health care providers know about statistics, why alpha levels have been set at 0.05, the role of randomization in the generation of sufficient grounds of belief, and the role of observational studies. The (...) essay concludes with recommendations to acknowledge the value permeation of outcome measures and suggests that attention to reasoning and argument analysis can augment traditional evidence-based approaches in providing a robust critical approach to medical knowledge. (shrink)
Translational research in medicine requires researchers to identify the steps to transfer basic scientific discoveries from laboratory benches to bedside decision-making, and eventually into clinical practice. On a parallel track, philosophical work in ethics has not been obliged to identify the steps to translate theoretical conclusions into adequate practice. The medical ethicist A. Cribb suggested some years ago that it is now time to debate ‘the business of translational’ in medical ethics. Despite the very interesting and useful perspective on the (...) field of medical ethics launched by Cribb, the debate is still missing. In this paper, I take up Cribb’s invitation and discuss further analytic distinctions needed to base an ethics aiming to translate between theory and practice. (shrink)
There has been much discussion about how to obtain legitimacy at macro-level priority setting in health care by use of fair procedures, but how should we consider priority setting by individual clinicians or health workers at the micro-level? Despite the fact that just health care totally hinges upon their decisions, surprisingly little attention seems being paid to the legitimacy of these decisions. This paper addresses the following question: what are the conditions that have to be met in order to ensure (...) that individual claims on health care are well aligned with an overall concept of just health care? Drawing upon a distinction between individual and aggregated needs, I argue that even though we assume the legitimacy of macro-level guidelines, this legitimacy is not directly transferable to decisions at micro-level simply by adherence to the guidelines’ recommendation. Further, I argue that individual claims are subject to the formal principle of equality and the demands of vertical and horizontal equity in a way that gives context- and patient-related equity concerns precedence over equity concerns captured at the macro-level. I conclude that if we aim to achieve just health care, we need to develop a complementary framework for legitimising individual judgment of patients’ claims on health care resources. Moreover, I suggest the basic structure of such a framework. (shrink)
An apparent paradox proposed by Aharonov and Vaidman in which a single particle can be found with certainty in two (or more) boxes is analyzed by way of a simple thought experiment. It is found that the apparent paradox arises from an invalid counterfactual usage of the Aharonov-Bergmann-Lebowitz (ABL) rule and effectively attributes conflicting properties not to the same particle but no different particles. A connection is made between the present analysis and the consistent histories formulation of Griffiths. Finally, a (...) critique is given of some recent counterarguments by Vaidman against the rejection of the counterfactual usage of the ABL rule. (shrink)
“To whom is the Consecration of Medal, Stature or even Pyramid more jusly due, than to … the late Illustraious Boyle? … for the happy Improvement of Otto Guericks Magdeburg Exhausterm and for his Profound and Noble Researches into all the abstruser Parts and Recesses of the most useful Philosophy … I have named the Illustrious Boyle, and fix his Trophy here.”John Evelyn, Numismata, 1697.
Hume's is/ought distinction has long limited the role of empirical research in ethics, saying that data about what something is cannot yield conclusions about the way things ought to be. However, interest in empirical research in ethics has been growing despite this countervailing principle. We attribute some of this increased interest to a conceptual breakdown of the is/ought distinction. MacIntyre, in reviewing the history of the is/ought distinction, argues that is and ought are not strictly separate realms but exist in (...) a close relationship that is clarified by adopting a teleological orientation. We propose that, instead of recovering a teleological orientation, society tends to generate its own goals via democratic methods like those described by Rousseau or adopt agnosticism about teleology such as described by Richard Rorty. In both latter scenarios, the distinction between is and ought is obscured, and the role for empirical research grows, but for controversial reasons. MacIntyre warns that the is/ought distinction should remain, but reminds ethicists to make careful arguments about when and why it is legitimate to move from is to ought. (shrink)
This paper explores the relationship between concepts of probability and hermeneutics. It seeks to examine the relationship between subjective (Bayesian) views of probability and hermeneutic descriptions of understanding. It is argued that Gadamer'saccount of the prejudicial nature of understanding, derived from Heidegger'sanalysis of foreunderstanding, offers a provocative model of clinical reasoning. The implications of this model for evidence-based medicine are discussed in conclusion.
This paper is an experiment in Leibnizian analysis. The reader will recall that Leibniz considered all true sentences to be analytically so. The difference, on his account, between necessary and contingent truths is that sentences reporting the former are finitely analytic; those reporting the latter require infinite analysis of which God alone is capable. On such a view at least two competing conceptions of entailment emerge. According to one, a sentence entails another when the set of atomic requirements for the (...) first is included in the corresponding set for the other; according to the other conception, every atomic requirement of the entailed sentence is underwritten by an atomic constituent of the entailing one. The former conception is classical on the twentieth century understanding of the term; the latter is the one we explore here. Now if we restrict ourselves to the formal language of the propositional calculus, every sentence has a finite analysis into its conjunctive normal form. Semantically, then, every sentence of that language can be represented as a simple hypergraph, H, on the powerset of a universe of states. Entailment of the sort we wish to study can be represented as a known relation, subsumption between hypergraphs. Since the lattice of hypergraphs thus ordered is a DeMorgan lattice, the logic of entailment thus understood is the familiar system, FDE of first-degree entailment. We observe that, extensionalized, the relation of subsumption is itself a DeMorgan Lattice ordered by higher-order subsumption. Thus the semantic idiom that hypergraph-theory affords reveals a hierarchy of lattices capable of representing entailments of every finite degree. (shrink)