A non-inferiority design accepts the possibility of some efficacy loss, as part of a “successful”, statistically significant result. That loss may be excessive when the non-inferiority threshold is lenient. However, even stringent significance thresholds and safety monitoring may fail to adequately protect study participants when the primary outcome is death. The OPTIMAAL trial, a large randomized clinical trial performed in high-risk patients, is discussed as an example, using the Belmont Report principles as an ethical frame of reference. OPTIMAAL (...) compared losartan, a new drug, to captopril, a drug known to reduce the risk of death in patients with heart failure after a myocardial infarction. Serious ethical challenges occurred in that study. Firstly, subjects had to tolerate captopril to participate, meaning that participation implied the possibility of higher risk of death if randomized to the losartan arm, as compared to the standard of care. Additionally, the stopping rules had to ensure enough powe... (shrink)

Discussions about the merits and shortcomings of non-inferiority trials are becoming increasingly common in the medical community and among regulatory agencies. However, criticisms targeting the ethical standing of non-inferiority trials have often been mistargeted. In this article we review the ethical standing of trials of non-inferiority. In the first part of the article, we outline a consequentialist position according to which clinical trials are best conceived as epistemic tools aimed at fostering the proper ends of medicine. According (...) to this view, clinical trials are means to ends, and thus their moral status depends both on how well they perform as means to reach desired ends and on which ends they are meant to achieve. Building upon this normative framework in the next two sections we analyze the specific ethical issues raised by non-inferiority trials. By making it clear that clinical trials are just epistemic tools – i.e. means to certain ends – it is possible not only to clarify the conceptual debate over a fundamental issue in clinical research, but also to identify which ethically relevant considerations ought to be addressed in setting up a non-inferiority trial. (shrink)

Background: People with traumatic brain injury face a range of mental health challenges during the adjustment process post-injury, but access to treatment can be difficult, particularly for those who live in regional and remote regions. eHealth provides the potential to improve access to evidence-based psychological therapy for people with a severe TBI. The aim of the current study is to assess the efficacy of a psychological intervention delivered via video consulting to reduce psychological distress in people with TBI.Methods: This paper (...) outlines the protocol for a multi-center, three-arm, parallel, non-inferiority randomized controlled trial of an evidence-based manualized psychological intervention, ACT-Adjust. ACT-Adjust provides nine sessions for adults with a moderate to severe TBI experiencing clinical levels of psychological distress. Fifty-six participants referred from Brain Injury Rehabilitation Units across New South Wales and the NSW icare scheme will be randomly allocated to three conditions; video consulting, face-to-face and, a waitlist control.Discussion: This is the first RCT to evaluate the efficacy of a psychological therapy delivered via video consulting for individuals with a moderate to severe TBI.Trial Registration:www.anzctr.org.au, Australian New Zealand Clinical Trials Registry ANZCTRN2619001602112. (shrink)

Introduction: Falls are the leading cause of fatal and nonfatal injuries among older adults. Studies showed that older adults can reduce the risk of falls after participation in an unexpected perturbation-based balance training, a relatively novel approach that challenged reactive balance control. This study aims to investigate the effect of the practice schedule on reactive balance function and its transfer to proactive balance function. Our primary hypothesis is that improvements in reactive balance control following block PBBT will be not inferior (...) to the improvements following random PBBT.Methods and Analysis: This is a double-blind randomized controlled trial. Fifty community-dwelling older adults will be recruited and randomly allocated to a random PBBT group or a block PBBT group. The random PBBT group will receive eight training sessions over 4 weeks that include unexpected machine-induced perturbations of balance during hands-free treadmill walking. The block PBBT group will be trained by the same perturbation treadmill system, but only one direction will be trained in each training session, and the direction of the external perturbations will be announced. Both PBBT groups will receive a similar perturbation intensity during training, the same training period, and the same concurrent cognitive tasks during training. The generalization and transfer of learning effects will be measured by assessing the reactive and proactive balance control during standing and walking before and after 1 month of PBBT, for example, step and multiple steps and fall thresholds, Berg balance test, and fear of falls. The dependent variable will be rank transformed prior to conducting the analysis of covariance to allow for nonparametric analysis.Discussion: This research will explore which of the balance retraining paradigms is more effective to improve reactive balance and proactive balance control in older adults over 1 month. The research will address key issues concerning balance retraining: older adults’ neuromotor capacities to optimize training responses and their applicability to real-life challenges.Clinical Trial Registration: Helsinki research ethics approval has been received. (shrink)

BackgroundFigure-disembedding is one of the most discussed visuo-cognitive functions, in which individuals with Autism Spectrum Disorder have been reported to outperform non-autistic individuals. A local processing bias has been assumed to underlie such superior performance patterns. The aim of the current study is to investigate whether processing preferences can be modified by procedural priming.MethodThe current study used a procedural priming task to induce more local or global processing in 25 autistic and 21 typically developing control participants, using hierarchical figures preceding (...) the figure-disembedding task.ResultsParticipants with ASD outperformed non-autistic individuals in the unprimed baseline task version. The performance was not modulated by priming in either direction in both groups. However, the performance of TD control participants was improved by training to the same level as that observed in the ASD group.ConclusionFigure-disembedding performance in ASD is superior to that in TD control participants and robust against procedural priming or training. In contrast, performance in the TD control group can be improved up to the level of the ASD group. Any studies reporting superiority in individuals with ASD in figure-disembedding should consider training effects when evaluating group differences. (shrink)

It is fairly well known that Hume added a footnote to his essay ‘Of National Characters’ in which he asserts that all non-white peoples are naturally inferior to white people. Subsequently, he revised the note to assert only that black people are naturally inferior to white people. But while the view expressed in this footnote has been described as ‘shockingly bigoted’, and even as his ‘racial law,’ it is still commonly thought that in Hume's voluminous writings it is apparently just (...) this single passage which is definitely racist in its import. My aim in this paper is to show how American Indians are thought to be naturally inferior to white people in An Enquiry Concerning the Principles of Morals. There are, therefore, passages in Hume's second Enquiry which are also definitely racist in their import. (shrink)

Informed consent is considered by many to be a moral imperative in medical research. However, it is increasingly acknowledged that in many actual instances of consent to participation in medical research, participants do not employ the provided information in their decision to consent, but rather consent based on the trust they hold in the researcher or research enterprise. In this article we explore whether trust-based consent is morally inferior to information-based consent. We analyse the moral values essential to valid consent (...) – autonomy, voluntariness, non-manipulation, and non-exploitation – and assess whether these values are less protected and promoted by consent based on trust than they are by consent based on information. We find that this is not the case, and thus conclude that trust-based consent if not morally inferior to information-based consent. (shrink)

This paper suggests a new principle for confirmation theory which is called the principle of explanatory surplus. This principle is shown to be non-Bayesian in character, and to lead to a treatment of simplicity in science. Two cases of the principle of explanatory surplus are considered. The first (number of parameters) is illustrated by curve-fitting examples, while the second (number of theoretical assumptions) is illustrated by the examples of Newton's Laws and Adler's Theory of the Inferiority Complex.

Many people experience feelings of inferiority in their life. The concept of striving to avoid inferiority is a belief associated with the unwanted fear of being overlooked, missing out on opportunities for advancement, and active rejection. This study examined the effect of striving to avoid inferiority on mental health and well-being. We hypothesized that striving to avoid inferiority would modify the relationship among socioeconomic status, mental health, and well-being, therefore examined the effect of striving to avoid (...) inferiority on the relationship between annual income, mental health, and well-being. The participants were 491 adults. The results indicated that insecure striving in competition with others positively correlated with depression, anxiety, and stress, whereas secure non-striving in acceptance of inferiority positively correlated with the satisfaction with life and negatively correlated with depression. The effect of striving to avoid inferiority on the relationship among annual income, mental health, and well-being indicated that SNS affected the relationships between annual income and well-being, annual income and depression, income and anxiety, and the interaction between IS and SNS. Moreover, the relationship between income and stress was influenced by SNS and the interaction between IS and SNS. These results indicated that SNS or the interaction between IS and SNS were the only variables regulating the relationship among annual income, mental health, and well-being. These findings suggested that accepting feelings of inferiority or striving to avoid inferiority influences the mental health and well-being of people. (shrink)

It has been shown that quantum mechanics in its orthodox interpretation violates four different formulations of causality principle endowed with empirical meaning. The present work aims to highlight how even a realistic non-standard interpretation of the theory conflicts with causality in its Cartesian formulation of the principle of the non-inferiority of causes over effects. Such an interpretation, which attributes some form of weak physical reality to the wave function (called empty wave, regarded as a zero-energy wave-like phenomenon), is a (...) sort of precursor of the more recent so-called wavefunction realism. We also discuss a more radical realistic interpretation according to which physical properties can also be assigned to non-metaphysical relative nothing, seen as the simple absence of a particle such as a photon, but not of its corresponding state (no-photon), which is considered real. By interpreting the wave function collapse as a consequence of an interaction with empty waves or of a detection of the no-photon, we will highlight how more real physical effects can derive from lower causes, including relative nothing. Finally, we will show how these interpretations, while violating Cartesian causality in its two variants, do not seem to affect the validity of the principle of a rational explanation that nothing can derive from (absolute) nothing, which does not seem satisfied by the orthodox interpretation. (shrink)

The key concept in Kant’s aesthetics is “aesthetic reflective judgment,” a critique of which is found in Part 1 of the Critique of the Power of Judgment (1790). It is a critique inasmuch as Kant unravels previous assumptions regarding aesthetic perception. For Kant, the comparative edge of a “judgment” implicates communicability, which in turn gives it a public face; yet “reflection” points to autonomy, and the “aesthetic” shifts the emphasis away from objective properties to the subjective response evoked by the (...) object. Contrary to the view he had inherited, Kant did not treat aesthetic judgments as confused perceptions or inferior cognitions, but rather put them in a category of their own. For Kant, aesthetic reflective judgments implicated not only the processes involved in understanding the empirical world but also the processes involved in ascribing ideas or meaning to experience (which go beyond what is given in perception/cognition). This “going beyond cognition” may have been referred to by Kant as non-cognitive, but it is conditioned on a way of cognizing the object. Kant describes the features of such judgments in the Analytic of the Beautiful before addressing their possibility in subtle ways throughout the Deduction of Pure Aesthetic Judgments. Kant’s critique gives rise to three apparent dichotomies: immediate intuition and prior learning; autonomy and communicability; and non-cognitive response and aesthetic ideas. An interpretation of Kant’s theory can be deemed correct to the degree that it succeeds in showing that the contradictions are only apparent. I will argue that the resulting positive account of Kant’s aesthetic theory offers an understanding of aesthetic reflective judgment that is quite different from the standard formalism that the critics of formalism usually target and by which they misrepresent Kant’s aesthetic theory. When I refer to Kant’s formalism, then, I mean something quite different by this than what is meant by “standard formalism.” The latter is the representation given Kant’s formalism by its contemporary critics and is the typical account of formalism found in the art theory and philosophy of art literature, as will be demonstrated. (shrink)

By analysing the two relevant psychological phenomena of "endurance" and "non-endurance," this essay aims to reveal the ethical implications of a Confucian approach, namely regarding non-endurance as an impulse of primary virtue. Based on this case study, the author then explores the significance of moral cultivation or psychological training in establishing moral personality and the complexities of such a process. Meanwhile, "love" in Confucian ethics means sympathy for the inferior rather than affection for the revered. Hopefully, this study may deepen (...) our understanding of virtue ethics. /// 通过对忍与不忍这两种相关的心理现象的分析，可揭示儒家把不忍人之心作 为首善之端加以强调的伦理学含义。以此为例，探讨修养功夫即心理训练对道德人 格形成的重要性及复杂性，进而可得出儒家伦理讲求的爱是对弱者的怜爱而非对崇 敬者的热爱。这项研究有助于深化我们对德性伦理的认识。. (shrink)

An increasing number of drugs removed from the market because of unacceptable toxicity raises concerns regarding preapproval testing of drug safety. In the present paper it is postulated that the non-inferiority type of trial should be abandoned in favor of the superiority trial with active controls and less stringent (p<0.1, both for efficacy and toxicity) statistics. This approach will increase sensitivity of detection of drug-induced adverse effects at the expense of increasing false positive results regarding the difference in efficacy (...) between the tested and reference drug. Such a move will increase the protection of future patients. In addition, the proposed design is far more acceptable from the clinical (e.g. no need to specify the statistically expected “unimportant” number of deaths) and ethical points of view, as well as being favored by the strong incentive of involved parties. In the second part of this paper arguments are presented in favor of the hypothesis that placebo (still used in some superiority trials) does not induce adverse effects. The assertion that placebo may induce adverse effects is probably biased by the nature of the clinical experiment. Such a conclusion is supported by studies indicating that placebo-induced adverse effects are disease — and treatment — specific. The modification of clinical trials according to the proposed changes may increase the trials’ sensitivity at detecting adverse effects of drugs. (shrink)

Scientists and their supporters often portray as exasperatingly irrational all those laypersons who refuse to accede to practical recommendations issued by expert scientists and 'science appliers'. After first considering the latter groups’ standard explanations for such non-deference, which focus upon irrationalities besetting the laity, I will propose that a better explanation for at least some of the non-deference is that many laypersons are rationally electing to substitute their own judgments for those urged upon them by the scientific community. Science-based recommendations, (...) as I treat them, have the general form In light of the science on X, if you seek outcome O, you ought to V. Non-deferring laypersons deny the soundness or cogency of the V-supporting argumentation—though they are supposedly not competent to do so, given their gross epistemic inferiority to the scientific authorities who create and endorse the arguments. On account of thus being epistemically irrational, they end up being instrumentally irrational, pursuing courses of action that are poor choices for serving their own interests. The non-deferring laypersons are thought to violate two mandates of rationality: for internal deference to the underlying science as true enough to constitute an unproblematic background for decisionmaking, and for external deference to the practical application of that science to the concrete extra-scientific circumstances in question. I claim that rationality does not require categorical adherence to these mandates. In any given case, non-deference by some laypersons might be warranted by one or more of four distinct rationales. 1. Value-ladenness: The science-based recommendation discernibly includes non-scientific value-choice or value-weighting assumptions. It embodies a certain prioritizing of the plurality of specific values packed within its O parameter, and some laypersons may permissibly substitute their own. 2. Non-scientific-reasoning-ladenness: The science-based recommendation discernibly relies upon reasoning moves that are not distinctive to science, moves whose critical assessment demands no scientific expertise. Error-free reasoning is difficult to attain, and the laypersons may justifiably take themselves to have found weaknesses in the V-supporting argumentation that undermine the case for conformity to the recommendation. 3. Overgeneralization: The science-based recommendation discernibly is not adequately tailored to the specific situation of the laypersons in question. 4. Untrustworthy science: The science-based recommendation discernibly is based upon scientific research that is of doubtful quality. The first three rationales cast doubt upon the External Deference Mandate, questioning not the existence of sound underlying research but the recommendation’s judgments about how this research ought to be applied. The fourth is a challenge to the Internal Deference Mandate. (shrink)

Aristotle’s discussions of natural slavery, ‘barbarian kingship’, and the natural characteristics of barbarians or non-Greeks are usually read as calling into question the intellectual, ethical, and political accomplishments of non-Greeks. Such accounts of non-Greek inferiority or inability to self-govern also appear to presuppose a climatic or environmental account that on the whole would imply severe limitations on the possibility of political flourishing for peoples living outside the Greek Mediterranean basin. In light of such accounts, it is somewhat astounding to (...) find Aristotle praising the social and political institutions of Carthage within his discussion of the best constitution in the second book of the Politics. In the 4th century BCE, Carthage (modern day Tunis) was a Phoenician commercial empire that culturally and linguistically was Semitic and clearly non-Greek. That Aristotle contrasts Carthage, a non-Greek polis, favorably with both Sparta and Crete undermines both the claim that Aristotle embraced a categorical opposition between Greeks and non-Greeks and the claim that he was dismissive of the achievements of non-Greeks. (shrink)

The quest for effective medicines is very old. In modern times two important tools have been developed to evaluate efficacy of drugs: superiority and non-inferiority types of clinical trials. The former tests the null hypothesis of μ (the difference between a tested drug and comparator) ≤ 0 against μ > 0; the latter tests the null hypothesis of μ ≤ - Δ against, μ > - Δ, where Δ is the clinical difference from the comparator. In a superiority trial, (...) a new drug is tested against a placebo; in a non-inferiority trial, a new drug is tested against active treatment. In this paper, arguments are presented to show that a superiority trial against a placebo is scientifically sound but ethically unacceptable, whereas a non-inferiority trial against active treatment is ethically sound but scientifically not reliable. Switching from a superiority type of trial with placebo to a non-inferiority trial with an active-control — following the latest revision of Declaration of Helsinki — is in practice switching from the violation of the uncertainty principle to uncertainty of results. Given human and financial resources, it appears an academic question as to which is more unethical: to violate patients’ rights or to produce results without scientific value. All presented considerations lead to the conclusion that the use of a superiority trial of design with an active control instead of placebo will satisfy scientific needs, expectation of patients, and the ancient quest for effective medicines. In the era of Good (Clinical, Laboratory, Manufacture) Practice, the attention of those performing clinical trials is focused on the procedure, not always on its essence. However even the excellent performance of a trial which is not worth doing is fruitless. (shrink)

By analysing the two relevant psychological phenomena of “endurance” and “non-endurance,” this essay aims to reveal the ethical implications of a Confucian approach, namely regarding non-endurance as an impulse of primary virtue. Based on this case study, the author then explores the significance of moral cultivation or psychological training in establishing moral personality and the complexities of such a process. Meanwhile, “love” in Confucian ethics means sympathy for the inferior rather than affection for the revered. Hopefully, this study may deepen (...) our understanding of virtue ethics. (shrink)

In this paper we suggest the existence of a generalized task-related cortical network that is up-regulated whenever the task to be performed requires the allocation of generalized non-specific cognitive resources, independent of the specifics of the task to be performed. We have labeled this general purpose network, the extrinsic mode network (EMN) as complementary to the default mode network (DMN), such that the EMN is down-regulated during periods of task-absence, when the DMN is up-regulated, and vice versa. We conceptualize the (...) EMN as a cortical network for extrinsic neuronal activity, similar to the DMN as being a cortical network for intrinsic neuronal activity. The EMN has essentially a fronto-temporo-parietal spatial distribution, including the inferior and middle frontal gyri, inferior parietal lobule, supplementary motor area, inferior temporal gyrus. We hypothesize that this network is always active regardless of the cognitive task being performed. We further suggest that failure of network up- and down-regulation dynamics may provide neuronal underpinnings for cognitive impairments seen in many mental disorders, such as, e.g., schizophrenia. We start by describing a common observation in functional imaging, the close overlap in fronto-parietal activations in healthy individuals to tasks that denote very different cognitive processes. We now suggest that this is because the brain utilizes the EMN network as a generalized response to tasks that exceeds a cognitive demand threshold and/or requires the processing of novel information. We further discuss how the EMN is related to the DMN, and how a network for extrinsic activity is related to a network for intrinsic activity. Finally, we discuss whether the EMN and DMN networks interact in a common single brain system, rather than being two separate and independent brain systems. (shrink)

In Nietzsche and Embodiment Kristen Brown reveals the smartness of bodies, challenging the traditional view in the West that bodies are separate from and morally inferior to minds. Drawing inspiration from Nietzsche, Brown vividly describes why the interdependence of mind and body matters, both in Nietzsche's writings and for contemporary debates (non-dualism theory, Merleau-Ponty criticism, and metaphor studies), activities (spinal cord research and fasting), and specific human experiences (menses, trauma, and guilt). Brown's theories about the dynamic relationship between body and (...) mind provide new possibilities for self-understanding and experience. (shrink)

The linguistic complexity of words has largely been studied on the behavioral level and in experimental settings. Only little is known about the neural processes underlying it in uninstructed, spontaneous conversations. We built up a multimodal neurolinguistic corpus composed of synchronized audio, video, and electrocorticographic (ECoG) recordings from the fronto-temporo-parietal cortex to address this phenomenon based on uninstructed, spontaneous speech production. We performed extensive linguistic annotations of the language material and calculated word complexity using several numeric parameters. We orthogonalized the (...) parameters with the help of a linear regression model. Then, we correlated the spectral components of neural activity with the individual linguistic parameters and with the residuals of the linear regression model, and compared the results. The proportional relation between the number of consonants and vowels, which was the most informative parameter with regard to the neural representation of word complexity, showed effects in two areas: the frontal one was at the junction of the premotor cortex, the prefrontal cortex, and Brodmann area 44. The postcentral one lay directly above the lateral sulcus and comprised the ventral central sulcus, the parietal operculum and the adjacent inferior parietal cortex. Beyond the physiological findings summarized here, our methods may be useful for those interested in ways of studying neural effects related to natural language production and in surmounting the intrinsic problem of collinearity between multiple features of spontaneously spoken material. (shrink)

We argue that planning and control may not be separable entities, either at the behavioural level or at the neurophysiological level. We review studies that show the involvement of superior and inferior parietal cortex in both planning and control. We propose an alternative view to the localization theory put forth by Glover.

BackgroundInformed consent forms for clinical research are several and variable at international, national and local levels. According to the literature, they are often unclear and poorly understood by participants. Within the H2020 project CORBEL—Coordinated Research Infrastructures Building Enduring Life-science Services—clinical researchers, researchers in ethical, social, and legal issues, experts in planning and management of clinical studies, clinicians, researchers in citizen involvement and public engagement worked together to provide a minimum set of requirements for informed consent in clinical studies.MethodsThe template was (...) based on a literature review including systematic reviews and guidelines searched on PubMed, Embase, Cochrane Library, NICE, SIGN, GIN, and Clearinghouse databases, and on comparison of templates gathered through an extensive search on the websites of research institutes, national and international agencies, and international initiatives. We discussed the draft versions step-by-step and then we referred to it as the “matrix” to underline its modular character and indicate that it allows adaptation to the context in which it will be used. The matrix was revised by representatives of two international patient groups.ResultsThe matrix covers the process of ensuring that the appropriate information, context and setting are provided so that the participant can give truly informed consent. It addresses the key topics and proposes wording on how to clarify the meaning of placebo and of non-inferiority studies, the importance of individual participants’ data sharing, and the impossibility of knowing in advance how the data might be used in future studies. Finally, it presents general suggestions on wording, format, and length of the information sheet.ConclusionsThe matrix underlines the importance of improving the process of communication, its proper conditions (space, time, setting), and addresses the participants’ lack of knowledge on how clinical research is conducted. It can be easily applied to a specific setting and could be a useful tool to identify the appropriate informed consent format for any study. The matrix is mainly intended to support multicentre interventional randomized clinical studies, but several suggestions also apply to non-interventional research. (shrink)

In this paper I argue that Newton’s stance on explanation in physics was enabled by his overall methodology and that it neither committed him to embrace action at a distance nor to set aside philosophical and metaphysical questions. Rather his methodology allowed him to embrace a non-causal, yet non-inferior, kind of explanation. I suggest that Newton holds that the theory developed in the Principia provides a genuine explanation, namely a law-based one, but that we also lack something explanatory, namely a (...) causal account of the explanandum. Finally, I argue that examining what it takes to have law-based explanation in the face of agnosticism about the causal process makes it possible to recast the debate over action at a distance between Leibniz and Newton as empirically and methodologically motivated on both sides. (shrink)

Cognitive dysfunction in Alzheimer’s disease is caused by disturbances in neuronal circuits of the brain underpinned by synapse loss, neuronal dysfunction and neuronal death. Amyloid beta and tau protein cause these pathological changes and enhance neuroinflammation, which in turn modifies disease progression and severity. Vagal nerve stimulation, via activation of the locus coeruleus, results in the release of catecholamines in the hippocampus and neocortex, which can enhance synaptic plasticity and reduce inflammatory signalling. Vagal nerve stimulation has shown promise to enhance (...) cognitive ability in animal models. Research in rodents has shown that VNS can have positive effects on basal synaptic function and synaptic plasticity, tune inflammatory signalling, and limit the accumulation of amyloid plaques. Research in humans with invasive and non-invasive VNS devices has shown promise for the modulation of cognition. However, the direct stimulation of the vagus nerve afforded with the invasive procedure carries surgical risks. In contrast, non-invasive VNS has the potential to be a broadly available therapy to manage cognitive symptoms in early AD, however, the magnitude and specificity of its effects remains to be elucidated, and the non-inferiority of the effects of non-invasive VNS as compared with invasive VNS still needs to be established. Ongoing clinical trials with healthy individuals and patients with early AD will provide valuable information to clarify the potential benefits of non-invasive VNS in cognition and AD. Whether invasive or non-invasive VNS can produce a significant improvement on memory function and whether its effects can modify the progression of AD will require further investigation. (shrink)

Restoration skills training is a mindfulness-based course in which participants draw support from a natural practice setting while they learn to meditate. Well-established conventional mindfulness training can improve psychological functioning but many perceive it as demanding and fail to sustain practice habits. Applying non-inferiority logic, previous research indicated that ReST overcomes compliance problems without compromising the benefits gained over 5 weeks’ training. This article applies similar logic in a 6-month follow-up. Of 97 contacted ReST and CMT course completers, 68 (...) responded and 29 were included with multiple imputation data. The online survey included questions about their psychological functioning in three domains and the forms and frequencies with which they had continued to practice mindfulness after the course. Former ReST participants continued, on average, to show higher dispositional mindfulness and fewer cognitive lapses compared to pre-course ratings. Improved psychological functioning in one or more domains was demonstrated by 35%, as determined by a reliable change index. Again, analyses detected no indications of any substantive disadvantages compared to the more demanding, established CMT approach. Compared to the CMT group, more ReST participants had also continued to practice at least occasionally. Continued practice was linked to sustained improvements for ReST but not clearly so for CMT. ReST participants thus continued to use the skills and sustained the improvements in psychological functioning that they had gained in the course, further supporting the utility of ReST as a health intervention. (shrink)

Clinical trials play a prominent role today in medicine, but are not without controversy. These issues start from the day physicians begin their specialization process in medical school and continues onto their day-to-day practice as attendings with referral patterns and resulting financial incentives. This combined with the lack of training in basic issues of epistemology and statistics, allows poor interpretations of clinical trials to reign free. A proposal to integrate the notion of severity to help remedy these issues are made (...) by ensuring that studies are tested “As Severe As Reasonably Possible” will put P-values, multiplicity adjustments, and model checking in their rightful place. In light of this, multiple clinical trials are examined with an in-depth analysis of erroneous statistical inferences taken from phase III randomized trials, non-inferiority, early phase, as well as observational studies. Severe testing in the setting of medicine will help with alleviate some of the issues with the current misinterpretation of clinical studies. (shrink)

In medical research, it is not unusual that risks are ruled out without any specification the exact risk that was ruled out. This makes it difficult to balance expected health benefits and risk of harm when choosing between alternative treatment options. International guidelines for reporting medical research results are sufficiently specific when it comes to establishing health benefits. However, there is a lack of standards for reporting on ruling out risks. We argue that transparency is needed, as in the case (...) of non-inferiority trials. The Consolidated Standards of Reporting Trials and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements should be revised accordingly. (shrink)

The contribution of action-perception systems of the brain to lexical semantics remains controversial. Here, we used high-definition transcranial direct current stimulation (HD-tDCS) in healthy adults to examine the role of primary (left hand motor area; HMA) and higher-order (left anterior inferior parietal lobe; aIPL) action areas in action-related word processing (action verbs and manipulable nouns) compared to non-action-related control words (non-action verbs and non-manipulable nouns). We investigated stimulation-related effects at three levels of semantic processing: subliminal, implicit, and explicit. Broadly, we (...) found that stimulation of HMA and aIPL resulted in relative facilitation of action-related language processing compared to non-action. HMA stimulation facilitated action verb processing in subliminal and implicit task contexts, suggesting that HMA helps represent action verbs even in semantically shallow tasks. HMA stimulation also facilitated manipulable noun comprehension in an explicit semantic task, suggesting that HMA contributes to manipulable noun comprehension when semantic demands are high. aIPL stimulation facilitated both manipulable noun and action verb processing during an implicit task. We suggest that both HMA and aIPL play a functional role in action semantics. HMA plays a general role in the semantics of actions and manipulable objects, while aIPL is important only when visuo-motor coordination is required for the action. (shrink)

Euro-American misrepresentations of the non-West in general, and in particular on Hinduism and ancient India, run deep and have far greater colonial connections than that have been exposed in academia. This book analyzes the psycho-social consequences that Indian American children face after they are exposed to the school textbook discourse on Hinduism and ancient India. The authors show that there is an intimate connection—an almost exact correspondence—between James Mill’s colonial-racist discourse and the current school-textbook discourse. The very parameters and coordinates (...) on which James Mill constructed the discourse are the ones that are being used to describe Hinduism, Hindus, and ancient India in the textbooks currently. Consequently, this archaic and racist discourse, camouflaged under the cover of political correctness, produces in the Indian American children a psychological impact quite similar to what racism is known to produce: shame, inferiority, embarrassment, identity confusion, assimilation, and a phenomenon similar to racelessness where the children dissociate from the tradition and culture of their ancestors. This book argues that the current school textbook discourse on Hinduism and India needs to change so that the Indian American children do not become victims of overt and covert racism. For the change to occur, the first step is to recognize the overarching and pervasive influence of the colonial-racist discourse of James Mill on the textbooks. For the reconstruction of the discourse to take place, the first step is to engage in a through deconstruction, which is what the book attempts. (shrink)

The Argument from Inferiority holds that our world cannot be the creation of an omnipotent and omnibenevolent being; for if it were, it would be the best of all possible worlds, which evidently it is not. We argue that this argument rests on an implausible principle concerning which worlds it is permissible for an omnipotent being to create: roughly, the principle that such a being ought not to create a non-best world. More specifically, we argue that this principle is (...) plausible only if we assume that there is a best element in the set of all possible worlds. However, as we show, there are conceivable scenarios in which that assumption does not hold. (shrink)

Social or relational egalitarians try to defend democracy non-instrumentally as a constitutive element of a society where no one stands as inferior or superior to anyone else. However, they face an instrumentalist challenge from within: Why not uphold a non-democratic regime if it outperforms democracy in protecting or promoting egalitarian social relations, for example, by stably producing substantive political decisions that guard against social hierarchies? This article explores the best response to this challenge from the social egalitarian non-instrumentalist standpoint. It (...) argues that the instrumentalist challenge can be accommodated without abandoning the essential non-instrumentalist commitment to democracy; while a nondemocratic regime may be justified under less-than-ideal circumstances as a contingently effective means to realize more social equality, democracy can nevertheless be viewed as a necessary condition for the realization of full social equality. (shrink)

This article critically evaluates bettering human life. Because this involves lives that do not exist yet, the article investigates human eugenics and enhancement through the social prism of ‘the imaginary’ (defined ‘as a set of assumptions and concepts for thinking and speaking about human enhancement and its future direction’) [1]. “Exploring basic assumptions underlying the idea of human enhancement” investigates underlying assumptions and claims for human enhancement. Firstly, human eugenics and enhancement entangles a factual as well as a normative claim (...) about what improvement/betterment maybe constitutive of. Secondly, claims about what a better life is, is often a future orientated claim about whether certain kinds of life that do not exist yet should ever exist. Moral images of thought are introduced and how they work to make normative judgments about lives that do not exist. This implicates the moral problem of difference, where an image of a ‘better’ life—classically expressed in eugenics as a ‘superior’ and/or ‘normal’ life—necessarily entails inferiority and/or deviance from a norm. “Moral imagination in contemporary fiction and the history of old eugenics”, introduces moral images in history of eugenics and demonstrates how examples fall foul of the problem. “The new (liberal) eugenics and the moral image of therapy” examines progress in contemporary debates, the move from authoritarian to non-authoritarian eugenics (human enhancement), and how, to some extent, this has solved the problem of difference, through liberal defence of personal choice. “The heart of the eugenic issue” suggests that personal choice in liberal non-authoritarian eugenics is not immune to basic drive behind all eugenic arguments; desire as lack which is expressed as the continual dissatisfaction of not having our future expectations met. (shrink)

The Argument from Inferiority holds that our world cannot be the creation of an omnipotent and omnibenevolent being; for if it were, it would be the best of all possible worlds, which evidently it is not. We argue that this argument rests on an implausible principle concerning which worlds it is permissible for an omnipotent being to create: roughly, the principle that such a being ought not to create a non-best world. More specifically, we argue that this principle is (...) plausible only if we assume that there is a best element in the set of all possible worlds. However, as we show, there are conceivable scenarios in which that assumption does not hold. (shrink)

Nel 1589 Hercole Filogenio scrisse un discorso che intitolò _Dell’eccellenza della donna_, con l’intento di allinearsi “all’opinione di coloro che si sforzano scoprire l’errore di molti, quali tanto si affannano in avilire il feminil sesso” e dedicò il suo scritto a Flavia Peretti Orsina, donna distinta e dallo spirito inquieto, che con i suoi interessi contribuì allo sviluppo della società dell’epoca. Nel suo tentativo di preservare le donne dal biasimo manifestato dal maschilismo egemone e, allo stesso tempo, elogiare le loro (...) virtù, Filogenio propone due conclusioni, l’analisi e l’approfondimento delle quali, per mezzo di un’argomentazione valida, costituiscono il nucleo testuale della sua opera. L’articolo presenta e analizza i ragionamenti che Filogenio sviluppa nella seconda parte del suo discorso sui quali intende imperniare la dimostrazione della seconda conclusione: che la Donna non è superiore né inferiore all’Uomo, ma simile e uguale per nobiltà, eccellenza e perfezione. (shrink)

Cicero, Lucullus 38: ‘…non potest animal ullum non adpetere id quod accommodatum ad naturam adpareat …’ From earliest childhood every man wants to possess something. One man collects horses. Another wants gold. Socrates has a passion for companions. He would rather have a good friend than a quail or a rooster. In this way, Socrates begins his interrogation of Menexenus. He then congratulates Menexenus and Lysis for each having what he himself still does not possess. How is it that one (...) gets a friend, Socrates asks? Since the nineteenth century many who have read these lines have found them repulsive. Scholars have damned the Lysis for its selfish egoism, for regarding persons as personal belongings. At the turn of the century some sought to discredit the dialogue as a forgery and a calumny. Others debated the dating of the dialogue as Socratic or Platonic, seeking whom to blame rather than whom to credit. And those who have regarded the dialogue as Platonic have tried to redeem it by detecting hints of Plato's theory of Forms. A few have attempted to salvage reputations by understanding the argument of the Lysis as a reductio of egoism, or else by invoking the loyalty of Socrates' friends and the history of Plato's friendship for Dion of Syracuse to speak up for their defence. Guthrie has condemned the dialogue as a failure of method and presentation , and Vlastos has pronounced it a failure of love: ‘The lover Socrates has in view seems positively incapable of loving others for their own sake, else why must he feel no affection for anyone whose good-producing qualities he did not happen to need?’ The Lysis appears to make no positive contribution to the Greek tradition on friendship when compared to the Symposium or the Phaedrus. And in the subsequent tradition, whatever Aristotle might have borrowed from the dialogue he uses for his own purposes. Aristotle too is quite critical of specific points raised in the Lysis. Now it might seem that Aristotle made a place for the selfish love of the Lysis in his own theory, as an inferior grade of utility love. But even this cannot be so, if we are to agree with recent studies of Aristotle's ethics. According to Aristotle, if a client is friendly to his benefactor because of the latter's usefulness, this utilitarian motive must accompany a genuine concern for the benefactor's own interest in that relation, if they are to be friends. Inferior and genuine friendship may differ in purpose but not in regard for the well-being of the beloved. This respect for the object of one's love has no parallel in the Lysis, according to the standard reading of the dialogue. (shrink)

By ruling out questions of impairment from the social critique of disability, Disability Studies analyses establish a limit point in the field. Of course the setting of “limits” enables possibilities in multiple directions as well as fortifies boundaries of refusal. For instance, impairment becomes in DS simultaneously a productive refusal to interpret disabled bodies as inferior to non-disabled bodies and a bar to thinking through more active engagements with disability as materiality. Disability materiality such as conditions produced by ecological toxicities (...) serve as active switch-points for creative corporeal navigations of the interaction between bodies and environments.In fact in this paper we want to propose a more “lively” definition of disability materiality to existing definitions of impairment as limiting expressions of non-normative bodies. We have no useful ways of explaining disability as adaptation and it’s time we begin the process of theorizing more active ideas of materiality that extend existing ideas of disability beyond simplistic conceptions of socially rejected biologies made available by social constructivist thought. (shrink)

What differentiates scientific research from non-scientific inquiry? Philosophers addressing this question have typically been inspired by the exalted social place and intellectual achievements of science. They have hence tended to point to some epistemic virtue or methodological feature of science that sets it apart. Our discussion on the other hand is motivated by the case of commercial research, which we argue is distinct from (and often epistemically inferior to) academic research. We consider a deflationary view in which science refers to (...) whatever is regarded as epistemically successful, but find that this does not leave room for the important notion of scientific error and fails to capture distinctive social elements of science. This leads us to the view that a demarcation criterion should be a widely upheld social norm without immediate epistemic connotations. Our tentative answer is the communist norm, which calls on scientists to share their work widely for public scrutiny and evaluation. (shrink)

This article critically questions the commercialization of hospice care and the ethical concerns associated with the industry's movement toward “market-driven medicine” at the end of life. For example, the article examines issues raised by an influx of for-profit hospice providers whose business model appears at its core to have an ethical conflict of interest between shareholders doing well and terminal patients dying well. Yet, empirical data analyzing the experience of patients across the hospice industry are limited, and general claims that (...) end-of-life patient care is inferior among for-profit providers or even that their business practices are somehow unseemly when compared to nonprofit providers cannot be substantiated. In fact, non-profit providers are not immune to potentially conflicting concerns regarding financial viability (i.e., “no margin, no mission”). Given the limitations of existing empirical data and contrasting ideological commitments of for-profit versus non-profit providers, the questions raised by this article highlight important areas for reflection and further study. Policymakers and regulators are cautioned to keep ethical concerns in the fore as an increasingly commercialized hospice industry continues to emerge as a dominant component of the U.S. health care system. Both practitioners and researchers are encouraged to expand their efforts to better understand how business practices and commercial interests may compromise the death process of the patient and patient's family — a process premised upon a philosophy and ethical tradition that earlier generations of hospice providers and proponents established as a trusted, end-of-life alternative. (shrink)

In a recent article, Bernáth and Tőzsér (2021) defend what they call the Bias Argument, a new skeptical argument from expert peer disagreement. They argue that the best contrastive causal explanation for disagreement among leading experts in philosophy is that they adopt their positions in a biased way. But if the leading experts are biased, non-experts either are also biased or only avoid bias through epistemic inferiority. Recognizing this is expected to prompt one to decrease one‘s confidence in one‘s (...) philosophical beliefs. This paper argues that some beliefs are immune to a key premise of the Bias Argument. To show this, the paper develops the concepts of self-favoring theories, decisive support, and standing-incommensurable disagreements. A plausible example of a self-favoring theory, dubbed Mere Reformed Protestantism, is sketched. Many disagreements over self-favoring theories and over beliefs decisively supported by self-favoring theories are shown to be standing-incommensurable. It is then argued that when non-experts are in standing-incommensurable disagreements with experts, the standards of assessing expertise are themselves controverted. This result undercuts the move in the Bias Argument from expert bias to non-expert bias. Finally, a couple reservations about the role of self-favoring theories in philosophy are addressed. (shrink)

Though Young’s “Throwing Like a Girl” has been praised for pre-senting the “I can” body as more of an aspiration than a reality for many women in the world today, she has also been criticized for claiming that women’s typical modes of bodily comportment are contradictory, and thus that their experience of the “I can” body is compromised. From her critics’ perspective, Young’s account seems to imply that women’s experiences of embodied agency are inferior or deficient in comparison to men (...) who have been encouraged to maximize their physical capabilities. The question this essay addresses is whether the “I can” body is itself a suspect notion that should be rejected altogether, or whether the problem lies in its sexist, racist, and ableist history that has failed to acknowledge the di-verse experiences of embodied agency it was originally intended to describe. Quoique « Lancer comme une fille » ait reçu des éloges pour sa pré-sentation du « je peux » corporel non comme la description d’un état de fait, mais plutôt comme une aspiration pour beaucoup de femmes dans le monde contemporain, certains critiquent la présentation des modalités typiques du comportement corporel féminin comme « contradictoire », car il en découle que l’expérience par les femmes du « je peux » corporel est compromise. Selon ces critiques, l’approche de Young semble impliquer que l’expérience féminine de l’agentivité corporelle est inférieure ou déficiente par rapport à celle des hommes, ces derniers ayant été encouragés à cultiver au maximum leurs capacités physiques. Dans cet article, nous poserons la question suivante : le « je peux » corporel est-il un concept sus-pect que l’on doit rejeter, ou doit-on plutôt dire que le problème gît dans l’histoire sexiste, raciste et capacitiste de ce concept, une histoire qui n’est pas parvenue à rendre compte des diverses expériences de l’agentivité corporelle que le « je peux » visait décrire initialement. (shrink)

Polyamory is a form of consensual non-monogamy. To render it palatable to critics, activists and theorists often accentuate its similarity to monogamy. I argue that this strategy conceals the distinctive character of polyamorous intimacy. A more discriminating account of polyamory helps me answer objections to the lifestyle whilst noting some of its unique pitfalls. I define polyamory, and explain why people pursue this lifestyle. Many think polyamory is an inferior form of intimacy; I describe four of their main objections. I (...) explain how commitment to ‘the polyamorous possibility’ prompts one to viscerally experience personal, practical, and social constraints. Unlike monogamous dynamics, these confrontations are mediated by third parties who destabilise the familiar dynamics of coupled life. Polyamory can be emotionally challenging but, as I outline in the article, it is sustained by interpersonal emotional work that helps people feel and understand their emotions, communicate without confrontation, and contain the difficult emotions of others. This work is qualitatively and quantitatively intensified in polyamory. Finally, I rebut objections to polyamory whilst also acknowledging the ways polyamory has its own pitfalls. (shrink)

Game theory studies the choices of two or more agents strategically interacting under various conditions. This paper examines two applications of omniscience in game theory. The first has to do with the paradox of altruism. The paradox of altruism results when players, by seeking to maximize the outcomes of other players, bring about inferior outcomes for all the players. Not surprisingly, an omniscient player could not find herself ensnarled in an altruistic paradox. The second application is what Steven Brams has (...) called the “paradox of omniscience”. The paradox of omniscience is the surprising proposition that omniscience disadvantages a player in certain games if her opponent knows that she is omniscient. Contrary to Brams, I argue that there is no resolution of the paradox of omniscience with regard to normal games. Indeed, I show that omniscience is not the only divine property that is a strategic liability in normal games. Omniscience then has a mixed standing in game theory—in some cases a strategic asset; in others, a strategic liability. (shrink)

Many philosophers believe that the criteria of identity over time for ordinary objects entail that such objects are permanent members of certain sortal kinds. The sortal kinds in question have come to be known as substance sortal kinds. But in this article, I defend a criterion of identity that is suited to phasalism, the view that alleged substance sortals are in fact phase sortals. The criterion I defend is a sortal‐weighted version of a change‐minimizing criterion first discussed by Eli Hirsch. (...) I present this criterion and then argue that it withstands attempts to show that it is inferior to non‐phasalist rivals. (shrink)

A simple inductive argument shows natural languages to have infinitly many sentences, but workers in the field have uncovered clear evidence of a diverse group of ‘exceptional’ languages from Proto-Uralic to Dyirbal and most recently, Pirahã, that appear to lack recursive devices entirely. We argue that in an information-theoretic setting non-recursive natural languages appear neither exceptional nor functionally inferior to the recursive majority.

A recalcitrant emotion is an emotion that we experience despite a judgment that seems to conflict with it. Having been bitten by a dog in her childhood, Jane cannot shake her fear of dogs, including Fido, the cute little puppy that she knows to be in no way dangerous. There is something puzzling about recalcitrant emotions, which appear to defy the putatively robust connection between emotions and judgments. If Jane really believes that Fido cannot harm her, what is she afraid (...) of? This article seeks to show how recalcitrant emotion is possible. I argue that reductive theories that identify emotions with judgments, desires, or some combination thereof, cannot explain the possibility of emotional irrationality without contradiction. I then show that the appeal to sui generis attitudes also fails to solve the puzzle of recalcitrant emotions, and diagnose this failure as stemming from a misleading analogy between emotions and perceptions, and in particular, between recalcitrant emotions and perceptual illusions. The solution can be found in a different analogy: between emotions and actions; more specifically, between recalcitrant emotions and weakness of the will, akrasia. Like akratic actions, recalcitrant emotions entail responding to reasons, but to inferior reasons. Irrational but non-contradictory emotions are possible just as weakness of will is possible. (shrink)

In the late eighteenth century, an array of European political thinkers attacked the very foundations of imperialism, arguing passionately that empire-building was not only unworkable, costly, and dangerous, but manifestly unjust. Enlightenment against Empire is the first book devoted to the anti-imperialist political philosophies of an age often regarded as affirming imperial ambitions. Sankar Muthu argues that thinkers such as Denis Diderot, Immanuel Kant, and Johann Gottfried Herder developed an understanding of humans as inherently cultural agents and therefore necessarily diverse. (...) These thinkers rejected the conception of a culture-free "natural man." They held that moral judgments of superiority or inferiority could be made neither about entire peoples nor about many distinctive cultural institutions and practices.Muthu shows how such arguments enabled the era's anti-imperialists to defend the freedom of non-European peoples to order their own societies. In contrast to those who praise "the Enlightenment" as the triumph of a universal morality and critics who view it as an imperializing ideology that denigrated cultural pluralism, Muthu argues instead that eighteenth-century political thought included multiple Enlightenments. He reveals a distinctive and underappreciated strand of Enlightenment thinking that interweaves commitments to universal moral principles and incommensurable ways of life, and that links the concept of a shared human nature with the idea that humans are fundamentally diverse. Such an intellectual temperament, Muthu contends, can broaden our own perspectives about international justice and the relationship between human unity and diversity. (shrink)