A certain kind of externalism—"the view from nowhere"—lies at the heart of evidence-based medicine (EBM). As a consequence, the individual case glides out of focus. However, to judge to what extent external knowledge is applicable to an individual case, the clinician has to rely on some sort of knowledge of the case at hand. The article focuses on the tension between the externalism of EBM and the "internal evidence" one has to presuppose when making clinical judgments.

Neural complexity and brain entropy have gained greater interest in recent years. The dynamics of neural signals and their relations with information processing continue to be investigated through different measures in a variety of noteworthy studies. The BEN of spontaneous neural activity decreases during states of reduced consciousness. This evidence has been showed in primary consciousness states, such as psychedelic states, under the name of “the entropic brain hypothesis.” In this manuscript we propose an extension of this hypothesis to physiological (...) and pathological aging. We review this particular facet of the complexity of the brain, mentioning studies that have investigated BEN in primary consciousness states, and extending this view to the field of neuroaging with a focus on resting-state functional Magnetic Resonance Imaging. We first introduce historic and conceptual ideas about entropy and neural complexity, treating the mindbrain as a complex nonlinear dynamic adaptive system, in light of the free energy principle. Then, we review the studies in this field, analyzing the idea that the aim of the neurocognitive system is to maintain a dynamic state of balance between order and chaos, both in terms of dynamics of neural signals and functional connectivity. In our exploration we will review studies both on acute psychedelic states and more chronic psychotic states and traits, such as those in schizophrenia, in order to show the increase of entropy in those states. Then we extend our exploration to physiological and pathological aging, where BEN is reduced. Finally, we propose an interpretation of these results, defining a general trend of BEN in primary states and cognitive aging. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Medicine-Based Values?Åge Wifstad (bio)KeywordsEthics committees, judgment, common moralityToulmin's DiagnosisIn his classical article with the unforgettable title "How medicine saved the life of ethics" (Toulmin 1982), Stephen Toulmin claims that medicine saved ethics by giving the philosophers a positive reality check through medical challenges: (1) Ethics in medicine is a serious topic, not just something to discuss at seminars. If, for example, both A and B need treatment and there (...) are only enough resources for one, the fundamental interests of these two people compete against each other. (2) In clinical medicine, the individual case might demand a different approach than that suggested by theory. Similarly, an ethicist who is confronted by a diversity of medical cases becomes aware of the fact that solutions drawn from ethical theory can be irrelevant in practice. (3) The moral philosopher has often focused on the individual and his or her universal commitments. The fact that ethical dilemmas can have deep roots in practical challenges and must be understood within a certain context has been "forgotten." (4) In clinically relevant ethics, it is important to find solutions that all involved parties find reasonable. This revitalizes central Aristotelian schools of thought on, for example, ethical judgment and situational understanding.Today, there is a common understanding that in both the education of doctors and in the implementation of medical knowledge and technology there needs to be ethical guidelines and control. Toulmin wants us to see that the background for this agreement is multifaceted. It was not just the ethicists who saved the doctors. The doctors helped the ethicists to escape their academic isolation.Ethics CommitteesThe establishment of ethics committees is perhaps the most interesting example of this. Here it is especially clear how ethical judgment establishes a basis for decision making: Each case presented to an ethics committee is special because one cannot reference decisions made in similar cases. At the same time, we are expected to handle similar cases equally. Consideration of the concrete, individual case must be balanced with the principle of similar treatment. Second, as a committee member, one must interpret and respect ethical principles that cannot be easily defined. Every principle must be interpreted and implemented within a specific and concrete context. Third, one must consider the law, but seen isolated, the implications of relevant rules can be difficult to determine. Fourth, the status of principles and rules are open for interpretation. The most important example of this is the Declaration of Helsinki, which was established through cooperation between the worlds' doctors unions. The strength and end result of such a document can be discussed. Fifth, multiple but partly conflicting juridical and ethical considerations can be [End Page 179] relevant at the same time. An example: Decisions about confidentiality can prevent data gathering that is crucial in ensuring that a research project is scientifically acceptable. Two important ethical considerations are then put up against one another. As a sixth and final point, it can be mentioned that the ethics committee is expected to make a qualitative, scientific judgment. But what kind of quality judgment and how detailed it should be is up for discussion.Two Definitions of Ethical JudgmentThe fact that the committee must base their holistic decision on ethical judgment means that the committee, in an important sense of the word, stands freely: It can be difficult to refer to specific ethical rules or laws when making an external review of the committee's decision. Unless the committee has clearly not followed known principles and rules, then the committee is able to confront criticism by replying that the decision is based on holistic considerations, where many views have been taken into account. In this way, the usage of ethical judgment makes sure that the committee has freedom to act. The catch here is that the committee's responsibility becomes even more obvious. One cannot simply say that the decision is made based on rules and principles formulated by others, such as the state. The committee must, as a unit, be able to defend their decision.The complexity of the work of the committee can, however, make it more tempting to think about ethics in... (shrink)

Fifteen original essays open up a novel area of inquiry: the distinctively ethical dimensions of women's experiences of and in aging. Contributors distinguished in the fields of feminist ethics and the ethics of aging explore assumptions, experiences, practices, and public policies that affect women's well-being and dignity in later life. The book brings to the study of women's aging a reflective dimension missing from the empirical work that has predominated to date. Ethical studies of aging have (...) so far failed to emphasize gender. And feminist ethics has neglected older women, even when emphasizing other dimensions of 'difference.' Finally work on aging in all fields has focused on the elderly, while this volume sees aging as an extended process of negotiating personal and social change. (shrink)

The Cognitive Reserve (CR) hypothesis suggests that the brain actively attempts to cope with neural damages by using pre-existing cognitive processing approaches or by enlisting compensatory approaches. This would allow an individual with high CR to better cope with aging than an individual with lower CR. Many of the proxies used to assess CR indirectly refer to the flexibility of thought. The present paper aims at directly exploring the relationships between CR and creativity, a skill that includes flexible thinking. (...) We tested a sample of 72 adults (aged between 45 and 78) assessing both their level of CR and their creativity. To evaluate CR we used the proxies commonly used in literature, namely, three subtests from the WAIS (vocabulary, similarities, and digit span) and the years of education. We also used an ad-hoc test asking people to report how frequently they tend to perform activities that are believed to increase CR. We used verbal creativity tasks (alternative uses and generation of acronyms) to assess individual levels of creativity. We asked participants to describe their main occupation (present or past) and coded each occupation as creative or not creative. Results (controlling for age-related differences) showed that scores from the WAIS correlated positively with creativity performance, even though correlations varied across the subtests. Focusing on the frequency and type of activities that people perform, and comparing individuals who have or had a creative job to those with a routine job, a clear relationship between creativity and CR emerged. This effect was more relevant than the level of job complexity. Implications for the study of CR and aging are discussed. (shrink)

This volume brings together chapters about aging in many non-Western cultures, from Africa and Asia to South America, from American Indians to Australian and Hawaii Aboriginals. It also includes articles on other issues of aging, such as falling, dementia, and elder abuse. It was thought that in Africa or Asia, elders were revered and taken care of. This certainly used to be the case. But the Western way has moved into these places, and we now find that elders (...) are often left on their own or in institutions, as younger people have migrated to other cities and even countries. Grandparents often find themselves being parents to their grandchildren, a far cry from the kind of life they believed they would have as they aged. This book will explore all these issues and will be of use to students and researchers in this relatively new field. (shrink)

Combining information from two or possibly several blocks of data is gaining increased attention and importance in several areas of science and industry. Typical examples can be found in chemistry, spectroscopy, metabolomics, genomics, systems biology and sensory science. Many methods and procedures have been proposed and used in practice. The area goes under different names: data integration, data fusion, multiblock analyses, multiset analyses and a few more. This book is an attempt to give an up-to-date treatment of the most used (...) and important methods within an important branch of the area; namely methods based on so-called components or latent variables. These methods have already obtained an enormous attention in for instance chemometrics, bioinformatics, machine learning and sensometrics and have proved to be important both for prediction and interpretation. The book is primarily a description of methodologies, but most of the methods will be illustrated by examples from the above-mentioned areas. The book is written such that both users of the methods as well as method developers will hopefully find sections of interest. In the end of the book there is a description of a software package developed particularly for the book. This package is freely available in R and covers many of the methods discussed. To distinguish the different type of methods from each other, the book is divided into five parts. Part I is introduction and preliminary concepts. Part II is the core of the book containing the main unsupervised and supervised methods. Part III deals with more complex structures and, finally, Part IV discusses alternative unsupervised and supervised methods. The book ends with Part V discussing the available software. Our recommendation for reading the book are as follows. A minimum read of the book would involve chapters 1, 2, 3, 5 and 7. Chapters 4, 6 and 8 are more specialized and chapters 9 and 10 contain methods we think are more advanced or less obvious to use. We feel privileged to have so many friendly colleagues who were willing to spend their time on helping us to improve the book by reading separate chapters. We would like to express our thanks to: Rasmus Bro, Margriet Hendriks, Ulf Indahl, Henk Kiers, Ingrid MaÌ⁽ge, Federico Marini, AÌ⁽smund Rinnan, Rosaria Romano, Lars Erik Solberg, Marieke Timmerman, Oliver Tomic, Johan Westerhuis and Barry Wise. Of course, the correctness of the final text is fully our responsibility! (shrink)

Slowing the aging process would be one of the most dramatic and momentous ways of enhancing human beings. It is also one that mainstream science is on the brink of pursuing. The state of the science, together with its possible impact, make it an important example for how to think about research into all enhancement technologies.

Geroscience and philosophy of aging have tended to focus their analyses on the biological and chronological dimensions of aging. Namely, one ages with the passage of time and by experiencing the cellular-molecular deterioration that accompanies this process. However, our concept of aging depends decisively on the social valuations held about it. In this article, we will argue that, if we study social aging in the contemporary world, a novel phenomenon can be identified: the paradox of (...) class='Hi'>aging in the digital era. If the social understanding of aging today is linked to unproductivity and obsolescence; then there is a possibility that, given the pace of change of digital technologies, we become obsolete at an early chronological and biological age, and therefore, feel old at a younger age. First, we will present the social dimension of aging based on Rowe and Kahn's model of successful aging. We will also show that their notion of social aging hardly considers structural aspects and weakens their approach. Second, departing from social aging in its structural sense, we will develop the paradox of aging in the digital era. On the one hand, we will explain how the institutionalization of aging has occurred in modern societies and how it is anchored in the concepts of obsolescence and productivity. On the other hand, we will state the kind of obsolescence that digitalization produces and argue that it can make cohorts of biologically and chronologically young individuals obsolete, and thus they would be personally and socially perceived as old. (shrink)

By combining a flanker task and a cuing task into a single paradigm, the authors assessed the effects of orienting and alerting on conflict resolution and explored how normal aging and Alzheimer’s disease (AD) modulate these attentional functions. Orienting failed to enhance conflict resolution; alerting was most beneficial for trials without conflict, as if acting on response criterion rather than on information processing. Alerting cues were most effective in the older groups— healthy aging and AD. Conflict resolution was (...) impaired only in AD. Orienting remained unchanged across groups. These findings provide evidence of different life span developmental and clinical trajectories for each attentional network. (shrink)

"Abstract: This book is a philosophical discussion of moral, legal, and medical issues related to aging, dying, and death. It considers different views about whether and why death is bad for the person who dies, and whether these views bear on why it would be bad if there were no more persons at all. The book looks at how the general public is being asked to think about end of life issues, as well, by examining some questionnaires and conversation (...) guides that have been developed for their use. It also considers views about the process of dying and whether it might make sense to not resist death, or even to bring about the end of one's life, given certain views about meaning in life and what things it is worth living on to get and do. Some hold that it is not only serious illness but ordinary aging that may give rise to some of these questions and the book considers various ways in which aging and the distribution of goods and bads in a life could occur. Physician assisted suicide would be one way to end one's life and the book examines arguments about its moral permissibility and whether or not it should be legalized as a matter of public policy. This discussion draws on capital punishment debates concerning State action and also on methods of balancing costs and benefits. The book examines the views of such prominent philosophers, medical doctors, and legal theorists as Shelly Kagan, Susan Wolf, Atul Gawande, Ezekiel Emanuel, Cass Sunstein, and Neil Gorsuch, among others. ". (shrink)

Glycogen is synthesized and stored to maintain postprandial blood glucose homeostasis and to ensure an uninterrupted energy supply between meals. Although the regulation of glycogen turnover has been well studied, the effects of glycogen on aging and disease development have been largely unexplored. In Caenorhabditis elegans fed a high sugar diet, glycogen potentiates resistance to oxidants, but paradoxically, shortens lifespan. Depletion of glycogen by oxidants or inhibition of glycogen synthesis extends the lifespan of worms by an AMPK‐dependent mechanism. Thus, (...) glycogen is not merely an inert storage molecule, but also an active regulator of energy balance and aging. Its depletion by oxidants may be beneficial in the treatment of hyperglycemia and glycogen‐related diseases. (shrink)

Frequency effects are pervasive in studies of language, with higher frequency words being recognized faster than lower frequency words. However, the exact nature of frequency effects has recently been questioned, with some studies finding that contextual information provides a better fit to lexical decision and naming data than word frequency ( Adelman et al., 2006 ). Recent work has cemented the importance of these results by demonstrating that a measure of the semantic diversity of the contexts that a word occurs (...) in provides a powerful measure to account for variability in word recognition latency ( Johns et al., 2012, 2015 ; Jones et al., 2012 ). The goal of the current study is to extend this measure to examine bilingualism and aging, where multiple theories use frequency of occurrence of linguistic constructs as central to accounting for empirical results ( Gollan et al., 2008 ; Ramscar et al., 2014 ). A lexical decision experiment was conducted with four groups of subjects: younger and older monolinguals and bilinguals. Consistent with past results, a semantic diversity variable accounted for the greatest amount of variance in the latency data. In addition, the pattern of fits of semantic diversity across multiple corpora suggests that bilinguals and older adults are more sensitive to semantic diversity information than younger monolinguals. (shrink)

What does it mean to become older? This question cannot be answered by biology or sociology alone but must be addressed by studying how aging appears to aging persons and to others who encounter them. The paper presents the outline of such a phenomenological analysis of aging. In contrast to a problematic tendency to reduce phenomenology to the study of first-person experience, it is suggested that aging should be understood as a complex process comprising of both (...) subjective and objective (mental, social and biological) elements, and as partly transcendent to experience, that is, not completely transparent to the aging person. In this it resembles physical and other “transcendent” objects as described by early phenomenologists like Husserl. It is further shown how Marcel Proust’s elaborate description of aging in the last volume of his Remembrance of Time Past can support and contribute to such an analysis, and how it is supported or at least compatible with findings from contemporary gerontology and cognitive psychology. (shrink)

"What do grown children owe their parents?" Over two decades ago philosopher Jane English asked this question and came up with the startling answer: nothing (English 1979). English joins many contemporary philosophers in rejecting the once-traditional view that grown children owe their parents some kind of fitting repayment for past services rendered. The problem with the traditional view, as argued by many, is, first, that parents have duties to provide fairly significant services to their growing children, and persons do not (...) owe repayment for others' mere performance of duty; second, even where parents go above and beyond duty in their loving and generous rearing of their children, the benefits are bestowed, at least on young children, without their voluntary acceptance and consent, and so, again, fail to generate any obligation of subsequent repayment on their part (see Blustein 1982: 182-3). Moreover, the entire idiom of obligation and repayment, in English's 1 words, "tends to obscure, or even to undermine, the love that is the correct ground of filial obligation" (352). English's alternative, however -- that children strictly "owe" their parents nothing except what flows naturally from whatever love and affection exist between them -- also strikes many as problematic. Christina Hoff Sommers offers examples of what seem to be clearly delinquent adult children, who simply don't "feel" like sharing their lives with their aging parents, or providing any emotional or financial support to them, and so don't (Sommers 1986: 440-41). Sommers points out that we need some talk of obligations in order to fill in the cracks in human relationships where love and affection fail: "The ideal relationship cannot be 'duty-free,' if only because sentimental ties may come unraveled, often leaving one of the parties at a material disadvantage'" (450-51). Sommers proposes as her alternative to English that legitimate duties arise out of special relationships defined by social roles: being a father or mother, a son or a daughter, "is socially as well as biologically prescriptive; it not only defines what one is; it also defines who one is and what one owes" (447).. (shrink)

Name der Zeitschrift: Jahrbuch für Wissenschaft und Ethik Jahrgang: 16 Heft: 1 Seiten: 5-40.

Causal complexities involved in biological phenomena often generate ambiguous experimental results that may create epistemic niches for new approaches and interpretations. The exploration for new approaches may foment momentum of larger epistemological shifts, and thereby introduce the possibilities of adopting new technologies. This paper describes British molecular biologist Robin Holliday’s cell aging research from 1963 to the 1980s that transformed from simple hypothesis testing to working on various alternative and integrative approaches designed to deal with complex data. In the (...) 1960s, hoping to use biochemical investigations of cells to settle a debate about whether DNA mutations or protein errors caused aging, Holliday carried out a series of experiments with fruit flies, fungi, and human fibroblast cells. The results seemed to demonstrate that cytoplasmic protein errors caused cell aging. However, other scientists obtained contradictory results and raised issues about potential flaws in Holliday’s experiments. In the 1970s, working as the director of the Genetics Division of the National Institute for Medical Research in Mill Hill, United Kingdom, Holliday relied on available talents of his associates, including computational expertise, to explore alternative hypotheses and approaches. By the early 1980s, they had worked out an epigenetic explanation and had established integrative, evolutionary models of cell aging that incorporated both DNA mutations and protein errors as critical factors. By delineating Holliday’s research path from simply testing hypotheses to integrating multiple factors involved in aging, this paper offers an account of the difficulties in targeting molecular cause in cell aging around the 1970s, whose failures nevertheless opened up an epistemic niche for integration. (shrink)

As a leader of the crusade to defeat aging, working to demonstrate both its feasibility and its desirability, I am often seen as an implacable opponent of all arguments that defend aging and criticize this crusade. This is an oversimplification.