Over sixty years ago, it was written of early Greek tyranny that it ‘had arisen only in towns where an industrial and commercial regime tended to prevail over rural economy, but where an iron hand was needed to mobilize the masses and to launch them in assault on the privileged classes… But tyranny nowhere endured. After it had performed the services which the popular classes expected of it, after it had powerfully contributed to material prosperity and to the development of (...) democracy, it disappeared with an astonishing rapidity… The people regarded tyranny only as an expedient. They used it as a battering ram with which to demolish the citadel of the oligarchs, and when their end had been achieved they hastily abandoned the weapon which wounded their hands.’ Thus Gustav Glotz, whose view found favour with de Ste Croix. He too concluded with appeal to Aristotle, who in a famous passage declared that unlike monarchy, which arises to help ‘the great and good’ against the People, and the monarch who is appointed as one of ‘the great and good’, ‘the tyrant comes from the People and the multitude to confront the men of note and prevent the People being unjustly treated by them. This is clear from what actually happened, for, generally speaking, the majority of the tyrants became tyrants from being demagogues so to speak, having got themselves trusted by their abusive attacks on the men of note.’ Against this view of Aristotle and all his latter-day satellites, this paper is directed. (shrink)

The left ventricular assist device was originally designed to be surgically implanted as a bridge to transplantation for patients with chronic end-stage heart failure. On the basis of the REMATCH trial, the US Food and Drug Administration and the US Centers for Medicare & Medicaid Services approved permanent implantation of the left ventricular assist device as a destination therapy in Medicare beneficiaries who are not candidates for heart transplantation. The use of the left ventricular assist device as a destination therapy (...) raises certain ethical challenges. Left ventricular assist devices can prolong the survival of average recipients compared with optimal medical management of chronic end-stage heart failure. However, the overall quality of life can be adversely affected in some recipients because of serious infections, neurologic complications, and device malfunction. Left ventricular assist devices alter end-of-life trajectories. The caregivers of recipients may experience significant burden (e.g., poor physical health, depression, anxiety, and posttraumatic stress disorder) from destination therapy with left ventricular assist devices. There are also social and financial ramifications for recipients and their families. We advocate early utilization of a palliative care approach and outline prerequisite conditions so that consenting for the use of a left ventricular assist device as a destination therapy is a well informed process. These conditions include: (1) direct participation of a multidisciplinary care team, including palliative care specialists, (2) a concise plan of care for anticipated device-related complications, (3) careful surveillance and counseling for caregiver burden, (4) advance-care planning for anticipated end-of-life trajectories and timing of device deactivation, and (5) a plan to address the long-term financial burden on patients, families, and caregivers. Short-term mechanical circulatory devices (e.g. percutaneous cardiopulmonary bypass, percutaneous ventricular assist devices, etc.) can be initiated in emergency situations as a bridge to permanent implantation of ventricular assist devices in chronic end-stage heart failure. In the absence of first-person (patient) consent, presumed consent or surrogate consent should be used cautiously for the initiation of short-term mechanical circulatory devices in emergency situations as a bridge to permanent implantation of left ventricular assist devices. Future clinical studies of destination therapy with left ventricular assist devices should include measures of recipients' quality of end-of-life care and caregivers' burden. (shrink)

This paper emphasizes the crucial role of variation, at several different levels, for a detailed historical understanding of the development of the biomedical sciences. Going beyond valuable recent studies that focus on model organisms, experimental systems and instruments, we argue that all of these categories can be accommodated within our approach, which pays special attention to organismal and cultural variation. Our empirical examples are drawn in particular from recent historical studies of nineteenth- and early twentieth-century genetics and physiology. Based on (...) the quasi-paradoxical conclusion that biological and cultural variation both constrains and enables innovation in the biomedical sciences, we argue that more attention should be paid to variation as an analytical category in the historiography of the life sciences. (shrink)

From the materialist stance that I find compelling, the metaproblem of consciousness -- explaining why the problem of consciousness seems hard -- is hardly distinct from the 'easy' problem of explaining how the underlying physical/computational system works, and how it gives rise to perceptions of its own functioning. I discuss several confusions that might plausibly arise in that process, and propose that these confusions could create apparent gaps, ontological and epistemic, in materialist accounts of consciousness, thereby making the hard problem (...) hard. Inversely, resolving these confusions may help solve the hard problem. (shrink)

In CQ n.s. 26 . 62–84 I argued that the defeat of Sparta in 371 B.C. was not due to the pursuit of unwise policies towards the other Greek states. Unwise policies there had been. Sparta being by no means superior to Athens in the formulation of foreign policy, but these did not affect the position on the eve of Leuctra when, with Thebes politically isolated, and with some of the Boeotians disaffected, Cieombrotus at the head of a numerically superior (...) Spartan and allied army was poised for the, destruction of Theban power; a triumph of policy it must have seemed. Sparta failed for military reasons. Her army was unequal to the military genius of Epaminondas. (shrink)

In 404 Sparta stood supreme, militarily and politically master of Greece, in concord with Persia. By 362, the year at which Xenophon terminated his history on the sad note of ‘even greater confusion and uncertainty’, she was eclipsed militarily, never to win a great battle again; and so far from being master even of the Peloponnese that she would spend the rest of time struggling to recover her own ancestral domain of Messenia, no longer a world power, merely a local (...) wrangler. The reasons for all this which are to seek are of absorbing interest and prime importance for the history of Greece, but it is hard to resist the temptation to connect the change with the policies of Agesilaus whose reign virtually coincided with the period in question. He was king for forty-one years and over thirty of them well before the battle of Leuctra and he had influence in the state unequalled as far as we can tell by any other king. (shrink)

It is commonly supposed that in the eighth century B.c. there was a ‘population explosion’ in Greece which moved the Greeks to send out colonies. A. J. Graham in the Cambridge Ancient History iii, 3 is typical: ‘The basic active cause of the colonizing movement was overpopulation’; ‘at the very time when the Archaic colonising movement began, in the second half of the eighth century, there was a marked increase in population in Greece’ . The presumed connection between overpopulation and (...) colonisation is not immediately obvious. The evidence for the population explosion is found in the increased number of burials in Attica and the Argolid, but Athens sent out no colony before the very end of the seventh century and Argos probably none at all, certainly none in this period. So special explanations have to be formulated for Athens' and Argos' lack of colonies while their postulated ‘population explosion’ is presumed for Greece as a whole and called in to explain the burst of colonising in the eighth century. The hypothesis is not used for seventh-century colonisation when the number of burials declines. (shrink)

The title of this presentation may suggest that the subject is homocystinuria. It is not. Rather, the subject is how our epistemology influences our concept of disease, which in turn determines our ability to help patients.

In the course of Demosthenes' lifetime, indeed within a mere decade, the whole balance of power in the Greek world was destroyed. By 338 the city states were completely overshadowed by the national state of Macedon, and it is the concern of all students of Demosthenes to analyse this dramatic change. The task is not easy. The evidence is most unsatisfactory. None of the great historians of the age has survived in other than a few precious fragments, and in the (...) absence of Ephorus, Anaximenes, Theopompus, and the Atthidographers the pale reflections of some of them in Book XVI of Diodorus are poor consolation. It is on the Athenian orators that we have to rely, the very men most concerned in the politics of Athens, in the act of glossing over and denying their own share in the disaster and of misrepresenting that of their opponents. Memories were no longer then than they are today. In 343 both Demosthenes and Aeschines in discussing the events of a mere three years past denied all responsibility for the making of the Peace of Philocrates; one, at least, was lying, confidently. The formal documents were, generally speaking, merely heard, and only in part at that, and the orators were well practised in exploiting such material. If Aeschines and Demosthenes could lie so freely within three years of the events, what they had to say at a longer interval must be much more suspect. (shrink)