Bringing together work composed from 1890 to 1924, the nineteen pieces collected in the posthumously published Last Essays serve as a primer to Conrad's wide interests and to the varieties of his style. This edition, supported by an extensive textual apparatus, brings together various prose pieces, including reminiscences, reviews, essays on the sea and politics, as well as several miscellaneous items, including his 'Congo Diary' and the other notebook he kept in Africa in 1890. The introduction situates these writings in (...) Conrad's career, offers new perspectives on Conrad in the marketplace and as a writer of occasional prose and traces the contemporary reception of the volume. The notes explain literary and historical references, identify real-life places and indicate Conrad's main sources. Early drafts and notes for several essays are published here for the first time, making this authoritative critical edition a major contribution to Conrad studies. (shrink)

We examine the question of which aspects of language are uniquely human and uniquely linguistic in light of recent suggestions by Hauser, Chomsky, and Fitch that the only such aspect is syntactic recursion, the rest of language being either specific to humans but not to language (e.g. words and concepts) or not specific to humans (e.g. speech perception). We find the hypothesis problematic. It ignores the many aspects of grammar that are not recursive, such as phonology, morphology, case, agreement, and (...) many properties of words. It is inconsistent with the anatomy and neural control of the human vocal tract. And it is weakened by experiments suggesting that speech perception cannot be reduced to primate audition, that word learning cannot be reduced to fact learning, and that at least one gene involved in speech and language was evolutionarily selected in the human lineage but is not specific to recursion. The recursion-only claim, we suggest, is motivated by Chomsky’s recent approach to syntax, the Minimalist Program, which de-emphasizes the same aspects of language. The approach, however, is sufficiently problematic that it cannot be used to support claims about evolution. We contest related arguments that language is not an adaptation, namely that it is “perfect,” non-redundant, unusable in any partial form, and badly designed for.. (shrink)

Pursuing the Forms: Equality and Excellence in Plato's Republic and Symposium -- Equality and Excellence in the Education of Cyrus -- Splendid Equality in the Nicomachean Ethics: Munificence -- How Excellence Bows to Equality in Aristotle's Politics -- First Among Equals: Philosophers, Statesmen, and Citizens in Spinoza's Democracy -- Excellence and Equality in Fénelon's Telemachus -- The Seductive Danger of Equality and Excellence: The Moderating Wisdom of Montesquieu's Science of Ovidian Metamorphosis -- Equality and Excellence in Rousseau's Emile, Book III (...) -- Hegel's Evaluation of Liberalism: Equality of Rights without Human Excellence -- Democracy, Nobility, and Freedom: The Political and Moral Aesthetics of Tocqueville -- Does Kierkegaard Have a Concept of Excellence? -- Nietzsche: The Indignity of Equality -- The Good and the Excellent: John Rawls's Egalitarian Liberalism. (shrink)

While endorsing Evans & Levinson's (E&L's) call for rigorous documentation of variation, we defend the idea of Universal Grammar as a toolkit of language acquisition mechanisms. The authors exaggerate diversity by ignoring the space of conceivable but nonexistent languages, trivializing major design universals, conflating quantitative with qualitative variation, and assuming that the utility of a linguistic feature suffices to explain how children acquire it.

Nine leading scholars explore some of the most important minds behind the new political economy of the American Founding and engage with the foundational work of Ralph Lerner. In his 1979 article, "Commerce and Character: The Anglo-American as New-Model Man," Ralph Lerner argued that the American Founders and the political theorists of the commercial republic were charting a new basis for society that broke with the "old order," which was "preoccupied with intangible goods to an extent we now hardly ever (...) see. The king had his glory, the nobles their honor, the Christians their salvation, the citizens of pagan antiquity their ambition to outdo others in serving the public good." By contrast, the commercial republic was a regime based on the belief that human behavior is best understood as driven by physical wants and tangible goods. A government grounded on this understanding of humanity would be a more stable system and thus more conducive to human flourishing. Lerner's article thus interpreted the Founding as a revolution in political philosophy that must be understood against the backdrop of the Enlightenment. Commerce and Character brings together nine distinguished scholars who explore individual Enlightenment or American thinkers who made important philosophical or political contributions to the new political economy of modern republicanism. Each contributor uses Lerner's essay as the jumping-off point, and at the end, Lerner provides a detailed response to each of his interlocutors where he carefully examines each chapter and reconsiders his arguments a half century later. (shrink)

In many systems, the tensors used to describe physical properties must acquire their structure from one vector. Knowledge of that fact alone leads to an interesting line of analysis for such systems. The analysis begins with a discussion of the types of dyadics that can be constructed from one vector. Attention is focused on certain exemplary dyadic operators, which, because of their geometrical properties, would appear particularly basic; the algebra of these dyadics is developed in detail. The algebra is then (...) used in a derivation of the expansion of general functions of these dyadics. Several applications of the general expansion are presented: the inverse of a general dyadic operator (when it exists), a general rotation operator that includes strains and reflections, the determinant of a general dyadic operator, and operators, including some new ones, used in constructing Lorentz boosts. Finally, a coordinate-free representation of the Levi-Civita tensor is provided. (shrink)

The coordinate-free methods of the preceding paper are illustrated in three problems. First, the electrodynamics of a homogeneous, isotropic, and gyrotropic medium is investigated; it is shown that such a medium can exhibit optical activity, and the propagation of a plane electromagnetic wave in such a medium is discussed. Then, the electrodynamics of a homogeneous system made anisotropic by a uniform external magnetic field is considered; a description of Faraday rotation is provided, the ionosphere being used in an example. Finally, (...) the reflection and refraction of a plane electromagnetic wave at the interface of two media are described by coordinate-free operators. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further (...) questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

The strong word and stance issue only from a strict will, a will that dares the error of reading all of reality as a text, and all prior texts as openings for its own totalizing and unique interpretations. Strong poets present themselves as looking for truth in the world, searching in reality and in tradition, but such a stance, as Nietzsche said, remains under the mastery of desire, of instinctual drives. So, in effect, the strong poet wants pleasure and not (...) truth; he wants what Nietzsche named as "the belief in truth and the pleasurable effects of this belief." No strong poet can admit that Nietzsche was accurate in this insight, and no critic need fear that any strong poet will accept and so be hurt by demystification. The concern of this book, as of my earlier studies in poetic misprision, is only with strong poets, which in this series of chapters is exemplified by the major sequence of High Romantic British and American poets: Blake, Wordsworth, Shelley, Keats, Tennyson, Browning, Yeats, Emerson, Whitman, and Stevens, but also throughout by two of the strongest poets in the European Romantic tradition: Nietzsche and Freud. By "poet" I therefore do not mean only verse-writer, as the instance of Emerson also should make clear. Harold Bloom is DeVane Professor of the Humanities at Yale University. This article is the first chapter of his new book, Poetry and Repression, to be published by the Yale University Press. The book completes a tetralogy, of which the earlier volumes are The Anxiety of Influence, A Map of Misreading, and Kabbalah and Criticism. See also: "Formalism, Savagery, and Care; or, The Function of Criticism Once Again" by Jerome J. McGann in Vol. 2, No. 3; "The Poet as Elaborator: Analytical Psychology as a Critical Paradigm" by David D. Cooper in Vol. 6, No. 1. (shrink)

Harold Bloom's The Anxiety of Influence (1973) is now half a century old. Despite being one of the most important contributions to poetic theory in the twentieth century, its formal innovations remain understudied. This essay examines the legacy of The Anxiety of Influence through its relationship to the burgeoning genre of "creative criticism." It looks at the various formal genres that Anxiety draws on, including the fragment, parable, and manifesto, before providing a theory of creative criticism through a reading (...) of Susan Howe's My Emily Dickinson. (shrink)

A review of Steven Fuller's excellent book. Steve Fuller, professor of sociology at the University of Warwick, argues that, unfortunately for science, Kuhn won this debate. In the wake of Kuhn, science has come to be justified more by its paradigmatic pedigree than by its progressive aspirations. In other words, science is judged by whatever has come to be the dominant scientific community.

In this note, I clarify the point of my paper “The Nature of Semantics: On Jackendoff’s Arguments” (NS) in light of Ray Jackendoff’s comments in his “Linguistics in Cognitive Science: The State of the Art.” Along the way, I amplify my remarks on unification.

In lieu of an abstract, here is a brief excerpt of the content:Reviews 85 RUSSELL’S CONTRIBUTION TO PHILOSOPHY OF LANGUAGE James Connelly Philosophy, Trent U. Peterborough, on k9l 1z6, Canada [email protected] Graham Stevens. The Theory of Descriptions: Russell and the Philosophy of Language. Basingstoke, uk: Palgrave Macmillan, 2011. Pp. xiii, 197. isbn: 978-0230 -20116-3. £50; us$85. ver the past decade, Graham Stevens has built his reputation as a lucid, durable, and oftentimes ground-breaking historian of analytic philosophy. His latest (...) book, entitled TheTheory of Descriptions: Russell and the Philosophy of Language, will only add to that burgeoning scholarly legacy. If it has not been established already, this book will doubtless cement Stevens’ place amongst the leading Russell scholars in the world today. It may very well herald Stevens ’ arrival on the scene as a noteworthy contributor to contemporary philosophy of language as well. The central goal of the book is “to bring the historical and purely philosophical analyses of [Russell’s] work into closer alignment” (p. 3). Stevens hopes to overcome a “striking disparity” (p. 2) in the ways that Russell’s contributions to the philosophy of language have been conceived by expositors of his philosophy, on the one hand, versus philosophers of language, on the other. In particular, though contemporary philosophers of language would tend to view Russell’s enormous contribution to that subject as being “undeniable” (p. 1), and to be “bewildered” (p. 94) by any suggestion to the contrary, expositors of Russell’s philosophy have nevertheless been at pains to emphasize that Russell “was not engaged in the philosophical study of language” (p. 2). As Stevens notes, this situation is especially puzzling since “these two groups [of scholars] overlap to a considerable extent” (p. 2). Stevens’ strategy for overcoming this disparity is two-pronged. First he aims to tackle, head on, the fallacious arguments of Monk,1 Dummett,2 and others, to the effect that Russell was not engaged in the philosophy of language. According to Stevens, such arguments have principally appealed to either (1) ______ 1 Ray Monk, “What Is Analytical Philosophy?”. 2 Michael Dummett, Frege: Philosophy of Language. l= 86 Reviews Russell’s dismissal of ordinary language philosophy, (2) his early, non-linguistic, conception of the nature of propositions, or (3) his view that natural language was inherently defective for philosophical purposes, and so called for replacement by a “logically perfect language”. In regards to (1), Stevens argues in a word that “[o]rdinary language philosophy has had its day” (p. 176). Over the past several decades, in other words, leading philosophers of language have come to agree with Russell in viewing ordinary language philosophy as “an outdated, and rather eccentric, relic of mid-twentieth century British philosophy” (ibid.).The classic Russell– Strawson debate over the question whether ordinary language lacks an exact logic3 has been settled decisively in Russell’s favour, as philosophers of language have transformed “the attempt to systematically specify the semantics of large regions of natural language” (ibid.) into a “central project” (ibid.). In regards to (2), moreover, Stevens notes that by this line of reasoning, absurdly, David Kaplan would not qualify as a philosopher of language since he “explicitly invokes the Russellian non-linguistic conception of a proposition as the conception appropriate for providing the content of properly context-situated indexical sentences” (p. 170). And, of course, Kaplan is not at all unique amongst contemporary philosophers of language in appealing to a Russellian conception of propositional content, as the examples of Nathan Salmon,4 Scott Soames,5 and many others show. In regards to (3), finally, Stevens argues that Russell’s dim view of natural language was grounded in his conception of logical form as non-linguistic, and that that conception, in turn, derives simply from the poverty of syntactic theory available to Russell, prior to the Chomskyian revolution in linguistics during the second half of the twentieth century. In light of the conceptual and analytic resources made available by this revolution, however, there exists “no insurmountable obstacle to assimilating Russell ’s notion of logical form to something akin to the modern notion of lf” (p. 172), where lf is conceived as one of four levels of syntactic representation within Chomsky’s Government and Binding Theory... (shrink)

Examining one of the fundamental issues in cognitive psychology: How does our conscious experience come to be the way it is?

Is argumentation essentially adversarial? The concept of a devil's advocate—a cooperative arguer who assumes the role of an opponent for the sake of the argument—serves as a lens to bring into clearer focus the ways that adversarial arguers can be virtuous and adversariality itself can contribute to argumentation's goals. It also shows the different ways arguments can be adversarial and the different ways that argumentation can be said to be "essentially" adversarial.

There is significant potential for machine learning (ML) models and systems to enhance prognostic, diagnostic, and therapeutic decision-making in the healthcare context. When used in clinical setti...

Some authors argue that the rule-of-law ideal gives judges a prima facie duty to provide a determinate formulation of the precedent’s general norm in all their precedent-opinions. I question that claim. I agree that judges have a duty to decide their cases based on reasons and that they should formulate these reasons in their opinions. I also agree that formulations of general norms should be the goal of common-law development and that judges have a duty to contribute to the realization (...) of this goal. However, I argue that judges may sometimes do so better if they do not provide a determinate formulation of a general norm in their opinion. Often, judges may not feel confident that they are able to formulate a good general norm for their precedent decision, even if they believe that their decision is both correct and justifiable through argument. In this case, various reasons speak against providing a determinate formulation of a general norm, including rule-of-law reasons. (shrink)

Short food supply chains have become the focus of considerable research in the last two decades. However, studies so far remain highly localized, and claims about the economic and social advantages of such channels for farmers are not backed by large-scale empirical evidence. Using a web survey of 613 direct-market farmers across Canada, this article explores the potential economic and social benefits that farmers derive from participating in short food supply chains. We used multivariate analysis to test whether a farmer’s (...) degree of involvement in direct food channels is positively correlated with levels of work enjoyment, social satisfaction, and economic satisfaction. The results indicate that, overall, direct-market farmers report high levels of occupational satisfaction, although work-related challenges persist, such as stress, excessive workloads, and competition. Farmer participation in short food chains was also a positive predictor of work enjoyment and economic satisfaction, but not of social satisfaction, as measured by the share of total farm sales attributable to direct selling. Net annual farm revenue, the share of direct food sales involving a middleman, age, and gender also correlated with one or more dimensions of occupational satisfaction. (shrink)

Awareness of the risks posed by excess nitrogen is low beyond the scientific community. As public understanding of scientific issues is partly influenced by news reporting, this article is the first to study how the British press has discussed nitrogen pollution. A corpus-assisted frame analysis of newspaper articles highlighted five frames: Activism, where environmental charities and organizations are portrayed as having an active role in fighting pollution; Government Responsibility, where privatization is presented as central and positioned as one of the (...) main causes of pollution; Industry Responsibility, in which industries’ actions are depicted as causing pollution to increase; Pollutions as Politics, in which pollution is not discussed as a problem to be solved but rather as a means to increase votes; and Risk, where readers are warned about the possible effects of pollution on human health, flora and fauna. The analysis also points to the absence of named scientists and sources with the coverage being dominated by politicians. (shrink)

ABSTRACT This paper contributes to the debate about the strawman fallacy. It is the received view that strawmen are employed to fool not the arguer whose argument they distort, but instead a third party, an audience. I argue that strawmen that fool their victims exist and are an important variation of the strawman fallacy because of their special perniciousness. I show that those who are subject to hermeneutical lacunae or who have since forgotten parts of justifications they have provided earlier (...) are especially vulnerable to falling for strawmen aimed at their own positions or arguments. Adversarial argumentation provides especially fertile ground for strawmen that fool their own victims, but cooperative argumentation is no fail-safe protection from them either. (shrink)

The rapid expansion of Big Tech companies into various societal domains (e.g., health, education, and agriculture) over the past decade has led to increasing concerns among governments, regulators, scholars, and civil society. While existing theoretical frameworks—often revolving around privacy and data protection, or market and platform power—have shed light on important aspects of Big Tech expansionism, there are other risks that these frameworks cannot fully capture. In response, this editorial proposes an alternative theoretical framework based on the notion of sphere (...) transgressions, which draws on political philosopher Michael Walzer's theory of justice. The editorial not only introduces the sphere transgressions framework, but it also highlights its potential to generate novel research questions. Furthermore, this editorial introduces eight articles and one commentary from a group of interdisciplinary scholars that critically examine Big Tech expansionism by reflecting on this expansionism from the perspective of different societal spheres or by engaging with the sphere transgressions framework itself. (shrink)

ABSTRACT I argue that this examination and appreciation for the shift to abductive reasoning should be extended to the intersection of neuroscience and novel brain-computer interfaces too. This paper highlights the implications of applying abductive reasoning to personalized implantable neurotechnologies. Then, it explores whether abductive reasoning is sufficient to justify insurance coverage for devices absent widespread clinical trials, which are better applied to one-size-fits-all treatments. INTRODUCTION In contrast to the classic model of randomized-control trials, often with a large number of (...) subjects enrolled, precision medicine attempts to optimize therapeutic outcomes by focusing on the individual.[i] A recent publication highlights the strengths and weakness of both traditional evidence-based medicine and precision medicine.[ii] Plus, it outlines a tension in the shift from evidence-based medicine’s inductive reasoning style (the collection of data to postulate general theories) to precision medicine’s abductive reasoning style (the generation of an idea from the limited data available).[iii] The paper’s main example is the application of precision medicine for the treatment of cancer.[iv] I argue that this examination and appreciation for the shift to abductive reasoning should be extended to the intersection of neuroscience and novel brain-computer interfaces too. As the name suggests, brain-computer interfaces are a significant advancement in neurotechnology that directly connects someone’s brain to external or implanted devices.[v] Among the various kinds of brain-computer interfaces, adaptive deep brain stimulation devices require numerous personalized adjustments to their settings during the implantation and computation stages in order to provide adequate relief to patients with treatment-resistant disorders. What makes these devices unique is how adaptive deep brain stimulation integrates a sensory component to initiate the stimulation. While not commonly at the level of sophistication as self-supervising or generative large language models,[vi] they currently allow for a semi-autonomous form of neuromodulation. This paper highlights the implications of applying abductive reasoning to personalized implantable neurotechnologies. Then, it explores whether abductive reasoning is sufficient to justify insurance coverage for devices absent widespread clinical trials, which are better applied to one-size-fits-all treatments.[vii] ANALYSIS I. The State of Precision Medicine in Oncology and the Epistemological Shift While a thorough overview of precision medicine for the treatment of cancer is beyond the scope of this article, its practice can be roughly summarized as identifying clinically significant characteristics a patient possesses (e.g., genetic traits) to land on a specialized treatment option that, theoretically, should benefit the patient the most.[viii] However, in such a practice of stratification patients fall into smaller and smaller populations and the quality of evidence that can be applied to anyone outside these decreases in turn.[ix] As inductive logic helps to articulate, the greater the number of patients that respond to a particular therapy the higher the probability of its efficacy. By straying from this logical framework, precision medicine opens the treatment of cancer to more uncertainty about the validity of these approaches to the resulting disease subcategories.[x] Thus, while contemporary medical practices explicitly describe some treatments as “personalized”, they ought not be viewed as inherently better founded than other therapies.[xi] A relevant contemporary case of precision medicine out of Norway focuses on the care of a patient with cancer between the ventricles of the heart and esophagus, which had failed to respond to the standard regimen of therapies over four years.[xii] In a last-ditch effort, the patient elected to pay out-of-pocket for an experimental immunotherapy (nivolumab) at a private hospital. He experienced marked improvements and a reduction in the size of the tumor. Understandably, the patient tried to pursue further rounds of nivolumab at a public hospital. However, the hospital initially declined to pay for it given the “lack of evidence from randomised clinical trials for this drug relating to this [patient’s] condition.”[xiii] In rebuttal to this claim, the patient countered that he was actually similar to a subpopulation of patients who responded in “open‐label, single arm, phase 2 studies on another immune therapy drug” (pembrolizumab).[xiv] Given this interpretation of the prior studies and the patient’s response, further rounds of nivolumab were approved. Had the patient not had improvements in the tumor’s size following a round of nivolumab, then pembrolizumab’s prior empirical evidence in isolation would have been insufficient, inductively speaking, to justify his continued use of nivolumab.[xv] The case demonstrates a shift in reasoning from the traditional induction to abduction. The phenomenon of ‘cancer improvement’ is considered causally linked to nivolumab and its underlying physiological mechanisms.[xvi] However, “the weakness of abductions is that there may always be some other better, unknown explanation for an effect. The patient may for example belong to a special subgroup that spontaneously improves, or the change may be a placebo effect. This does not mean, however, that abductive inferences cannot be strong or reasonable, in the sense that they can make a conclusion probable.”[xvii] To demonstrate the limitations of relying on the abductive standard in isolation, commentators have pointed out that side effects in precision medicine are hard to rule out as being related to the initial intervention itself unless trends from a group of patients are taken into consideration.[xviii] As artificial intelligence (AI) assists the development of precision medicine for oncology, this uncertainty ought to be taken into consideration. The implementation of AI has been crucial to the development of precision medicine by providing a way to combine large patient datasets or a single patient with a large number of unique variables with machine learning to recommend matches based on statistics and probability of success upon which practitioners can base medical recommendations.[xix] The AI is usually not establishing a causal relationship[xx] – it is predicting. So, as AI bleeds into medical devices, like brain-computer interfaces, the same cautions about using abductive reasoning alone should be carried over. II. Responsive Neurostimulation, AI, and Personalized Medicine Like precision medicine in cancer treatment, computer-brain interface technology similarly focuses on the individual patient through personalized settings. In order to properly expose the intersection of AI, precision medicine, abductive reasoning, and implantable neurotechnologies, the descriptions of adaptive deep brain stimulation systems need to deepen.[xxi] As a broad summary of adaptive deep brain stimulation, to provide a patient with the therapeutic stimulation, a neural signal, typically referred to as a local field potential,[xxii] must first be detected and then interpreted by the device. The main adaptive deep brain stimulation device with premarket approval, the NeuroPace Responsive Neurostimulation system, is used to treat epilepsy by detecting and storing “programmer-defined phenomena.”[xxiii] Providers can optimize the detection settings of the device to align with the patient’s unique electrographic seizures as well as personalize the reacting stimulation’s parameters.[xxiv] The provider adjusts the technology based on trial and error. One day machine learning algorithms will be able to regularly aid this process in myriad ways, such as by identifying the specific stimulation settings a patient may respond to ahead of time based on their electrophysiological signatures.[xxv] Either way, with AI or programmers, adaptive neurostimulation technologies are individualized and therefore operate in line with precision medicine rather than standard treatments based on large clinical trials. Contemporary neurostimulation devices are not usually sophisticated enough to be prominent in AI discussions where the topics of neural networks, deep learning, generative models, and self-attention dominate the conversation. However, implantable high-density electrocorticography arrays (a much more sensitive version than adaptive deep brain stimulation systems use) have been used in combination with neural networks to help patients with neurologic deficits from a prior stroke “speak” through a virtual avatar.[xxvi] In some experimental situations, algorithms are optimizing stimulation parameters with increasing levels of independence.[xxvii] An example of neurostimulation that is analogous to the use of nivolumab in Norway surrounds a patient in the United States who was experiencing both treatment-resistant OCD and temporal lobe epilepsy.[xxviii]Given the refractory nature of her epilepsy, implantation of an adaptive deep brain stimulation system was indicated. As a form of experimental therapy, her treatment-resistant OCD was also indicated for the off-label use of an adaptive deep brain stimulation set-up. Another deep brain stimulation lead, other than the one implanted for epilepsy, was placed in the patient’s right nucleus accumbens and ventral pallidum region given the correlation these nuclei had with OCD symptoms in prior research. Following this, the patient underwent “1) ambulatory, patient-initiated magnet-swipe storage of data during moments of obsessive thoughts; (2) lab-based, naturalistic provocation of OCD-related distress (naturalistic provocation task); and (3) lab-based, VR [virtual reality] provocation of OCD-related distress (VR provocation task).”[xxix] Such signals were used to identify when to deliver the therapeutic stimulation in order to counter the OCD symptoms. Thankfully, following the procedure and calibration the patient exhibited marked improvements in their OCD symptoms and recently shared her results publicly.[xxx] In both cases, there is a similar level of abductive justification for the efficacy of the delivered therapy. In the case study in which the patient was treated with adaptive deep brain stimulation, they at least had their neural activity tested in various settings to determine the optimum parameters for treatment to avoid them being based on guesswork. Additionally, the adaptive deep brain stimulation lead was already placed before the calibration trials were conducted, meaning that the patient had already taken on the bulk of the procedural risk before the efficacy could be determined. Such an efficacy test could have been replicated in the first patient’s cancer treatment, had it been biopsied and tested against the remaining immunotherapies in vitro. Yet, in the case of cancer with few options, one previous dose of a drug that appeared to work on the patient may justify further doses. However, as the Norwegian case presents, corroboration with known responses to a similar drug (from a clinical trial) could be helpful to validate the treatment strategy. (It should be noted that both patients were resigned to these last resort options regardless of the efficacy of treatment.) There are some elements of inductive logic seen with adaptive deep brain stimulation research in general. For example, abductively the focus could be that patient X’s stimulation parameters are different from patient Y’s and patient Z’s. In contrast, when grouped as subjects who obtained personalized stimulation, patients X, Y, and Z demonstrate an inductive aspect to this approach’s safety and/or efficacy. The OCD case holds plenty of abductive characteristics in line with precision medicine’s approach to treating cancer and as more individuals try the method, there will be additional data. With the gradual integration of AI into brain-computer interfaces in the name of efficacy, this reliance on abduction will continue, if not grow, over time. Moving forward, if a responsive deep brain stimulation treatment is novel and individualized (like the dose of nivolumab) and there is some other suggestion of efficacy (like clinical similarities to other patients in the literature), then it may justify insurance coverage for the investigative intervention, absent other unrelated reasons to deny it. III. Ethical Implications and Next Steps While AI’s use in oncology and neurology is not yet as prominent as its use in other fields (e.g., radiology), it appears to be on the horizon for both.[xxxi] AI can be found in both the functioning of the neurotechnologies as well as the implementation of precision medicine. The increasing use of AI may serve to further individualize both oncologic and neurological therapies. Given these implications and the handful of publications cited in this article, it is important to have a nuanced evaluation of how these treatments, which heavily rely on abductive justification, ought to be managed. The just use an abductive approach may be difficult as AI infused precision medicine is further pursued. At baseline, such technology relies on a level of advanced technology literacy among the general public and could exclude populations who lack access to basic technological infrastructure or know-how from participation.[xxxii] Even among nations with adequate infrastructure, as more patients seek out implantable neurotechnologies, which require robust healthcare resources, the market will favor patient populations that can afford this complex care.[xxxiii] If patients already have the means to pay for an initial dose/use of a precision medicine product out of pocket, should insurance providers be required to cover subsequent treatments?[xxxiv] That is, if a first dose of a cancer drug or a deep brain stimulator over its initial battery life is successful, patients may feel justified in having the costs of further treatments covered. The Norwegian patient’s experience implies there is a precedent for the idea that some public insurance companies ought to cover successful cancer therapies, however, insurance companies may not all see themselves as obligated to cover neurotechnologies that rely on personalized settings or that are based on precision/abductive research more than on clinical trials. CONCLUSION The fact that the cases outlined above rely on abductive style of reasoning implies that there may not be as strong a justification for coverage by insurance, as they are both experimental and individualized, when compared to the more traditional large clinical trials in which groups have the same or a standardized protocol (settings/doses). If a study is examining the efficacy of a treatment with a large cohort of patients or with different experimental groups/phases, insurance companies may conclude that the resulting symptom improvements are more likely to be coming from the devices themselves. A preference for inductive justification may take priority when ruling in favor of funding someone’s continued use of an implantable neurostimulator. There are further nuances to this discussion surrounding the classifications of these interventions as research versus clinical care that warrant future exploration, since such a distinction is more of a scale[xxxv] than binary and could have significant impacts on the “right-to-try” approach to experimental therapies in the United States.[xxxvi] Namely, given the inherent limitations of conducting large cohort trials for deep brain stimulation interventions on patients with neuropsychiatric disorders, surgically innovative frameworks that blend abductive and inductive methodologies, like with sham stimulation phases, have traditionally been used.[xxxvii] Similarly, for adaptive brain-computer interface systems, if there are no large clinical trials and instead only publications that demonstrate that something similar worked for someone else, then, in addition to the evidence that the first treatment/dose worked for the patient in question, the balance of reasoning would be valid and arguably justify insurance coverage. As precision approaches to neurotechnology become more common, frameworks for evaluating efficacy will be crucial both for insurance coverage and for clinical decision making. ACKNOWLEDGEMENT This article was originally written as an assignment for Dr. Francis Shen’s “Bioethics & AI” course at Harvard’s Center for Bioethics. I would like to thank Dr. Shen for his comments as well as my colleagues in the Lázaro-Muñoz Lab for their feedback. - [i] Jonathan Kimmelman and Ian Tannock, “The Paradox of Precision Medicine,” Nature Reviews. Clinical Oncology 15, no. 6 (June 2018): 341–42, https://doi.org/10.1038/s41571-018-0016-0. [ii] Henrik Vogt and Bjørn Hofmann, “How Precision Medicine Changes Medical Epistemology: A Formative Case from Norway,” Journal of Evaluation in Clinical Practice 28, no. 6 (December 2022): 1205–12, https://doi.org/10.1111/jep.13649. [iii] David Barrett and Ahtisham Younas, “Induction, Deduction and Abduction,” Evidence-Based Nursing 27, no. 1 (January 1, 2024): 6–7, https://doi.org/10.1136/ebnurs-2023-103873. [iv] Vogt and Hofmann, “How Precision Medicine Changes Medical Epistemology,” 1208. [v] Wireko Andrew Awuah et al., “Bridging Minds and Machines: The Recent Advances of Brain-Computer Interfaces in Neurological and Neurosurgical Applications,” World Neurosurgery, May 22, 2024, S1878-8750(24)00867-2, https://doi.org/10.1016/j.wneu.2024.05.104. [vi] Mark Riedl, “A Very Gentle Introduction to Large Language Models without the Hype,” Medium (blog), May 25, 2023, https://mark-riedl.medium.com/a-very-gentle-introduction-to-large-language-models-without-the-hype-5 f67941fa59e. [vii] David E. Burdette and Barbara E. Swartz, “Chapter 4 - Responsive Neurostimulation,” in Neurostimulation for Epilepsy, ed. Vikram R. Rao (Academic Press, 2023), 97–132, https://doi.org/10.1016/B978-0-323-91702-5.00002-5. [viii] Kimmelman and Tannock, 2018. [ix] Kimmelman and Tannock, 2018. [x] Simon Lohse, “Mapping Uncertainty in Precision Medicine: A Systematic Scoping Review,” Journal of Evaluation in Clinical Practice 29, no. 3 (April 2023): 554–64, https://doi.org/10.1111/jep.13789. [xi] Kimmelman and Tannock, “The Paradox of Precision Medicine.” [xii] Vogt and Hofmann, 1206. [xiii] Vogt and Hofmann, 1206. [xiv] Vogt and Hofmann, 1206. [xv] Vogt and Hofmann, 1207. [xvi] Vogt and Hofmann, 1207. [xvii] Vogt and Hofmann, 1207. [xviii] Vogt and Hofmann, 1210. [xix] Mehar Sahu et al., “Chapter Three - Artificial Intelligence and Machine Learning in Precision Medicine: A Paradigm Shift in Big Data Analysis,” in Progress in Molecular Biology and Translational Science, ed. David B. Teplow, vol. 190, 1 vols., Precision Medicine (Academic Press, 2022), 57–100, https://doi.org/10.1016/bs.pmbts.2022.03.002. [xx] Stefan Feuerriegel et al., “Causal Machine Learning for Predicting Treatment Outcomes,” Nature Medicine 30, no. 4 (April 2024): 958–68, https://doi.org/10.1038/s41591-024-02902-1. [xxi] Sunderland Baker et al., “Ethical Considerations in Closed Loop Deep Brain Stimulation,” Deep Brain Stimulation 3 (October 1, 2023): 8–15, https://doi.org/10.1016/j.jdbs.2023.11.001. [xxii] David Haslacher et al., “AI for Brain-Computer Interfaces,” 2024, 7, https://doi.org/10.1016/bs.dnb.2024.02.003. [xxiii] Burdette and Swartz, “Chapter 4 - Responsive Neurostimulation,” 103–4; “Premarket Approval (PMA),” https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P100026. [xxiv] Burdette and Swartz, “Chapter 4 - Responsive Neurostimulation,” 104. [xxv] Burdette and Swartz, 126. [xxvi] Sean L. Metzger et al., “A High-Performance Neuroprosthesis for Speech Decoding and Avatar Control,” Nature 620, no. 7976 (August 2023): 1037–46, https://doi.org/10.1038/s41586-023-06443-4. [xxvii] Hao Fang and Yuxiao Yang, “Predictive Neuromodulation of Cingulo-Frontal Neural Dynamics in Major Depressive Disorder Using a Brain-Computer Interface System: A Simulation Study,” Frontiers in Computational Neuroscience 17 (March 6, 2023), https://doi.org/10.3389/fncom.2023.1119685; Mahsa Malekmohammadi et al., “Kinematic Adaptive Deep Brain Stimulation for Resting Tremor in Parkinson’s Disease,” Movement Disorders 31, no. 3 (2016): 426–28, https://doi.org/10.1002/mds.26482. [xxviii] Young-Hoon Nho et al., “Responsive Deep Brain Stimulation Guided by Ventral Striatal Electrophysiology of Obsession Durably Ameliorates Compulsion,” Neuron 0, no. 0 (October 20, 2023), https://doi.org/10.1016/j.neuron.2023.09.034. [xxix] Nho et al. [xxx] Nho et al.; Erik Robinson, “Brain Implant at OHSU Successfully Controls Both Seizures and OCD,” OHSU News, accessed March 3, 2024, https://news.ohsu.edu/2023/10/25/brain-implant-at-ohsu-successfully-controls-both-seizures-and-ocd. [xxxi] Awuah et al., “Bridging Minds and Machines”; Haslacher et al., “AI for Brain-Computer Interfaces.” [xxxii] Awuah et al., “Bridging Minds and Machines.” [xxxiii] Sara Green, Barbara Prainsack, and Maya Sabatello, “The Roots of (in)Equity in Precision Medicine: Gaps in the Discourse,” Personalized Medicine 21, no. 1 (January 2024): 5–9, https://doi.org/10.2217/pme-2023-0097. [xxxiv] Green, Prainsack, and Sabatello, 7. [xxxv] Robyn Bluhm and Kirstin Borgerson, “An Epistemic Argument for Research-Practice Integration in Medicine,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 43, no. 4 (July 9, 2018): 469–84, https://doi.org/10.1093/jmp/jhy009. [xxxvi] Vijay Mahant, “‘Right-to-Try’ Experimental Drugs: An Overview,” Journal of Translational Medicine 18 (June 23, 2020): 253, https://doi.org/10.1186/s12967-020-02427-4. [xxxvii] Michael S. Okun et al., “Deep Brain Stimulation in the Internal Capsule and Nucleus Accumbens Region: Responses Observed during Active and Sham Programming,” Journal of Neurology, Neurosurgery & Psychiatry 78, no. 3 (March 1, 2007): 310–14, https://doi.org/10.1136/jnnp.2006.095315. (shrink)

Deep brain stimulation interventions are novel devices being investigated for the management of severe treatment-resistant psychiatric illnesses. These interventions require the invasive implantation of high-frequency neurostimulatory probes intracranially aiming to provide symptom relief in treatment-resistant disorders including obsessive-compulsive disorder and anorexia nervosa. In the scientific literature, these neurostimulatory interventions are commonly described as reversible and to be used as a last resort option for psychiatric patients. However, the ‘last resort’ status of these interventions is rarely expanded upon. Contrastingly, usages of (...) DBS devices for neurological symptoms have paved the way for established safety and efficacy standards when used earlier in a disease’s timeline. As DBS treatments for these neurological diseases progress to have earlier indications, there is a parallel ethical concern that early implementation may one day become prescribed for psychiatric illnesses. The purpose of this article is to build off contemporary understandings of reversible neurostimulatory interventions to examine and provide clarifications on the ‘last resort’ status of DBS to better address its ethically charged use in psychiatric neurosurgery. To do this, evaluative differences between DBS treatments will be discussed to demonstrate how patient autonomy would be a paramount guiding principle when one day implementing these devices at various points along a psychiatric disease’s timeline. In presenting the clarification of ‘last resort’ status, the ethical tensions of early DBS interventions will be better understood to assist in providing psychiatric patients with more quality of life years in line with their values. (shrink)

It is well known that Russell abandoned his multiple-relation theory of judgment, which provided the philosophical foundations for _PM_'s ramified type-theory, in response to criticisms by Wittgenstein. Their exact nature has remained obscure. An influential interpretation, put forth by Sommerville and Griffin, is that Wittgenstein showed that the theory must appeal to the very hierarchy it is intended to generate and thus collapses into circularity. I argue that this rests on a mistaken interpretation of type-theory and suggest an alternative one (...) to explain Russell's reaction. (shrink)

Si la tradition analytique cautionne en general la preference moderne pour une rationalite de type mathematique, et demeure mefiante vis-a-vis de la causalite formelle et de l'intuition eidetique, la tradition phenomenologique, en revanche, privilegie l'intuition intellectuelle plutot que les procedures techniques, et propose de rehabiliter nombre des categories meprisees par les penseurs modernes. La these developpee dans cette etude soutient que la phenomenologie offre une explication a la fois plus equilibree et plus coherente de l'objectivite de la connaissance. La vulnerabilite (...) de la philosophie analytique face aux versions contemporaines de l'historicisme et du relativisme est l'aboutissement logique des premisses empiristes communes a la critique fregeenne du psychologisme et a la critique wittgensteinienne de la representation. Le point de vue phenomenologique a pour clef la theorie husserlienne de l'intuition categoriale qui retrouve et renouvelle l'explication aristotelicienne de l'origine des predicats classificatoires a partir des aspects des choses. (shrink)