Keeping a conversation going is the social glue of friendships. The DSM criteria for autism list difficulties with back-and-forth conversation but does not necessitate that all autistic children will be equally impacted. We carried out three studies (two pre-registered) with verbally-fluent school children (age 5-9 years) to investigate how autistic and neurotypical children maintain a conversation topic. We also investigated within-group relationships between conversational ability and cognitive and socio-cognitive predictors. Study 1 found autistic children were more likely than neurotypical controls (...) to give off-topic and generic minimal responses (e.g. ‘mm’, ‘oh’) and were less likely to give non-verbal responses (e.g. nodding or use of facial affect to respond). Nonetheless, the autistic group provided topic-supporting responses 62% of the time, indicating some aspects of conversation topic maintenance are a relative strength. Studies 2 and 3 found large individual differences in topic-supporting conversational responding amongst both neurotypical and autistic children. These were positively related to theory of mind ability and age in both groups. Conversational skills lie on a continuum for the general population and differences by diagnostic group are a matter of degree. Given the importance for peer relationships, we suggest a whole-classroom approach to supporting conversation skills in all children. (shrink)

Qu'est-ce que l'individualité? Sommes-nous faits que de matière? Comment fonctionne notre esprit? Comment prend-on une décision? Quelle est la place de la politique dans la vie humaine? Quelle frontière entre politique et morale? Comment peut-on mobiliser l'opinion publique? Qu'est-ce que l'émotion? Quelle est sa place dans la société? De quelle nature est la conscience? Comprendre 1'homme d'aujourd'hui dans toute sa complexité, tel est le but de cet ouvrage, qui fait dialoguer le droit, la génétique, la médecine, les neurosciences, la philosophie, (...) la morale, les sciences politiques. (shrink)

The National Institute for Health and Care Excellence, the UK’s main healthcare priority-setting body, recently reaffirmed a longstanding claim that in recommending technologies to the National Health Service it cannot apply the ‘rule of rescue’. This paper explores this claim by identifying key characteristics of the rule and establishing to what extent these are also features of NICE’s approach to evaluating ultra-orphan drugs through its highly specialised technologies programme. It argues that although NICE in all likelihood does not (...) act because of the rule in prioritising these drugs, its actions in relation to HSTs are nevertheless in accordance with the rule and are not explained by the full articulation of any alternative set of rationales. That is, though NICE implies that its approach to HSTs is not motivated by the rule of rescue, it is not explicit about what else might justify this approach given NICE’s general concern with overall population need and value for money. As such, given NICE’s reliance on notions of procedural justice and its commitment to making the reasons for its priority-setting decisions public, the paper concludes that NICE’s claim to reject the rule is unhelpful and that NICE does not currently meet its own definition of a fair and transparent decision-maker. (shrink)

The UK’s National Institute for Health and Care Excellence is responsible for conducting health technology assessment on behalf of the National Health Service. In seeking to justify its recommendations to the NHS about which technologies to fund, NICE claims to adopt two complementary ethical frameworks, one procedural—accountability for reasonableness —and one substantive—an ‘ethics of opportunity costs’ that rests primarily on the notion of allocative efficiency. This study is the first to empirically examine normative changes to NICE’s approach and (...) to analyse whether these enhance or diminish the fairness of its decision-making, as judged against these frameworks. It finds that increasing formalisation of NICE’s approach and a weakening of the burden of proof laid on technologies undergoing HTA have together undermined its commitment to EOC. This implies a loss of allocative efficiency and a shift in the balance of how the interests of different NHS users are served, in favour of those who benefit directly from NICE’s recommendations. These changes also weaken NICE’s commitment to AfR by diminishing the publicity of its decision-making and by encouraging the adoption of rationales that cannot easily be shown to meet the relevance condition. This signals a need for either substantial reform of NICE’s approach, or more accurate communication of the ethical reasoning on which it is based. The study also highlights the need for further empirical work to explore the impact of these policy changes on NICE’s practice of HTA and to better understand how and why they have come about. (shrink)

Recent work in cognitive and computational neuroscience depicts human brains as devices that minimize prediction error signals: signals that encode the difference between actual and expected sensory stimulations. This raises a series of puzzles whose common theme concerns a potential misfit between this bedrock informationtheoretic vision and familiar facts about the attractions of the unexpected. We humans often seem to actively seek out surprising events, deliberately harvesting novel and exciting streams of sensory stimulation. Conversely, we often experience some wellexpected sensations (...) as unpleasant and to-be-avoided. In this paper, I explore several core and variant forms of this puzzle, using them to display multiple interacting elements that together deliver a satisfying solution. That solution requires us to go beyond the discussion of simple information-theoretic imperatives and to recognize the essential role of species-specific prestructuring, epistemic foraging, and cultural practices in shaping the restless, curious, novelty-seeking human mind. (shrink)

NICE, the draft fertility guideline and dodging the big question: should fertility treatment be provided by the NHS?In August of this year the National Institute for Clinical Excellence made its draft guideline on fertility treatment available for consultation.1 As has been widely reported in the media the draft guideline recommends that the National Health Service should provide publicly funded fertility treatment in a consistent way across England and Wales. The guideline recommends that three cycles of IVF should be available (...) when “The woman is within the optimal range for in vitro fertilisation and there is an appropriately diagnosed cause of infertility of any duration, or unexplained infertility of at least three years’ duration .Those who need fertility treatment will celebrate the guideline, as will many fertility clinics. The guideline does not, however, address key questions that will be obvious to many. Is fertility treatment the kind of thing that ought to be available on the NHS? Will the inevitable increase in demand mean that resources are directed away from other services? Is fertility treatment really the same kind of intervention as heart or hip replacement surgery?My view is that there are good reasons for doing what we can to help people access fertility services. Most of us will start a family and for those of us who do it is probably the most important of all of our life projects. Given that social status and wealth can be significant obstacles to many of the things that people would like to do with their lives, the fact that most of us are able to pursue this important life project is good from an egalitarian …. (shrink)

Michael Rawlins and Andrew Dillon start their defence of Nice in fine polemical style, unfortunately polemics is all they have to offer. They totally fail to justify the Nice proposals on dementia treatments nor do they make any more plausible than formerly their use of the notorious QALY. They say:"Harris’s recent editorial, It’s not NICE to discriminate, is long on both polemic and invective – but short on scholarship. He offers nothing to illuminate the debate about allocating (...) healthcare in circumstances of finite resources; he has no understanding of the quality adjusted life year and its use in health economic evaluation; and he makes ill-researched, unsubstantiated and offensive charges against the Institute and its advisory bodies."Accusations are easy to make, difficult to substantiate. There are a number of claims here, only one of which is true. It is true that my editorial was robust, polemical if you like, but editorials are not the same as research papers and these are important issues which deeply affect real lives. Although Rawlins and Dillon affect to take the high ground their own article contains even more vigorous and much more personal invective than my editorial, I make no complaints. But as to the rest of what they say, well, let’s just see!They claim I offer nothing to illuminate resource allocation and that I have no understanding of the QALY. Both of these claims may well be true, but nothing they say goes any way to support these claims or even towards making them plausible. I have studied and written about the QALY for almost 20 years1,2,3,4,5,6,7,8,9,10,11,12,13,14,15 and Rawlins and Dillon show no evidence of any awareness or indeed any understanding of the issues, whether …. (shrink)

Attacks similar to those in Nice and Munich could happen in any other Western city in the near future. Discussion about the political culture that grounds liberal democracies should not be delayed.

A response is given to the claim by Claxton and Culyer, who stated that the policies of the National Institute for Health and Clinical Excellence (NICE) do not evaluate patients rather than treatments. The argument is made that the use of values such as quality of life and life-years is ethically dubious when used to choose which patients ought to receive treatments in the National Health Service (NHS).

During the last several years, philosophers of religion have witnessed a long-drawn debate between Nelson Pike and John Fischer on the problems of theological fatalism, Fischer claiming in his most recent contribution to have proved that even if God's past beliefs are ‘nice soft facts’, still theological fatalism cannot be averted. Unfortunately, this debate has not – at least it seems to this observer – served substantially either to clarify the issues involved or to move toward a resolution of (...) the question, but has instead confused matters by its use of misleading terminology and diverted the discussion into unpromising side roads. (shrink)

It is shown that a set of semi-recursive logics, including many fragments of CL, can be embedded within CL in an interesting way. A logic belongs to the set iff it has a certain type of semantics, called nice semantics. The set includes many logics presented in the literature. The embedding reveals structural properties of the embedded logic. The embedding turns finite premise sets into finite premise sets. The partial decision methods for CL that are goal directed with respect (...) to CL are turned into partial decision methods that are goal directed with respect to the embedded logics. (shrink)

Includes bibliographical references and index. isbn 0-226-97861-3 (alk. paper) — isbn 0-226-97862-1 (pbk. : alk. paper) 1. Science — Philosophy. 2. Science — History. 3. Progress. I. Title. Q175 .Z25 2004 501 — dc2i 200301 1970 ...

Reproduced with the kind permission of the author. Currently available in the collection I Looked Alive . © 2010 The Brooklyn Rail/Black Square Editions | ISBN 978-1934029-07-7 Originally published 2003 Four Walls Eight Windows. continent. 1.1 (2011): 43-51. Introduction Ben Segal What interests me is instigated language, language dishabituated from its ordinary doings, language startled by itself. I don't know where that sort of interest locates me, or leaves me, but a lot of the books I see in the stores (...) seem to lack language entirely. Gary Lutz (2006). This issue of continent.'s fiction section features a reprint of “This Is Nice of You” from the first edition of Gary Lutz's collection I Looked Alive . That book was originally released by Four Walls Eight Windows in 2003 and has since been reissued in 2010 by The Brooklyn Rail/Black Square Editions. Calamari Press has also reissued Lutz's Stories in the Worst Way (originally published by Knopf, largely forgotten and dismissed, and then re-issued by the too-short-lived 3rd Bed). “This Is Nice of You” was edited for the re-issue of I Looked Alive and, as the original book is out of print, the earlier version of the story has been hard to come by for some time. This initial version is a bit longer than the new version—Lutz is a master of tightening down his texts to their most linguistically intensified cores—but it is in no way sloppy. It is a great privilege for continent. to be able to make available rare texts of (first) aesthetic and (second) scholarly value. For those readers unfamiliar with Gary Lutz, I believe this story will serve as a worthy introduction. Like Raymond Carver, Diane Williams, Christine Schutt, and so many other important twentieth century and contemporary short story writers, Lutz studied with and was edited by Gordon Lish. This connection is apparent in his attention to sound and the sentence as compositional unit, but Lutz's is a unique voice. “This Is Nice of You” bears Lutz's trademark torqued and turning syntax, his sexed-but-nameless characters, his rendering of the human body and its emissions as utterly discomfiting. Lutz's preoccupations with the mundane raise ordinariness, via startling language and observation, to grandiosity and grotesquery. In the fall of 2008, Lutz delivered a lecture entitled “The Sentence is a Lonely Place” to writing students at Columbia University. The lecture was later printed in The Believer (and is linked below). In it, he spoke about the importance of the sentence as a compositional unit, as even the distinguishing formal characteristic of prose. Specifically, Lutz explained that, from Lish, he had developed a "poetics of the sentence." Accordingly, Lutz constructs his stories at the level of the sentence, paying extreme attention to the material of words- their letters and their sounds- and the way they abut one another and interact on this material level even before they are employed in the service of traditional aims of fiction like meaning or story. Lutz often uses a(n almost constraint-related) technique called consecution. Letters or sounds from one word are carried forward into the following, producing drama and movement in the language itself at a level entirely apart from that of plot. For example, you can see how the 't's in the first sentence of “This Is Nice of You” repeat fast and hard through met and then soften into the 'th's of brothers and they. This close attention to the specific material and characteristic conditions of prose means that Gary Lutz's work always involves both a happening in language and of language. “This Is Nice of You” has a richness and depth that is hidden not in symbolism or obscure reference but on the surface of the page, in the language of every sentence. FURTHER READING Lutz, Gary. “ The Sentence Is a Lonely Place. ” The Believer January, 2009. Web. Short stories and excerpts at Web del Sol . Web. Taylor, Justin. “ An Interview with Gary Lutz .” Bookslut. July, 2006. Web. THIS IS NICE OF YOU [156] [1] I was a man dropping already well through my forties, filthy with myself, when, taking a turn at the toilets one afternoon, I met two brothers-they said they were brothers-who swore they had a sister, a schoolteacher, an officer of instruction at the county college, a whirlwind midlife turmoil of everything already put to ruin, who had gone off from a new marriage in an old car, an upkept and ennobling sedan, but had returned now to the apartment and [157] was living there alone with the little runoff there was from the marriage-some outcurved appliances, apparently, and low-posted furniture promoting its own mystery but becoming figurable in certain concentrations of TV light-and, above all, a telephone (on a pedestal, they insisted), the handpiece of which she gripped in lieu of exercise, or in fury, and I thus let out my little, reliable cry that I was in fact a student of the telephone, that it was a debasing apparatus in the main, with its meager economy of bells and tones, and the intimacy of the mouthpiece that sent your breath, tiny aftervapors of it, back toward your lips, so that regardless of the party accepting the outgoing products of your voice, you were, at most, in a further, rivaling exchange with yourself alone, and this is what must have brought the two of them around, the men who proclaimed brotherhood with the woman, because they offered me her phone number, put it at my disposal on a piece of paper one of them had already committed it to, a tearing from a menu, and the looks the men were now giving me had deletions in them, already, of my exact, beanpole shape and size. So off I went to a pay phone, the nearest canopied one I could find. The woman answered after the second ring and said she needed a lift right that very moment into the little, unlevel city close by. She was idling in the doorway of the building when I pulled up in front, and I helped her into the car, then got back in myself. I had always had a way of not having to look at people that nonetheless brought them to me in full, and so I still am certain of the susceptive and impressible comp-[158]lexion, the shimmer on the mouth, a lipstick of low brilliance, a difficulty around the eyes, the hair short and rayed out exclamation ally, skin bagged up over the elbow bone, conflict even in how her arms stayed at her sides—in sum, a spinal loveliness for me, an off-blonde quantity with shadowed, thumbworn hollows that put me out of as much as I might have ever known of women before. I set the two of us into the narrow traffic, and I remember telling her, by way of explaining the little burden which I had shifted, by now, from the shelf of the dashboard and onto my lap, that when you lived in filth, as I then did, a daily newspaper came to count for a lot, although instead of the thick-supplemented local paper I bought a trimmer one from a backlying town—not, of course, for any affluences of native data it carried, but as an article of house ware: a rough immaculacy in four lank sections, a set of fresh, hygienic surfaces to come between the table, say, and whatever I had going for me at the table, if the table was where I was going forward—because what else so cheap comes so clean and far-spreading? The woman told me that her own trouble with paper was that through a modest hole, no larger than a quarter, that had been drilled a foot or so above the floor (the standard height, she had reasoned, of legitimate electrical outlets), and by means of which her faculty office had at last gained communication with the roomier but unoccupied office next door, more and more often shot a single sheet of paper, plain copier paper she had rolled just barely into a tube, [159] so that after landing on the floor of the neighboring office the paper would preserve little if any of the curl, and there would be nothing written or typed on it, of course, and it was always a blank sheet that had been ageing on her desk for some time and had already been moved around, or advanced, from station to station on the desktop, coming into further creaselets and crimps and other infirmities—paper, in short, still too bare and unfraught to be thrown responsibly and forgettably away, and yet too seasoned and beset with irritations of the surface (a molelike blemish, say, or what looked like a tiny hair, an eyelash, sunk into it, or frecklings, or notational pressings of a fingernail), too wrought, in sum, for the paper to be appointed to any secure curricular purpose. Her office, she claimed, was in fact full of such paper, much-handled and singularized sheets of it by the loose, functionless hundred. I had to get it across to the woman that I myself no longer had an office, or any other place to divide me reliably from everybody else, and that for much of the daylight I thus appeared to be among people because I kept putting myself where people came together into even closer-fitting assortments, the viewing areas and showrooms and rotundas and such: I took in the lean-to look of the women, the tongues coming and going in what the men kept thinking of to say—whole families of low knees for me to bark my shins against during the crowded and involving way out. At home afterward, in the one room where my life was packed down, I would keep my nose stuck in the safehold of the phone [160] book, where the names of people suffered reduction to mere episodes of the alphabet and underwent humbling declensions down every column (Lail, Lain, Laine, Lainerd), and he names of streets, of the towns and townships, got docked in crude, heedless abbreviations (the vowels almost always the first to get poked out), and I would run my eyes over the telephone numbers themselves, each sequence of digits another fallible run of the infinite. I thus corrected my feelings for people and assembled myself emotionally into whatever else I had at hand—the obligating arms of the clothes hangers, usually, or the keen-angled understructure, the guardian legginess, of the ironing board. The woman said that in her case, though, it was more a matter of making slow circuits of the classroom where she had to put across the Emporial Sciences, retail theory and methods, to heat-giving and suggestive young women, some of them world cruelties already. There was the cooing of empty stomachs in the hour just before lunch, and the braying and fizzle of loaded stomachs in the low hours of the afternoon. She would recite her notes in a voice barely loyal to anyone octave, a tiny alluvium of slaver hardening at the corners of her mouth on the days she gave the glassy lozenges a slow, warming suck, and she would take lowering notice of how whatever she said succumbed at once to freak spellings and razzing paraphrase in the big, dividered notebooks; and because in midafternoon light the world looked as thorough, as filled in, as it was ever going to get, a better way to set about ruining her eyes was to review how hair had [161] established itself on the arms of the young women, because almost every arm had brought across itself a welcome and diversifying shadow. On one girl it would be a fine, driftless haze afloat above the white of the arm, never seeming to touch down on the skin itself. (An atmosphere, at most, of chestnut brown.) On another, it was as if copper wire, the narrowmost lengthlets of it, had been stuck into the fleshy batter of the thick, freckled forearms. On a third: a field of it–wheat-colored, thin-spun. On a fourth; a differencing, darkish updrift that shaded off as it approached the inner bend of the elbow, then re-emerged at the base of the upper arm as whiskery fringe. On others it was a brassy or rust-colored frizz, or it was as coarse as cornsilk, or it looked fussed on, as if the arm had been slowly stroked with charcoal. But here the woman broke off, or I may well have made an interruption of my own—I think I must have asked whether she was hungry, and she said if I was, and so on one of the lesser streets I parked the car and led her down into a belowstairs eating house I still remembered. Sandwiches were presently lowered in front of us. I watched her remove the festooned toothpick from hers and then play her fingers over the toasted planes before she took a fond first bite. "This is nice of you," she said. I must have looked at her in the way I then had of getting people to speak so they would not seem to be dwelling any longer on my features, because if on the well-set face the mouth and eyes are said to seem frozen in elegant orbit about the til) of the nose, then mine was a face that behold-[162]ers, regarders, could not help trying to round off with greater success, to goad the particulars of it back into the arcs they had wandered away from—the mouth, for instance, having been pursed and pinched suchwise that it seemed resident more on one side of the face than the other—and there were other signs of original strife to be busied with (slapdash eyebrows unbunched, it appeared, from reserves of hair elsewhere on my person; a showing of adult acne, a shrivelly little relevance of it, confined to the declivity of my nose); and so to be polite, the woman thus sank her gaze into her sandwich, and told me, in a voice lowered accordingly, that, one late-childhood summer, she had devoted herself to collecting postage stamps: it was a tongue-involving sideline to early-arriving puberty, and she liked having to lick the pale, gummed hinges instead of the sticky backs of the stamps themselves before entering everything into the hosting album; and once, during some foul weather between her and a brother (the older, thrown-over one, who had already made a habit of fooling the underside of his arm across the top of hers and calling her "pussified"), she reached for the shoe box in which she had let duplicate stamps accumulate—Spanish ones, mostly, of a fading orange—and sent the box slooshing through the lower air so that the stamps showered onto the brother's bare legs with a full, delicate harm. The woman was now touching up the surface of her iced tea with tiny activities, initiatives, of the longspun spoon. I myself was good at getting my touch onto things, although in a way that seemed to mix up the motive atoms inside [163] them, but I was satisfied that for the moment my sandwich, the unbitten-at half of it, was displayable and fit and local to my plate. The woman went on to say that, as a child, she had been bundled off, many an afternoon, to the slope-ceilinged quarters of a bachelor uncle who, when speaking of anybody not immediately present, could not bring himself to use the person's name but instead would say "an acquaintance of mine in ..." and then mention the name of some lapsed homeland, or little-loved rural orchestra, or backset building about to come down; and it was never a riddle, this device of his (not once could the girl have been expected to identify any of the subjects), and no matter how often and aloud he insisted that particularizing persons any further—bringing even a first name down upon anyone of them—would have been indecent, he claimed, much like doing things to people while they slept, the girl accepted all of the uncle's prim and extravagant evasion for what he surely must have intended it to be: a neat, protective trick to space the world out a little further in her favor, to scatter the population so that wherever her hand might at last come down, it would have to be on herself alone. And here I could sense that the woman wanted from my mouth an account of as much as I myself might have ever managed of attachment, so I told her I had once owned a house (a rising, really, of much-fingered, handwrought architecture that amounted to a little family of rooms above garages: a boxlike building with a rattly thorax of downspouts [164] and drainpipes and an unfolded but full-toned fire escape), and I had had for a time a boarder, a student, a high-colored, loose-packed representative of declining girlhood, hung with necklaces and barrettes, a girl of precise but shifting leanings and inclinations; and the afternoon she had come round to ask after the room, I stood in the entranceway, handshaken and asweat, and from what would later be my memory of the girl, I made off with, first, how every pore of her nose seemed to be sheltering within itself a tiny dark seedlet, a grain of something immediately, enormously valuable. And an almost lipless mouth (just a slit, practically), the teeth inside looking wet, watered-it was my life's chore, at that instant, to keep from sending the back of my thumb blotterlike across the line of them (I was later to learn she drank everything cold and through the narrowest of straws). And her hair: it was tea-colored hair she had, long and reachful, an unstopped downcome of it. Tall for a girl, but she managed to stay out of much of her height and put herself across as somebody backward, or behind. I must have told the girl, as best I could, that I of course had a wife, a full-faced, imperishable partner, though for the moment she was gone otherwhere in the marriage, and here the woman, my present companion, my tablemate, whose feet were now parked, in parallel, on the grade of my upper leg, interrupted to say that her husband, too, had been such a liar, and what could I bring up by way of reply other than that a lie is a truth struck through with other, further truth, or that a lie is the present multiplied by the past or that a lie [165] is an outcry of borrowed hope? The woman gave me an allowed look of disgust, her eyes lowered but still popular with me, and on I went with what had now become the girl of my story. For there had been a great, gainful carpet in the room I put the girl into, a matty expanse of coarse, grabby piles, an engrossing affair that took things into itself and held them tight, misered them, and I of course insisted that the girl not bother herself with its upkeep, that I enjoyed weekly access to a prestigious, upstanding vacuum cleaner; but no sooner was the girl out of the house each morning than I would withdraw from my room, where time was unportionable, and loose myself into the ticktock impertinence of the girl's room and get down on my knees, and, going after the carpet first with my fingers, then with a forceps, and finally by unspooling lengths of clear package-sealing tape and pressing them against the tufts in neat rectangles to catch what I might have missed, I brought vast tracts of the carpet to depletion, recovering not simply the girlinesses, the girleries, one would expect (buttons, straight pins, downed jewelry), but flirtier personalia in the form, say, of a stray confetto brought into the world when a page had been wrung with out caution from a spiral-bound notebook, or some pleated paper shells of the chocolates she required, or one of the bargain antihistamines she took to get her naps going, or a trash-bag tie ragged enough to show the kinked line of the wire within (this I would get wound around my finger), or a cough drop enwrapped like a bonbon (I would undo the [166] wings of the wrapper and have to decide whether to suck the drop all down or begin chewing it midway)—I became the following, the public, that these things, these off-faIlings, had come to have; but mostly there was hair, afloat above the uppermost pushings of the fabric of the carpet an almost continuous haziness of loose hairs of all lengths and sources, and I would have to set them out on a fresh sheet of paper and assort them according to the regions of the body they had taken their departure from, and in no time I had nest-like filiations of broken filaments and smaller involvements of the hairs that made me think of hooks, of barbs, of treble clefs, and each pile required a separate envelope, to be filed in a separate shoe box for every sector of the body until, I hoped, the boxes themselves would no longer be enough and I would have raised something semblable, brought up something equal in volume to the comprehensive girl herself. And her wastebasket! For every bit of rubbish, every dreariment she tossed into the thing, I would, in secret, deposit a reciprocal discard of my own, matching a spotted, confessory tissue of hers with a lurid throwaway after my own heart–the cardboard substructions of a fresh parcel of underwear, maybe, or tearings from pantyhose I now and again pressed against a span of my forearm to work onto it the complications of female shading I otherwise made do, choosily, without. I thus built the two of us up together in her trash! One afternoon-it was another of those lifeful, unsam-[167]pled days on which the world humors us each a little differently to keep us nicely on our last legs—I discovered in the wastebasket an inch-deep textbook of hers, a paperback with a celery-colored cover that had come partly unglued, and this dilapidation I paired off, naturally, with a name-your baby guide to whose pages, during my recurrent turnings of them, in bed or at table, I had contributed dried produces of my person, a chemical splendor entirely mine. This coupling sent a sudden spigoty thrill from me that forced an unbuckling and an unzipping and a cleanup with a handkerchief I then ventured responsively into the wastebasket as well. It was in the bathroom afterward that I found a suds-clouded puddle on the unlevel floor of the tub, a little undrained remainder, rimmed with offscum, of the girl's prolonged early-morning soak, and this was as much as I needed to get on my hands; I pressed them flat against the wet porcelain, then flapped them around in the air, and that was when I noticed it—in the amphitheater of the toilet bowl, an orange-yellow tint, or value, to the waters. When the girl arrived home that evening, I told her, of course, that I had discovered fresh, unforeseen trouble within the tank of thelet (a misalignment of the trip lever, a waywardness of the float ball, a ulation of the lift wires, kinks and defects, really, throughout the entire system) and that in fine it was an apparatus now operable only by means of advanced and strenuous equilibrial manipulations that it would be unseemly, inhospitable, of me to pre-[168]sume to burd to burden her with–so that from here on out, following any leak or evacuation she need merely lower the lid and then, before quitting the room, ring the handbell that had been placed on the would seeeverythinghing else. But the bell never rang, not even once, and from my window the next morning I watched the girl carry from the house a little plastic bag distended balloonishly, much like those bags you will remember having seen in the hands of children bearing homeward their solitary carnival-prize goldfish. In fact, I never ran across the likes of the girl again. The man who came to collect her things-not the father, apparently, but an advocate, an upholder-l found to be dull-eared and lax in his speech, and the better part of his face seemed to have already begun making tiny, rotational departures from whatever it was that the eyes, themselves impressively mobile, were just that moment having to take in. (Was there a lamp in the house that was not that night slopping its wattage over everything?) I guess I was waiting for the man to take a laggard, last-minute interest in me, and by now I was pushing everything out into the paired first person–it was, I said, “Our night shot,” and I began including the two of us in whatever it might be doing out, the expected sprinkles and such—but he was no friendship buff, and he paid no heed to my telling him that the only dress of hers I'd ever twidged myself into even part of the way had been the simplest of them all, a large-buttoned wonder of depthless blue, and then only on the principle that one naturally fits whatever one has into whatever somebody else [169] had first, or how else would the world keep getting any taller with people? The man just went about the removal of the girl's things without having to be reminded too noticeably, I guess, of how every dick hangs by a thread. My listener, though, had by this time brought about some becoming slowings of her arm—it was an arm inclinable to langorous diagonals and magicianly swoops through the air above the tabletop—but it no longer was involving itself with her plate, so I suggested we shove off, I made payment for the food, and on our way to the car, and then in the car as I took to following her pointings, the directional tilts of her head, she said that you naturally kept putting more and more of yourself into another person, at first wondering how much she can take, how much of you is accumulable and how much she can hold, and you're letting things out, disbursing yourself, and you've soon got things set up in her, and room is being made for even more of you, and if you bring this off with enough people, even two or three, what you've got is at first a comfort, because you can pass yourself along and move a little more widely through the world and leave it to these others to man your grievances, your disappointments; and what brought this to mind, the woman said, was a term of financial hardship she had contrived for herself a few years back, an unpaid leave of absence from scrupling letter grades onto quiz papers (propped-up As, and upended Bs made to look, rather, like fannies; all As and Bs, no Cs or anything lower, the difference between an A and a B having less to do with the accuracy of whatever facts might [170] have been impounded in provided for an answer than with anything recallable about the way the enrollee ad conformed her body to the confining perpendiculars of her chair and the navel-level writing surface that projected from it, or the way there might one day have been an unignorable blush on the instep of a once-moseying foot, disburdened of its shoe, that had got itself trapped in the grillwork of that cagelike involvement, intended for books, that was welded to, or otherwise schemed into, the underworks of the chair)—this had been a duration, in short, of controlled difficulty when the misexpenditure of even a twenty-dollar bill had set her thrilling, gloating, over everything she would miss out on, and one afternoon she had made an engagement for a haircut, just a trim, and very early in the session the haircutter, a woman ill-defined in the face but otherwise full of conspicuities of emotion, set down the prevailing scissors and pressed the flat of a lukewarm hand against the woman's cheek, held it there for a good minute or longer, while the other hand eventually found its way into a drawer, a shallow treasury of slender specialty scissors, one pair of which the cutter withdrew and began routing deductively through the woman's hair, the other hand staying put on the cheek, longer and longer, and the woman went home and for afterward the bathtub was now a more likely destination than any of the upright furniture, and it got easier to fill the tub with further clarifying volumes than to clear space on the difficult heights of the sofa, and she was hardly claiming to have become a cleaner [171] person in result—she in fact would often discover, voyaging about her body, a browned, fractionary detail of a larger crepe of toilet tissue that must have got itself stuck in some assy crevice and was impossible to get plucked out of the revolving suds—she was saying only that she spent more and more of her time thus immersed, ill off in water, and the haircutter had surely had a hand in it, the woman was doing some of the cutter's life now, coming into some of its wrong, because you sometimes have to look to somebody else's life to get dimensions set back even part of the way around your own, and it should not have to be any less your own life when it comes from somebody else, and you could surely fudge a society out of anyone available person and get this person doubling for the many, so that in the little run of things perpetuable from one person to the next, every loose moment stood to become a complete, active finality. But by now this was a new day, with only an hour or so off it already, and the place the woman had made me bring us to, the man's place, with a promise that the man was elsewhere—this was on a little offshoot of a street, a stewy efficiency apartment the color had long ago gone out of; and when, once in bed, still clothed, I found among the sheets and blankets a spoiling pair of the man's underpants, one of the leg openings of which was puckered into an avid, sloppy mouth, I held myself accountable for redisposing the fabric until I got a befitting featurelessness back onto it; but all the while, I am sure I had to make myself go over again in my mind that if the body is the porter of as many organs of affec-[172]tion as there might one day turn out to be, then the idea was to let the thing carry you to where you would otherwise never have any reason to arrive, because I listened for the unmelodiof the the thede ofthe woman's zipper, and then the woman made me put myself out of my own clothes, the attritional corduroys and overshirt, and got herself up at last onto the topic not of the man whose apartment it was (because his story was scarcely the story of how the boy who decides he is half a girl no sooner starts to worry about where the other half might than he gets careless with where he rests his eyes, or what he gives even the feeblest of fingerholds to, and anything, even a crumbly triangle of pie offered on a saucer instead of on a pie plate proper, comes in easy, ready, wronging answer), but of her husband, and how, no more than a couple of months into the marriage, he had begun snugging away in his undershorts a little source of chanc, reliable frictions to nudge him onward through the workday—anything company-keeping that could be counted on not to slide out of the elasticky leg holes: a half-dollar packet of chocolate tittles, maybe, that was barely noticeable in the baggy surround of the widecut trousers so popular at the time. For by now the woman had at last brought what is usually called the other mouth to within only inches of my lips, but it is not a mouth, obviously, although I let myself go along with the goodwill behind the comparison, the way I will remain loyal to anything deliberately and faithfully misunderstood, and I fussed my tongue against the vital trifles hung inside of her, as much of the curtailed finery as I could find, [173] and gave the whole insimplicity of it a slow-circling, examinational lick, until I was taking a sudden tepid downwash on the tongue. It was a familiar, latrine in dribble that must have tasted, no doubt, like trouble just starting out.p [1] Editor's Note: Original pagination from first edition print denoted with bracketed page numbers. (shrink)

NICE must not say people are not worth treatingThe National Institute for Health and Clinical Excellence has proposed that drugs for the treatment of dementia be banned to National Health Service patients on the grounds that their cost is too high and “outside the range of cost effectiveness that might be considered appropriate for the NHS”i.1This is despite NICE’s admission that these drugs are effective in the treatment of Alzheimer’s disease and despite NICE having approved even more (...) expensive treatments. The effect is that thousands of Alzheimer’s patients will be denied the only treatment available. It is difficult to think of this as anything but wickedness or folly or more likely both. At the same time, and with no apparent sense of irony, NICE has launched a public consultation document3 on its guidelines on social value judgments. As we shall see these guidelines are ethically illiterate as well as socially divisive.Assuming permanently scarce resources it is clearly crucial that such healthcare resources as are available are not wasted. This point is often made in terms of cost effectiveness and it is argued, not implausibly, that to talk of cost effectiveness implies that we are able to measure just how cost effective each treatment is. To do so of course we need a standard of measurement. NICE has adopted the ubiquitous, but justly infamous QALY, the Quality Adjusted Life Year.The QALY combines life expectancy after treatment with measures of the expected quality of that life. There are two ways in which QALYS can be used. They might be used to determine which of rival therapies to give to a particular patient or which procedure to use to treat a particular condition, in short which of two different treatments is the more …. (shrink)

This article examines the intrinsic and instrumental value of higher education, in relation to jobs that do not exist anymore and jobs that do not exist yet.

One of the key roles of the English National Institute for Health and Clinical Excellence (NICE) is technology appraisal. This essentially involves evaluating the cost effectiveness of pharmaceutical products and other technologies for use within the National Health Service. Based on a content analysis of key documents which shed light on the nature of appraisals, this paper draws attention to the multiple layers of uncertainty and complexity which are latent within the appraisal process, and the often socially constructed mechanisms (...) for tackling these. Epistemic assumptions, bounded rationality and more explicitly relational forms of managing knowledge are applied to this end. These findings are discussed in the context of the literature highlighting the inherently social process of regulation. A framework is developed which posits the various forms of uncertainty, and responses to these, as potential conduits of regulatory bias—in need of further research. That NICE’s authority is itself regulated by other actors within the regulatory regime, particularly the pharmaceutical industry, exposes it to the threat of regulatory capture. Following Lehoux, it is concluded that a more transparent and reflexive format for technological appraisals is necessary. This would enable a more robust, defensible form of decision-making and moreover enable NICE to preserve its legitimacy in the midst of pressures which threaten this. (shrink)

This paper treats the situation where a single mathematical construction satisfies a multitude of interesting mathematical properties. The examples treated are all infinitely large entities. The clustering of properties is termed ‘niceness’ by the mathematician Michiel Hazewinkel, a concept we compare to the ‘robustness’ described by the philosopher of science William Wimsatt. In the final part of the paper, we bring our findings to bear on the question of realism which concerns not whether mathematical entities exist as abstract objects, but (...) rather whether the choice of our concepts is forced upon us. (shrink)

The Socratic method is a paradoxical one. On the one hand, to practice it you must admit that you do not know the truth. On the other hand, you must act as if you were sure you knew the truth.

This essay argues that in linguistic communication, nothing corresponds to a linguistic competence as summarized by the three principles of first meaning in language: that first meaning is systematic, first meanings are shared, and first meanings are governed by learned conventions or regularities. There is no such a thing as a language, not if a language is anything like what many philosophers and linguists have supposed. We must give up the idea of a clearly defined shared structure which language users (...) acquire and then apply to cases, as well as the attempt to illuminate how we communicate by appeal to conventions. (shrink)

In a series of articles, P. Vranas recently proposed a new imperative logic. The strong and weak inferences of this logic are motivated by an appeal to a strong and weak ‘support by reasons’ that transfers from the premisses of an argument to its conclusion. They also combine nonmonotonic and monotonic reasoning patterns. I show that for any moral agent, Vranas’s proposal can be simplified enormously.

We define a family of non‐principal ultrafilters on which are, in a sense, very far from P‐points. We prove the existence of such ultrafilters under reasonable conditions. In subsequent articles, we intend to prove that such ultrafilters may exist while no P‐point exists. Though our primary motivations came from forcing and independence results, the family of ultrafilters introduced here should be interesting from combinatorial point of view too.

Two experiments investigated subliminal semantic and form priming in a word-completion task. Visual gap-words with a dominant and a subordinate solution were preceded by form-related or by semantically related words, which were briefly presented and sandwich-masked. Priming of the subordinate solution was assessed in Experiment 1, relative to a neutral condition. Both solutions were primed in Experiment 2. In the absence of conscious prime recognition, both semantic and form primes reliably increased the probability with which the primed solution was given. (...) With our variant of fragment-completion, response priming can be ruled out as explanation. Moreover, effects were already present at first presentation, excluding an interpretation in terms of partial awareness due to massive repetition. The data demonstrate automatic activation at both form and semantic levels in the absence of conscious awareness. (shrink)

Throughout history, one focus of society has been expanding and educating its less fortunate or less advanced. This has not change in the twenty-first century. It seems to be a topic in every political election: what are you going to do to help the poor? What are you going to do to help the poor in other countries? The mistreatment of others is all over the media. It fills the home and the head. The squalor of poorer countries is featured (...) on the nightly news. People typically say, send food. Send medicine. One man had a different idea. Send education in the form of inexpensive laptops. (shrink)

The bottom line is that Claxton and Culyer believe, and are on record as saying, that a therapy or procedure is not cost effective if “the health benefits that it is estimated could be gained from the technology are less than those estimated to be forgone by other patients as other procedures are necessarily curtailed or not undertaken. It is this comparison of health gained and health forgone that is at the heart of the rationale of cost-effectiveness analysis”. To estimate (...) whether the gains made …. (shrink)