Hasty generalizations and generics in medical research: A systematic review.

It is unknown to what extent medical researchers generalize study findings beyond their samples when their sample size, sample diversity, or knowledge of conditions that support external validity do not warrant it. It is also unknown to what extent medical researchers describe their results with precise quantifications or unquantified generalizations, i.e., generics, that can obscure variations between individuals. We therefore systematically reviewed all prospective studies (n = 533) published in the top four highest ranking medical journals, Lancet, New England Journal of Medicine (NEJM), Journal of the American Medical Association (JAMA), and the British Medical Journal (BMJ), from January 2022 to May 2023. We additionally reviewed all NEJM Journal Watch clinical research summaries (n = 143) published during the same time. Of all research articles reporting prospective studies, 52.5% included generalizations beyond specific national study populations, with the numbers of articles with generics varying significantly between journals (JAMA = 12%; Lancet = 77%) (p < 0.001, V = 0.48). There was no evidence that articles containing broader generalizations or generics were correlated with larger or more nationally diverse samples. Moreover, only 10.2% of articles with generalizations beyond specific national populations reported external validity strengthening factors that could potentially support such extrapolations. There was no evidence that original research articles and NEJM Journal Watch summaries intended for practitioners differed in their use of broad generalizations, including generics. Finally, from the journal with the highest citation impact, articles containing broader conclusions were correlated with more citations. Since there was no evidence that studies with generalizations beyond specific national study populations or with generics were associated with larger, more nationally diverse samples, or with reports of population similarity that may permit extensions of conclusions, our findings suggest that the generalizations in many articles were insufficiently supported. Caution against overly broad generalizations in medical research is warranted.

Generalization Bias in Science.

Many scientists routinely generalize from study samples to larger populations. It is commonly assumed that this cognitive process of scientific induction is a voluntary inference in which researchers assess the generalizability of their data and then draw conclusions accordingly. We challenge this view and argue for a novel account. The account describes scientific induction as involving by default a generalization bias that operates automatically and frequently leads researchers to unintentionally generalize their findings without sufficient evidence. The result is unwarranted, overgeneralized conclusions. We support this account of scientific induction by integrating a range of disparate findings from across the cognitive sciences that have until now not been connected to research on the nature of scientific induction. The view that scientific induction involves by default a generalization bias calls for a revision of the current thinking about scientific induction and highlights an overlooked cause of the replication crisis in the sciences. Commonly proposed interventions to tackle scientific overgeneralizations that may feed into this crisis need to be supplemented with cognitive debiasing strategies against generalization bias to most effectively improve science.

Algorithmic Political Bias in Artificial Intelligence Systems.

Some artificial intelligence (AI) systems can display algorithmic bias, i.e. they may produce outputs that unfairly discriminate against people based on their social identity. Much research on this topic focuses on algorithmic bias that disadvantages people based on their gender or racial identity. The related ethical problems are significant and well known. Algorithmic bias against other aspects of people's social identity, for instance, their political orientation, remains largely unexplored. This paper argues that algorithmic bias against people's political orientation can arise in some of the same ways in which algorithmic gender and racial biases emerge. However, it differs importantly from them because there are (in a democratic society) strong social norms against gender and racial biases. This does not hold to the same extent for political biases. Political biases can thus more powerfully influence people, which increases the chances that these biases become embedded in algorithms and makes algorithmic political biases harder to detect and eradicate than gender and racial biases even though they all can produce similar harm. Since some algorithms can now also easily identify people's political orientations against their will, these problems are exacerbated. Algorithmic political bias thus raises substantial and distinctive risks that the AI community should be aware of and examine.

Extended Implicit Bias: When the Metaphysics and Ethics of Implicit Bias Collide.

It has recently been argued that to tackle social injustice, implicit biases and unjust social structures should be targeted equally because they sustain and ontologically overlap with each other. Here I develop this thought further by relating it to the hypothesis of extended cognition. I argue that if we accept common conditions for extended cognition then people's implicit biases are often partly realized by and so extended into unjust social structures. This supports the view that we should counteract psychological and social contributors to injustice equally. But it also has a significant downside. If unjust social structures are part of people's minds then dismantling these structures becomes more difficult than it currently is, as this will then require us to overcome widely accepted ethical and legal barriers protecting people's bodily and personal integrity. Thus, while there are good grounds to believe that people's biases and unjust social structures ontologically overlap, there are also strong ethical reasons to reject this view. Metaphysical and ethical intuitions about implicit bias hence collide in an important way.

In vitro evaluation of the anti-pathogenic activity of Okoubaka aubrevillei on the human gastrointestinal tract.

BACKGROUND: Okoubaka aubrevillei is used in traditional West African medicine and in homeopathy for treatment and prevention of several gastrointestinal problems. The aim of this in vitro study was to evaluate the effect of repeated doses of two Okoubaka products (10 % ethanolic tincture, mother tincture (MT); 3rd decimal potency, 3X) on the microbial activity of physiological human colon microbiota using a Simulator of the Human Intestinal Microbial Ecosystem (SHIME®) and to investigate any preventive effect against infections with diarrhea-causing pathogens. METHODS: Upon inoculation with fecal microbiota from a healthy donor, 4 parallel proximal colon compartments of the SHIME were treated either with Okoubaka MT, Okoubaka 3X, ethanol control or blank control for 7 days. Using the Okoubaka-adapted microbial community from SHIME, 48 h challenge tests were performed with enterotoxigenic Escherichia coli (ETEC) and Salmonella enteritidis in 4 different doses (103-108 colony forming units as typical in vivo infectious doses). Pathogen concentrations, short-chain fatty acids (SCFAs) and branched SCFA production were measured in triplicate at 0, 24 and 48 h. RESULTS: In the challenge tests, both Okoubaka products were able to restrict the colonization of ETEC and Salmonella at 3 of the 4 pathogen doses (except the highest doses), with a stronger anti-pathogenic effect for MT, which included a reduction of 2.0 log-units of ETEC (p < 0.0001) and 1.1 log-units of Salmonella (p < 0.0001). Total SCFA levels remained unaffected, but butyrate increased during the first 24 h (p < 0.0001 for ETEC), accompanied by decreased acetate production. CONCLUSION: We observed in vitro a systemic activating effect of Okoubaka on intestinal microbiome resistance, which resulted in an anti-pathogenic effect, especially against ETEC. We hypothesize that the mode of action in vivo is also based on systemic regulative effects.

Weighing the costs: the epistemic dilemma of no-platforming.

'No-platforming'-the practice of denying someone the opportunity to express their opinion at certain venues because of the perceived abhorrent or misguided nature of their view(s)-is a hot topic. Several philosophers have advanced epistemic reasons for using the policy in certain cases. Here we introduce epistemic considerations against no-platforming that are relevant for the reflection on the cases at issue. We then contend that three recent epistemic arguments in favor of no-platforming fail to factor these considerations in and, as a result, offer neither a conclusive justification nor strong epistemic support for no-platforming in any of the relevant cases. Moreover, we argue that, taken together, our epistemic considerations against no-platforming and the three arguments for the policy suggest that no-platforming poses an epistemic dilemma (i.e., a difficult choice situation involving two equally undesirable options). While advocates and opponents of no-platforming alike have so far overlooked this dilemma, it should be addressed not only to prevent that actual no-platforming decisions create more epistemic harm than good, but also to put us into a better position to justify the policy when it is indeed warranted.

Hidden figures: epistemic costs and benefits of detecting (invisible) diversity in science.

Demographic diversity might often be present in a group without group members noticing it. What are the epistemic effects if they do? Several philosophers and social scientists have recently argued that when individuals detect demographic diversity in their group, this can result in epistemic benefits even if that diversity doesn't involve cognitive differences. Here I critically discuss research advocating this proposal, introduce a distinction between two types of detection of demographic diversity, and apply this distinction to the theorizing on diversity in science. Focusing on 'invisible' diversity (i.e., differences in, e.g., LGBTQ+, religious, or political orientation), I argue that in one common kind of group in science, if group members have full insight into their group's diversity, this is likely to create epistemic costs. These costs can be avoided and epistemic benefits gained if group members only partly detect their group's diversity. There is thus an epistemic reason for context-dependent limitations on scientists' insight into the diversity of their group.

Quality of life and outcome of patients with metastatic pancreatic cancer receiving first-line chemotherapy with nab-paclitaxel and gemcitabine: Real-life results from the prospective QOLIXANE trial of the Platform for Outcome, Quality of Life and Translational Research on Pancreatic Cancer registry.

Few data exist on health-related quality of life (QoL) in patients with metastatic pancreatic cancer (mPC) receiving first-line chemotherapy (Awad L ZE, Mesbah M Boston, MA. Applying survival data methodology to analyze quality of life data, in Mesbah M, Cole BF, Ting Lee M-L (eds): Statistical Methods for Quality of Life Studies: Design, Measurements and Analysis. Kluwer Academic Publishers 2002). The QOLIXANE study is a prospective, noninterventional, multicenter substudy of the Platform for Outcome, Quality of Life and Translational Research on Pancreatic Cancer (PARAGON) registry, which evaluated QoL in patients with mPC receiving first-line gemcitabine and nab-paclitaxel chemotherapy in real-life setting. QoL was prospectively measured via EORTC QLQ-C30 questionnaires at baseline and every month thereafter. Therapy and efficacy parameters were prospectively collected. Main objectives were the rate of patients without deterioration of Global Health Status/QoL (GHS/QoL) at 3 and 6 months. Six hundred patients were enrolled in 95 German study sites. Median progression-free survival was 5.9 months (95% confidence interval [CI], 5.2-6.3). Median overall survival (OS) was 8.9 months (95% CI, 7.9-10.2), while median time to deterioration of GHS/QoL was 4.7 months (95% CI, 4.0-5.6). With a baseline GHS/QoL score of 46 (SD, 22.8), baseline QoL of the patients was severely impaired, in most cases due to loss in role functioning and fatigue. In the Kaplan-Meier analysis, 61% and 41% of patients had maintained GHS/QoL after 3 and 6 months, respectively. However, in the QoL response analysis, 35% and 19% of patients had maintained (improved or stable) GHS/QoL after 3 and 6 months, respectively, while 14% and 9% had deteriorated GHS/QoL with the remaining patients being nonevaluable. In the Cox regression analysis, GHS/QoL scores strongly predicted survival with a hazard ratio of 0.86 (P < .0001). Patients with mPC have poor QoL at baseline that deteriorates within a median of 4.7 months. Treatment with gemcitabine and nab-paclitaxel is associated with maintained QoL in relevant proportions of patients. However, overall, results remain poor, reflecting the aggressive nature of the disease.

Source attribution of community-acquired cases of Legionnaires' disease-results from the German LeTriWa study; Berlin, 2016-2019.

INTRODUCTION: Sources of infection of most cases of community-acquired Legionnaires' disease (CALD) are unknown. OBJECTIVE: Identification of sources of infection of CALD. SETTING: Berlin; December 2016-May 2019. PARTICIPANTS: Adult cases of CALD reported to district health authorities and consenting to the study; age and hospital matched controls. MAIN OUTCOME MEASURE: Percentage of cases of CALD with attributed source of infection. METHODS: Analysis of secondary patient samples for monoclonal antibody (MAb) type (and sequence type); questionnaire-based interviews, analysis of standard household water samples for Legionella concentration followed by MAb (and sequence) typing of Legionella pneumophila serogroup 1 (Lp1) isolates; among cases taking of additional water samples to identify the infectious source as appropriate; recruitment of control persons for comparison of exposure history and Legionella in standard household water samples. For each case an appraisal matrix was filled in to attribute any of three source types (external (non-residence) source, residential non-drinking water (RnDW) source (not directly from drinking water outlet), residential drinking water (RDW) as source) using three evidence types (microbiological results, cluster evidence, analytical-comparative evidence (using added information from controls)). RESULTS: Inclusion of 111 study cases and 202 controls. Median age of cases was 67 years (range 25-93 years), 74 (67%) were male. Among 65 patients with urine typable for MAb type we found a MAb 3/1-positive strain in all of them. Compared to controls being a case was not associated with a higher Legionella concentration in standard household water samples, however, the presence of a MAb 3/1-positive strain was significantly associated (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.7 to 11). Thus, a source was attributed by microbiological evidence if it contained a MAb 3/1-positive strain. A source was attributed by cluster evidence if at least two cases were exposed to the same source. Statistically significant general source types were attributed by calculating the population attributable risk (analytical-comparative evidence). We identified an external source in 16 (14%) cases, and RDW as source in 28 (25%). Wearing inadequately disinfected dentures was the only RnDW source significantly associated with cases (OR = 3.2, 95% CI 1.3 to 7.8) and led to an additional 8% of cases with source attribution, for a total of 48% of cases attributed. CONCLUSION: Using the appraisal matrix we attributed almost half of all cases of CALD to an infectious source, predominantly RDW. Risk for LD seems to be conferred primarily by the type of Legionella rather than the amount. Dentures as a new infectious source needs further, in particular, integrated microbiological, molecular and epidemiological confirmation.

[Consequences of a Failed Project: Introduction and Management of a Hospitalization-Substituting Treatment Model]. / Erfolgreich scheitern ­ Die Folgen eines Projekts zur Einführung stationsersetzender Behandlung und ihrer Steuerung.

This article is a report on a psychiatric project introducing services that substitute in-patient treatment and a new control and management system. The implementation of the project was a failure. Nevertheless, the project has made a contribution to further development of community-based psychiatry. Design, organization and course of the project are described and analyzed from the point of view of the communal actors involved. Effects going beyond the time course of the project have been taken into consideration. The results show that the contracting authority, project developer and local actors involved had differing ideas on the weight attached to different parts of the project as well as on the project goal and resources for carrying out the project.

Human thinking, shared intentionality, and egocentric biases.

The paper briefly summarises and critiques Tomasello's (2014) A Natural History of Human Thinking. After offering an overview of the book, the paper focusses on one particular part of Tomasello's proposal on the evolution of uniquely human thinking and raises two points of criticism against it. One of them concerns his notion of thinking. The other pertains to empirical findings on egocentric biases in communication.

El siglo de la psiquiatría alemana: ¿Cómo empezó y cómo finalizó? / The century of German psychiatry: how it began and ended?

Este artículo es una revisión histórica de la tradición psiquiátrica alemana, que tiene sus orígenes tanto en la filosofía de Christian Wolff e Immanuel Kant como en el movimiento religioso denominado pietismo. El autor se refiere, en el marco de esa tradición, a los trabajos de Emil Kraepelin y Sigmund Freud, así como a la escuela fenomenológica. Finalmente, señala que en la actualidad la psiquiatría norteamericana ha desplazado a la tradición psiquiátrica alemana, incluso en la misma Alemania.

This essay surveys the history of the German psychiatric tradition that originates in the philosophy of Christian Wolff and Immanuel Kant as well as the religious movement termed pietism. This tradition received influence from the works of Emil Kraepelin and Sigmund Freud, and the School of Phenomenology which is also discussed. The author finally claims that contemporary American psychiatry has displaced the German psychiatric tradition even in present Germany.