Artificial Intelligence in Otolaryngology: Topics in Epistemology & Ethics.

To fuel artificial intelligence (AI) potential in clinical practice in otolaryngology, researchers must understand its epistemic limitations, which are tightly linked to ethical dilemmas requiring careful consideration. AI tools are fundamentally opaque systems, though there are methods to increase explainability and transparency. Reproducibility and replicability limitations can be overcomed by sharing computing code, raw data, and data processing methodology. The risk of bias can be mitigated via algorithmic auditing, careful consideration of the training data, and advocating for a diverse AI workforce to promote algorithmic pluralism, reflecting our population's diverse values and preferences.

Janina Hosiasson and the value of evidence.

I.J. Good's "On the Principle of Total Evidence" (1967) looms large in decision theory and Bayesian epistemology. Good proves that in Savage's (1954) decision theory, a coherent agent always prefers to collect, rather than ignore, free evidence. It is now well known that Good's result was prefigured in an unpublished note by Frank Ramsey (Skyrms 2006). The present paper highlights another early forerunner to Good's argument, appearing in Janina Hosiasson's "Why do We Prefer Probabilities Relative to Many Data?" (1931), that has been neglected in the literature. Section 1 reviews Good's argument and the problem it was meant to resolve; call this the value of evidence problem. Section 2 offers a brief history of the value of evidence problem and provides biographical background to contextualize Hosiasson's contribution. Section 3 explicates the central argument of Hosiasson's paper and considers its relationship to Good's (1967).

From the philosophy of measurement to the philosophy of classification: Generalizing the problem of coordination and historical coherentism.

The objective of this paper is twofold. First, I present a framework called historical coherentism (Chang, 2004; Tal, 2016; Van fraassen 2008) and argue that it is the best epistemological framework available to tackle the problem of coordination, an epistemic conundrum that arises with every attempt to provide empirical content to scientific theories, models or statements. Second, I argue that the problem of coordination, which has so far been theorized only in the context of measurement practices (Reichenbach, 1927; Chang, 2001; Tal, 2012; Van fraassen 2008), can be generalized beyond the philosophy of measurement. Specifically, it will be shown that the problem is embodied in classificatory practices and that, consequently, historical coherentism is well suited to analyze these practices as well as metrological ones. As a case study, I look at a contemporary debate in phylogenetics, regarding the evolutionary origin of a newly identified archaeal phylum called Methanonatronarchaeia. Exploring this debate through the lens of historical coherentism provides a detailed understanding of the dynamics of the field and a foothold for critical analyses of the standard rationale used by practitioners.

The cultural turn in understanding 'addiction'.

In this essay we want to foreground a question: what happens to 'addiction' when we take seriously cultural scripts informing its trajectories? Can this bring us to unthink addiction as problematic notion and move it onto new paradigms that fit better the now acknowledged fluidity and pluralistic episteme of 'addiction' and more broadly of chronic life conditions? Indeed, 'addiction' has become a pivotal concept in the contemporary world. A powerful diagnostic framework in interpreting human behaviour, for some 'addiction' has become the 'new normal' with chronic relations with different things such as food, sex, gambling, and mind-altering substances touching upon the lifestyle of a majority of individuals, making everyone 'addicts in practice'. Perhaps this has something to do with the constituent force that 'habit' - as in 'addiction' - has in defining our present and future. Though 'addiction' goes beyond the question of mind-altering drugs, the politics of 'addiction' is intimately tied to substances such as opioids and opiates, cocaine, cannabis, and psychedelics that have been the object of durable systemic political control and security repression. Contextually the line between licit/illicit substances is softening and blurring, the 'dual' purpose that drugs serve is now recognised in scientific and popular analysis moving the question of 'addiction' beyond the medicine/drug dichotomy. Yet, culture is generally absent in understanding 'addiction.' When it is referred to, this happens in diminutive terms limited to Anglo-American modern culture. Culture matters and it matters with different weights and measures as it moves across the world. There are cultural environments of health informed by practices and epistemologies of well-being that have evolved in lines opposites from or only intersecting with the Anglo-American, and generally Western, world. Exploring these spaces and cultural scripts enables our scholarship on drugs and 'addiction' to move the barycentre of discussion towards novel considerations around the historical trajectories and potential futures of our diagnostic terms and policy interventions.

[Nursing science put to the epistemological test]. / La science infirmière à l'épreuve de l'épistémologie.

Today, we are witnessing the emergence of a nursing discipline that is clearly seeking to base its legitimacy primarily on science. However, only an epistemological approach can assure us of the relevance of such an approach. While the nursing discipline must unquestionably be based on a rational, scientific approach, can we not nevertheless assume that an irreducible element of mystery will forever remain at the heart of care?

Lessons from insiders: Embracing subjectivity as objectivity in victimology.

Due to the prevalence of victimization in society, it is likely that many victimologists have been victimized or will be in their lifetimes. This poses a challenge for the field of victimology as traditional, positivist conceptions of 'good science' require researchers to be outsiders relative to populations they study. This paper asks: What are the epistemological and practical implications of victimological research conducted by researchers who have firsthand experiences of victimization? What lessons can be retained by other victimologists and researchers in general? How can these epistemological considerations be applied in practice? To answer these questions, I examine the meanings of insider and outsider status and the implications for objectivity and subjectivity as per positivist and standpoint epistemologies. I present the case of victimologists who have been victimized as well as the advantages and disadvantages of this form of insider research. I deconstruct insider-outsider, subjectivity-objectivity dualisms as they pertain to victimologists, concluding that all victimologists can be subjective whether they are technically insiders or not. In closing, I discuss how all victimologists can embrace their own and their participants' subjectivity as a resource for objectivity by examining location, emotions and bodies, and ethics throughout the research process.

The Figure of the Staggering Rat: Reading Colonial Outbreak Narratives Against the Grain of "Virus Hunting".

The image of dazed, plague-infected rats coming out of their nests and performing a pirouette in front of the surprised eyes of humans before dying is one well-known to us through Albert Camus's The Plague (1947). This article examines the historical roots of this image and its emergence in French missionary narratives about plague outbreaks in the Chinese province of Yunnan in the 1870s on the eve of the Third Plague Pandemic. Showing that accounts of the "staggering rat" were not meant as naturalist observations of a zoonotic disease, as is generally assumed by historians, but as a cosmological, end-of-the-world narrative with a colonial agenda, the article argues for an approach to historical accounts of epidemics that does not succumb to the current trend of "virus hunting" in the archive, but rather takes colonial outbreak narratives ethnographically seriously.

India's need to integrate its socio-cultural and scientific epistemology to position itself as a global leader.

Somewhat pitch-forked into a role it had been envisioning for itself for a long time now by the rapidly changing politico-administrative dynamics of the nations across the world and emerging and re-emerging crises limited not the least to wars and pandemics, India needs to leverage its strengths to deliver on the promise it has long held. But India's struggle to stem the outward flow of many of the brightest may just be one among the many factors that can play a spoilsport. The civilizational strength of India has been its cultural-scientific epistemology, strengthening the exploration of which will help it position itself as the global leader. The freedom to question and seek answers, no matter how successful a hypothesis has been in the past, is consistent with its (India's) epistemology, both scientific and cultural.

Diagnostic staging and stratification in psychiatry and oncology: clarifying their conceptual, epistemological and ethical implications.

Staging and stratification are two diagnostic approaches that have introduced a more dynamic outlook on the development of diseases, thus participating in blurring the line between the normal and the pathological. First, diagnostic staging, aiming to capture how diseases evolve in time and/or space through identifiable and gradually more severe stages, may be said to lean on an underlying assumption of "temporal determinism". Stratification, on the other hand, allows for the identification of various prognostic or predictive subgroups based on specific markers, relying on a more "mechanistic" or "statistical" form of determinism. There are two medical fields in which these developments have played a significant role and have given rise to sometimes profound nosological transformations: oncology and psychiatry. Drawing on examples from these two fields, this paper aims to provide much needed conceptual clarifications on both staging and stratification in order to outline how several epistemological and ethical issues may, in turn, arise. We argue that diagnostic staging ought to be detached from the assumption of temporal determinism, though it should still play an essential role in adapting interventions to stage. In doing so, it would help counterbalance stratification's own epistemological and ethical shortcomings. In this sense, the reflections and propositions developed in psychiatry can offer invaluable insights regarding how adopting a more transdiagnostic and cross-cutting perspective on temporality and disease dynamics may help combine both staging and stratification in clinical practice.

Arthur Schopenhauer: An underappreciated philosopher in psychiatry and his applied epistemology of body and self- experience.

BACKGROUND: Arthur Schopenhauer (1788-1860) was one of the most important thinkers of the 19th century. Although his writings have exerted great influence in many different disciplines, his epistemological concepts and analysis of the body and self-experience were rarely considered in the context of psychiatric research of schizophrenia spectrum disorders (SSD) and depression (MDD). METHODS: The method applied for the study of anomalous self and body-experience first consists in the close reading and analysis of Schopenhauer's most influential writings, namely his opus magnus "The World as Will and Representation" and his dissertation "On the Fourfold Root of the Principle of Sufficient Reason". Second, psychopathological and phenomenological aspects of the anomalous body and self, as well as altered space and time experience, are discussed by means of Schopenhauer's philosophy and four patient cases. RESULTS: Schopenhauer's insights contribute to contemporary psychiatry by (1) unifying materialistic (neurobiological) and idealistic (subjective) conceptions of psychiatric disorders and improving the awareness of methods in psychiatric research; (2) emphasizing the integral significance of the body as a gateway to the surrounding world and basal self-experience; (3) delineating subjective space and time-experience as crucial dimensions of the conditio humana in SSD and MDD; and (4) demonstrating the feasibility of transferring his theories directly to clinical case vignettes stemming from the daily clinical routine. CONCLUSION: Close reading of Schopenhauer's texts might help bridge the gap between different scientific methods in psychiatry and overcome the translational crisis of contemporary psychiatry by unifying neurobiological and subjective approaches to SSD and MDD.

Which Ethnography? Whose Ethnography? Medical anthropology's Epistemic Sensibilities Among Health Ethnographies.

Medical anthropologists working in interdisciplinary teams often articulate expertise with respect to ethnography. Yet increasingly, health scientists utilize ethnographic methods. Through a comparative review of health ethnographies, and autoethnographic observations from interdisciplinary research, we find that anthropological ethnographies and health science ethnographies are founded on different epistemic sensibilities. Differences center on temporalities of research, writing processes, sites of social intervention, uses of theory, and analytic processes. Understanding what distinguishes anthropological ethnography from health science ethnography enables medical anthropologists - who sometimes straddle these two ethnographic modes - to better articulate their epistemic positionality and facilitate interdisciplinary research collaborations.

How to lose your memory without losing your money: shifty epistemology and Dutch strategies.

An objection to shifty epistemologies such as subject-sensitive invariantism is that it predicts that agents are susceptible to guaranteed losses. Bob Beddor (Analysis, 81, 193-198, 2021) argues that these guaranteed losses are not a symptom of irrationality, on the grounds that forgetful agents are susceptible to guaranteed losses without being irrational. I agree that forgetful agents are susceptible to guaranteed losses without being irrational- but when we investigate why, the analogy with shifty epistemology breaks down. I argue that agents with shifty epistemologies are susceptible to guaranteed losses in a way which is a symptom of irrationality. Along the way I make a suggestion about what it takes for an agent to be coherent over time. I close by offering a taxonomy of shifty epistemologies.

Navigating the Science System: Research Integrity and Academic Survival Strategies.

Research Integrity (RI) is high on the agenda of both institutions and science policy. The European Union as well as national ministries of science have launched ambitious initiatives to combat misconduct and breaches of research integrity. Often, such initiatives entail attempts to regulate scientific behavior through guidelines that institutions and academic communities can use to more easily identify and deal with cases of misconduct. Rather than framing misconduct as a result of an information deficit, we instead conceptualize Questionable Research Practices (QRPs) as attempts by researchers to reconcile epistemic and social forms of uncertainty in knowledge production. Drawing on previous literature, we define epistemic uncertainty as the inherent intellectual unpredictability of scientific inquiry, while social uncertainty arises from the human-made conditions for scientific work. Our core argument-developed on the basis of 30 focus group interviews with researchers across different fields and European countries-is that breaches of research integrity can be understood as attempts to loosen overly tight coupling between the two forms of uncertainty. Our analytical approach is not meant to relativize or excuse misconduct, but rather to offer a more fine-grained perspective on what exactly it is that researchers want to accomplish by engaging in it. Based on the analysis, we conclude by proposing some concrete ways in which institutions and academic communities could try to reconcile epistemic and social uncertainties on a more collective level, thereby reducing incentives for researchers to engage in misconduct.

The Social Epistemology of Clinical Placebos.

Many extant theories of placebo focus on their causal structure wherein placebo effects are those that originate from select features of the therapy (e.g., client expectations or "incidental" features like size and shape). Although such accounts can distinguish placebos from standard medical treatments, they cannot distinguish placebos from everyday occurrences, for example, when positive feedback improves our performance on a task. Providing a social-epistemological account of a treatment context can rule out such occurrences, and furthermore reveal a new way to distinguish clinical placebos from standard medical treatments.

Perceptions of Clinical Experience and Scientific Evidence in Medical Decision Making: A Survey of a Stratified Random Sample of Swedish Health Care Professionals.

BACKGROUND: Evidence-based medicine recognizes that clinical expertise gained through experience is essential to good medical practice. However, it is not known what beliefs clinicians hold about how personal clinical experience and scientific knowledge contribute to their clinical decision making and how those beliefs vary between professions, which themselves vary along relevant characteristics, such as their evidence base. DESIGN: We investigate how years in the profession influence health care professionals' beliefs about science and their clinical experience through surveys administered to random samples of Swedish physicians, nurses, occupational therapists, dentists, and dental hygienists. The sampling frame was each profession's most recent occupational registry. RESULTS: Participants (N = 1,627, 46% response rate) viewed science as more important for decision making, more certain, and more systematic than experience. Differences among the professions were greatest for systematicity, where physicians saw the largest gap between the 2 types of knowledge across all levels of professional experience. The effect of years in the profession varied; it had little effect on assessments of importance across all professions but otherwise tended to decrease the difference between assessments of science and experience. Physicians placed the greatest emphasis on science over clinical experience among the 5 professions surveyed. CONCLUSIONS: Health care professions appear to share some attitudes toward professional knowledge, despite the variation in the age of the professions and the scientific knowledge base available to practitioners. Training and policy making about clinical decision making might improve by accounting for the ways in which knowledge is understood across the professions. HIGHLIGHTS: Study participants, representing 5 health care professions-medicine, nursing, occupational therapy, dentistry, and dental hygiene-viewed science as more important for decision making, more certain, and more systematic than their personal clinical experience.Of all the professions represented in the study, physicians saw the greatest differences between the 2 types of knowledge.The effect of years of professional experience varied but tended to be small, attenuating the differences seen between science and clinical experience.

Limits of Optimization.

Optimization is about finding the best available object with respect to an objective function. Mathematics and quantitative sciences have been highly successful in formulating problems as optimization problems, and constructing clever processes that find optimal objects from sets of objects. As computers have become readily available to most people, optimization and optimized processes play a very broad role in societies. It is not obvious, however, that the optimization processes that work for mathematics and abstract objects should be readily applied to complex and open social systems. In this paper we set forth a framework to understand when optimization is limited, particularly for complex and open social systems.

A dataset without a code book: ethnography and open science.

This paper reflects upon calls for "open data" in ethnography, drawing on our experiences doing research on sexual violence. The core claim of this paper is not that open data is undesirable; it is that there is a lot we must know before we presume its benefits apply to ethnographic research. The epistemic and ontological foundation of open data is grounded in a logic that is not always consistent with that of ethnographic practice. We begin by identifying three logics of open data-epistemic, political-economic, and regulatory-which each address a perceived problem with knowledge production and point to open science as the solution. We then evaluate these logics in the context of the practice of ethnographic research. Claims that open data would improve data quality are, in our assessment, potentially reversed: in our own ethnographic work, open data practices would likely have compromised our data quality. And protecting subject identities would have meant creating accessible data that would not allow for replication. For ethnographic work, open data would be like having the data set without the codebook. Before we adopt open data to improve the quality of science, we need to answer a series of questions about what open data does to data quality. Rather than blindly make a normative commitment to a principle, we need empirical work on the impact of such practices - work which must be done with respect to the different epistemic cultures' modes of inquiry. Ethnographers, as well as the institutions that fund and regulate ethnographic research, should only embrace open data after the subject has been researched and evaluated within our own epistemic community.

Comparative Law and Christianity-A Plank in the Eye?

This article examines the epistemic bias of comparative law scholarship. Comparatists are unable or unwilling to recognise the religious dimensions in Western law as they see religion only in the context of non-Western law. This problem is typical of modern macro-comparative law, which fails to recount the influence of Christianity on Western law and legal culture. The article invites legal scholars to reach beyond the notions of 'religious law' and 'secular law' in terms of classifying the world's legal systems. Firstly, the article explains how comparative law has a problematic relationship with religion; secondly, it shows that, despite Christianity having been deemed a thing of the past, its influence can and should also be charted in modern law. I argue for a need to rethink the manner in which Western law is depicted as a thoroughly secular law as opposed to the religious law of exoticised others.

To(o) Queer the Analyst: Lesbiana, Junguiana and Sudamericana. Towards Woven Onto-Epistemologies.

This is a two-part paper: in the first one, a personal story serves as a conceptual prism through which I address the issue of how a queer analyst can be a problem for analytical psychology; in the second, I present some readings and images-mostly from decolonial feminisms-that have been of interest to me lately in my path to queer Jungian psychology, that is, to de-essentialize and de-individualize its theory and practice. By borrowing (and altering) the title from Gloria Anzaldúa's (1991/2009a) essay "To(o) queer the writer", this paper explores some themes she has elaborated there on solidarity, theorization and ways of writing and reading from othered points of view. In dialogue with Donna Haraway's (2016) Staying with the Trouble and Ursula K. Le Guin's (1989/2000) The Carrier Bag Theory of Fiction, together with the imagery of bags, weaving and string figures game, this paper aims to explore the potential of what I have called "woven onto-epistemologies". By imagining and developing this new condition of knowledge, other stories and theories in analytical psychology may have an opportunity to be told.

Cet essai est composé de deux parties : dans la première, une histoire personnelle sert de prisme conceptuel à travers lequel j'aborde la question de savoir comment un analyste queer peut être un problème pour la psychologie analytique ; dans la seconde, je présente quelques lectures et images ­ principalement issues des féminismes décoloniaux ­ auxquelles je me suis intéressée ces derniers temps, afin de rendre la psychologie jungienne plus queer, c'est­à­dire désessentialiser et désindividualiser cette théorie et cette pratique. En empruntant (et en modifiant) le titre de l'essai de Gloria Anzaldúa « To(o) queer the writer ¼, cet article explore certains thèmes qu'elle y a développés sur la solidarité, la théorisation et les manières d'écrire et de lire à partir du point de vue d'autrui. En dialoguant avec Staying with the Trouble de Donna Haraway et Carrier Bag of Fiction d'Ursula K. Le Guin, ainsi qu'avec l'imagerie des sacs, du tissage et du jeu avec des figurines en ficelle, cet article vise à explorer le potentiel de ce que j'ai appelé les onto­épistémologies tissées. En imaginant et en développant cette nouvelle condition de la connaissance, d'autres histoires et théories de la psychologie analytique auront peut­être l'occasion d'être racontées.

Este ensayo consta de dos partes: en la primera, una historia personal sirve como prisma conceptual a través del cual abordo la cuestión de cómo una analista 'queer' puede ser un problema para la psicología analítica; en la segunda, presento algunas lecturas e imágenes ­principalmente de los feminismos decoloniales­ que me han interesado últimamente, con el fin de 'queerizar' la psicología junguiana, es decir, des­esencializar y des­individualizar esta teoría y práctica. Tomando prestado (y alterando) el título del ensayo de Gloria Anzaldúa "To(o) queer the writer", este artículo explora algunos temas allí elaborados acerca de la solidaridad, la teorización y las formas de escribir y leer desde otros puntos de vista. En diálogo con 'Staying with the Trouble' de Donna Haraway y 'Carrier Bag of Fiction' de Ursula K. Le Guin, junto con las imágenes de bolsas, tejidos y juegos de cuerdas, este artículo busca explorar el potencial de lo que he denominado onto­epistemologías tejidas. Imaginando y desarrollando esta nueva condición para el conocimiento, otras historias y teorías en psicología analítica pueden tener la oportunidad de ser contadas.