Living happily alone in Plato's cave? On loneliness, technology and the metaphysics of presence.

In a lot of research on loneliness and technology, there is an underlying premise that actual, physical presence is more real than 'virtual' presence. This premise is rarely explicit, yet it implies a hierarchy of reality, where the 'here and now' is always on top. In this theoretical paper, we examine this latent hierarchy and the understandings of presence and mediation it implies. We point towards potential consequences of this understanding for research on the role of technology in reducing loneliness and social isolation. To do this, we draw on the philosophical analysis made by Martin Heidegger and Jacques Derrida of what they called 'the metaphysics of presence'. This is the tendency to privilege presence as the only immediate and truthful access to reality, whereas all forms of mediations constitute mere approximations, derivations and second-rate realities with dubious truth value. First, we present their diagnosis, and then we show how it pertains to research on virtual presence and loneliness by analysing some examples from this research. Finally, we discuss some potential implications of the metaphysics of presence through a case story compiled from our empirical research. Our foundational assertion is that the question of whether anyone experiences loneliness is an empirical and not a metaphysical question. If we want to properly understand loneliness and the potential for alleviating it through the use of teletechnologies, we might get off on the wrong foot if we carry with us assumptions suggesting the existence of ascending levels of reality and presence.

From evidence-based to sustainable healthcare: Cochrane revisited.

Evidence-based healthcare is the prevailing model for healthcare services. In Cochrane's seminal thinking, political context was included with the purpose of promoting healthcare equity. However, the subsequent evidence-based healthcare models marginalized political context. In this paper, we argue that current models of evidence-based healthcare fail to respond to emerging healthcare challenges. We claim that reintegration of political context is crucial to make healthcare sustainable. Global communities are anticipating ecological crises with immense repercussions for healthcare. This prospect illustrates that healthcare models failing to integrate political context also risk neglecting some of the most relevant healthcare issues of our time.

Who cares? The lost legacy of Archie Cochrane.

Over the last 20 years, the evidence-based medicine (EBM) movement has sought to develop standardised approaches to patient treatment by drawing on research results from randomised controlled trials (RCTs). The Cochrane Collaboration and its eponym, Archie Cochrane, have become symbols of this development, and Cochrane's book Effectiveness and Efficiency from 1972 is often referred to as the first sketch of what was to become EBM. In this article, we claim that this construction of EBM's historical roots is based on a selective reading of Cochrane's text. Through a close reading of this text, we show that the principal aim of modern EBM, namely to warrant clinical decisions based on evidence drawn from RCTs, is not part of Cochrane's original project. He had more modest ambitions for what RCTs can accomplish, and, more importantly, he was more concerned with care and equality than are his followers in the EBM movement. We try to reconstruct some of Cochrane's lost legacy and to articulate some of the important silences in Effectiveness and Efficiency From these clues it might be possible, we argue, to remodel EBM in a broader, more pluralistic, more democratic and less authoritarian manner.

Politics and Power in Global Health: The Constituting Role of Conflicts: Comment on "Navigating Between Stealth Advocacy and Unconscious Dogmatism: The Challenge of Researching the Norms, Politics and Power of Global Health".

In a recent article, Gorik Ooms has drawn attention to the normative underpinnings of the politics of global health. We claim that Ooms is indirectly submitting to a liberal conception of politics by framing the politics of global health as a question of individual morality. Drawing on the theoretical works of Chantal Mouffe, we introduce a conflictual concept of the political as an alternative to Ooms' conception. Using controversies surrounding medical treatment of AIDS patients in developing countries as a case we underline the opportunity for political changes, through political articulation of an issue, and collective mobilization based on such an articulation.