Scientific plurality and amyotrophic lateral sclerosis (ALS): A philosophical and historical perspective on Charcot's texts.

The history of amyotrophic lateral sclerosis (ALS)-also known as Charcot's disease, Lou Gehrig's disease, and motor neuron disease (MND)-freezes the texts of the scientist and physician Jean-Martin Charcot in a hagiographic narrative describing a brilliant discovery, based on the anatomo-clinical method. This narrative is often used by biologists and physicians as a reference point. This article shows that the use of the hagiographic register faces limitations. In particular, it obscures points of interest from Charcot's texts on ALS, such as the epistemological and ontological implications of scientific plurality in medicine. Although Charcot recognized the importance of scientific plurality in medicine, he prioritized the approaches and conferred the most important epistemic authority on clinical and pathological observations. In his view, animal modeling remains secondary to the understanding of disease. The concept of ALS and its diagnostic operability are the result of symptoms and lesions. By studying the past, we can highlight the specific features of the present. Today, although the ALS concept retains its diagnostic and clinical relevance, it is increasingly called into question in etiological and mechanistic research. Despite these differences, Charcot's reflections are a reminder of the importance of theoretical thinking on scientific plurality, all the more so today in the context of ALS research, in which combining different approaches is increasingly valued to understand the phenotypic and genetic heterogeneity of ALS.

When artistic is altruistic: the power of beauty from P. A. Sorokin's sociology to Building Beauty social project.

The article contributes to the ongoing debates on the social value and sociological relevance of the arts by examining the intuitions of the Russian-American sociologist P. A. Sorokin (1889-1968) on the concept of "beauty" as a force akin to what he calls "Altruistic Creative Love", both potentially catalysing a process of "fraternisation of humanity". Starting from the author's sociological reflections on the relationship between "Altruistic Love" and "beauty" and an analytical model of "altruistic artistic social action," the article proposes the analysis of a specific social project named Building Beauty, promoted in Turin (Italy) by universities, public bodies and the third sector, which aims to foster the social inclusion of homeless people through participatory processes, discovering expressions of beauty with aesthetic and sociological relevance simultaneously, able to move social transformations.

A model of faulty and faultless disagreement for post-hoc assessments of knowledge utilization in evidence-based policymaking.

When evidence-based policymaking is so often mired in disagreement and controversy, how can we know if the process is meeting its stated goals? We develop a novel mathematical model to study disagreements about adequate knowledge utilization, like those regarding wild horse culling, shark drumlines and facemask policies during pandemics. We find that, when stakeholders disagree, it is frequently impossible to tell whether any party is at fault. We demonstrate the need for a distinctive kind of transparency in evidence-based policymaking, which we call transparency of reasoning. Such transparency is critical to the success of the evidence-based policy movement, as without it, we will be unable to tell whether in any instance a policy was in fact based on evidence.

Pursuit-worthy research in health: Three examples and a suggestion.

This paper, in a nutshell, is a plea for community participation in research along with an adapted idea for how such participation should be shaped and understood. I will give varied examples of the ways in which scientists viewing a perceived problem solely from an external perspective has led to mistakes. If we do not properly take into account the knowledge and values of people with a condition, we are liable to pursue the wrong sorts of treatments. In particular, I provide examples of three ways (exemplified in the cases of "female hysteria", autism, and chronic fatigue syndrome) scientists are liable to pursue treatment of what they perceive to be at least partially mental illnesses that they/we shouldn't. I present the idea of deliberative research-the concept is based on that of deliberative democracy. The idea of deliberative democracy is that decisions should be made on the basis of reasons that would be acceptable to the target population. I similarly argue that research decisions should be made on the basis of reasons that would be acceptable to the target population, even if it requires other experts to determine how those reasons are best to be respected in the context of a particular project.

Revisiting the philosophy of technology and nursing: Time to move beyond romancing resistance or resisting romance.

Technology remains enmeshed in our daily lives and given its continuing presence in clinical practice and rapid technological proliferation; it becomes relevant for nurses to examine techno-onto-epistemology in relation to the discipline of nursing. This is critical considering the intersection of technology and nursing remains an area of ongoing discussion revealing a need for further philosophical reflection. To this end, this paper sought to examine the philosophy of technology from the engineering and humanities perspectives to contribute to the discussion regarding its intersection with the onto-epistemology of nursing. Although technology seems to be constantly present in nursing practice, two opposing perspectives reflecting a love-hate relationship is highlighted: technological optimism (promotes technology) and technological romanticism (dissuades technology). Based on Mitcham's interpretation of 'mutual relationship' and 'being-with', a potential way to break away from the binary perspectives is to view the intersection of/relationship between technology and nursing as being on a continuum rather than entirely monolithic entities. Caring is presented as multidimensional reflecting actions and attitudes. Arguably, some caring actions may intersect with the engineering perspective to suggest that technology can support nurses in their roles, that is, by imitating some of what nurses do, but not to replace them. From the humanities perspective, technology is presented as a way of being with humans exercising control over what technology has to offer. Put together, it is clearly time to break away from the love-hate relationship between nursing and technology. Although this emphasises a great need to build the technological competency of nurses, there is an even greater call for nurses to reflect on and voice the epistemological, ontological, axiological, and ethical issues that the application of technology raises for the discipline.

Self-serving beliefs about science: Science justifies my weaknesses (but not other people's).

This research explored the strategic beliefs that people have about science and the extent to which it can explain moral and immoral behaviors. Although people do not believe that science is able to explain certain aspects of their mind, they might nevertheless accept a scientific explanation for their immoral behaviors if that explanation is exculpatory. In a first study, participants reflected on moral and immoral deeds that they performed or that other people performed. Participants were somewhat skeptic that science can account for people's behavior-except for when they reflected on the wrongdoings that they committed. Two further studies suggest that strategic belief in science arises because it enables external attributions for the behavior, outside of the wrongdoers' control. Implications are discussed for science understanding and communication.

Revisiting Epigenetics Fundamentals and Its Biomedical Implications.

In light of the post-genomic era, epigenetics brings about an opportunity to better understand how the molecular machinery works and is led by a complex dynamic set of mechanisms, often intricate and complementary in many aspects. In particular, epigenetics links developmental biology and genetics, as well as many other areas of knowledge. The present work highlights substantial scopes and relevant discoveries related to the development of the term from its first notions. To our understanding, the concept of epigenetics needs to be revisited, as it is one of the most relevant and multifaceted terms in human knowledge. To redirect future novel experimental or theoretical efforts, it is crucial to compile all significant issues that could impact human and ecological benefit in the most precise and accurate manner. In this paper, the reader can find one of the widest compilations of the landmarks and epistemic considerations of the knowledge of epigenetics across the history of biology from the earliest epigenetic formulation to genetic determinism until the present. In the present work, we link the current body of knowledge and earlier pre-genomic concepts in order to propose a new definition of epigenetics that is faithful to its regulatory nature.

Is evidence-based practice justified?-A philosophical critique.

BACKGROUND: Evidence-based practice is the principle governing a range of healthcare practices and beyond. However, it has suffered from a lack of philosophical rigour. This paper sets out to analyse the epistemological basis of evidence-based practice. METHOD: The paper uses a conceptual analysis. First, it describes the implicit epistemology at work in evidence-based practice. Second, it evaluates the implicit epistemological basis. RESULTS: The analysis indicates that evidence-based practice lacks an explicit epistemological basis. It shows, moreover, that the implicit epistemological basis is untenable. CONCLUSION: There is a need to re-think the epistemological basis for evidence-based practice. Evidence-based practice is out of touch with developments within philosophy of science.

Material History, Historied Materials and the Question of Epistemic Freedom in Ghana's Medical Schools.

Medical schools rely on a wide range of tools, technologies and materials for their teaching, on books, and bodies, and on the buildings which house them. This article considers the histories of this material culture in the three oldest medical schools operating in Ghana today. Borrowing theoretical concepts from Science and Technology Studies, medical anthropology and postcolonial political economy, this article takes that the material culture of modern medical education often binds contemporary pedagogy to outdated ideas and faraway places. The agential, proselytising nature of these historied materials agitates against the localisation of biomedicine and contributes to a distracting scientific imaginary which remains centred around historical, often imperial centres of knowledge production in Europe and North America.

Empathy or sympathy: a necessary distinction?

As a deeply hybrid discipline, psychiatry demands research that tackles the concepts constituting it and its objects. This is an essential prerequisite to empirical studies, the validity of which are directly dependent on a clear understanding of the underlying concepts. Empathy and sympathy are concepts used variably and inconsistently in clinical practice and research, with ensuing uncertainties around their role and meaning. Using a historical epistemology approach, this paper compares these concepts by examining the structures, intersections, stabilities and factors that shape them. It shows that neither concept is invariant, and, despite overlap, the concepts are essentially different, underpinned by different assumptions, holding different functions and capturing different phenomena. In turn, such differences require apposite approaches to their empirical study.

Virtual diversity: Resolving the tension between the wider culture and the institution of science.

There are widespread calls for increased demographic diversity in science, often linked to the epistemic claim that including more perspectives will improve the quality of the knowledge produced. By distinguishing between demographic and epistemic diversity, we show that this is only true some of the time. There are cases where increasing demographic diversity will not bring about the necessary epistemic diversity and cases where failing to exclude some voices reduces the quality of the scientific debate. We seek to resolve these tensions with an analysis that turns on the way the experience-based expertise of non-scientists can be absorbed into mainstream science. Mostly it has to be done via what we call 'virtual diversity', in which scientists take responsibility for acquiring interactional expertise in the non-scientific expertise-based domains which they consider provide knowledge valuable to the science. We argue that virtual diversity represents the only feasible option in most scenarios, with cases where demographic diversity or full cultural mergers provide the solution being the exception rather than the rule. This analysis is an exercise in the sociology of knowledge, which is considered as being continuous with philosophy. The paper is prescriptive as well as descriptive, and the moral, cultural, political, and educational implications of the argument are drawn out. A main conclusion is that the acquisition of virtual diversity should be a new norm for science, allowing the voices of experienced non-scientist citizens to be heard but without eroding the institution of science, which continues to be a vital foundation of truth in democracy.

Science and Faith to Understand Milk Bioactivity for Infants.

Milk bioactivity refers to the specific health effects of milk components beyond nutrition. The science of milk bioactivity involves the systematic study of these components and their health effects, as verified by empirical data, controlled experiments, and logical arguments. Conversely, 'faith in milk bioactivity' can be defined as personal opinion, meaning, value, trust, and hope for health effects that are beyond investigation by natural, social, or human sciences. Faith can be strictly secular, but also influenced by spirituality or religion. The aim of this paper is to show that scientific knowledge is frequently supplemented with faith convictions to establish personal and public understanding of milk bioactivity. Mammalian milk is an immensely complex fluid containing myriad proteins, carbohydrates, lipids, and micronutrients with multiple functions across species, genetics, ages, environments, and cultures. Human health includes not only physical health, but also social, mental, and spiritual health, requiring widely different fields of science to prove the relevance, safety, and efficacy of milk interventions. These complex relationships between milk feeding and health outcomes prevent firm conclusions based on science and logic alone. Current beliefs in and understanding of the value of breast milk, colostrum, infant formula, or isolated milk proteins (e.g., immunoglobulins, α-lactalbumin, lactoferrin, and growth factors) show that both science and faith contribute to understand, stimulate, or restrict the use of milk bioactivity. The benefits of breastfeeding for infants are beyond doubt, but the strong beliefs in its health effects rely not only on science, and mechanisms are unclear. Likewise, fear of, or trust in, infant formula may rely on both science and faith. Knowledge from science safeguards individuals and society against 'milk bioactivity superstition'. Conversely, wisdom from faith-based convictions may protect science from unrealistic 'milk bioactivity scientism'. Honesty and transparency about the potentials and limitations of both scientific knowledge and faith convictions are important when informing individuals and society about the nutritious and bioactive qualities of milk.

Positionality statements in science.

The goal of this essay is to clarify positionality as an epistemological scientific concept and address related misunderstandings to help researchers assess whether statements thereof contribute to their work. Positionality statements can be useful for various research designs across scientific fields, when they are used knowingly.

Public discourse and wilful incommensurability: a case for attentive free speech.

Many thinkers lament the decline of liberal democracy. Some argue that, to rejuvenate it, we must think big. Thinking big involves generating new ideas about how to achieve an unprecedented level of social transformation aimed at cultivating solidarity, empowering citizen efficacy, and promoting the common good. We propose that fundamental to such a transformation must be a radical change in how people speak to one another. To this end, the primary objective of this paper is to offer a framework for understanding how speech currently erodes democratic engagement. The central idea is that much of speech today both reflects and perpetuates a culture of wilful incommensurability. The core features of this culture are totalizing safetyism, expressive safetyism, dismissive intransigence, and polarized alienation, all of which have been worsened by the current trajectory of social media. The result is that people are increasingly prone to engage in degraded free speech, which is characterized by a pervasive aversion to reach out, identify points of unity, benefit from diverse perspectives, and discover truth in all its potential complexity. In view of this diagnosis and the response of those who advocate for freedom of speech, a second objective of this paper is to introduce the concept of attentive free speech. Attentive free speech has similarities with civil discourse but is specifically characterized by discernment and thoughtfulness and is imbued with key dispositions such as courage, reverence, and love. We end by inviting future research into how such speech can promote the social and spiritual health of the public sphere and freedom itself at a practical level.

Epistemological aspects of participatory design studies conducted in the field of health science.

AIM(S): To discuss the methodological aspects of participatory design, arguing for a three-phase approach and the suitability of situating participatory design within a phenomenological-hermeneutical tradition in health science. DESIGN AND METHODS: Methodological discussion based on participatory design theory, epistemology and research studies. RESULTS: The epistemological and methodological discussions show how the core values and key elements of participatory design align with the phenomenological-hermeneutical approach. In addition, examples of participatory design studies are provided to illustrate how it can be conducted in health science. CONCLUSION: Participatory design is a flexible framework based on genuine participation, defined by three core values: having a say, mutual learning and democratization. The iterative processes allow for adjustments in alignment with the core values and the scientific stance that defines the choice of methods, tools and techniques. A phenomenological-hermeneutic approach in participatory design studies is relevant and aligned with the core values of participatory design. Thus, this paper argues for a close integration between the participatory design methodology and the phenomenological-hermeneutic scientific approach within health science. IMPLICATIONS FOR THE PROFESSION: Participatory design is a powerful methodology with core values that can co-design sustainable health technologies with potential to impact patient care and the clinical practice of nurses. When combined with qualitative research methods, patients' lived experiences serve as the foundation for improving clinical nursing practice. Discussing the epistemological aspects of participatory design provides nurse researchers with a coherent methodological understanding, essential for the continual development of nursing research. IMPACT: This paper discusses the research methodology of participatory design within health sciences. It aims to address the lack of understanding of the methodology, particularly within a specific scientific stance. The main finding is the elaboration on participatory design and the relevance of a phenomenological-hermeneutical approach. The paper has the potential to impact researchers, master's and PhD students, as well as others engaged in participatory design or other methodologies related to user involvement within health science. REPORTING METHOD: No available EQUATOR guidelines were applicable to this methodological paper, as no new data were created or analysed. PATIENT OR PUBLIC CONTRIBUTION: There was no direct patient or public contribution, as this is a methodological paper.

Epistemological Flexibility in Person-Centered Care: The Cynefin Framework for (Re)Integrating Indigenous Body Representations in Manual Therapy.

BACKGROUND: Chiropractic, osteopathy, and physiotherapy (COP) professionals regulated outside the United States traditionally incorporate hands-on procedures aligned with their historical principles to guide patient care. However, some authors in COP research advocate a pan-professional, evidence-informed, patient-centered approach to musculoskeletal care, emphasizing hands-off management of patients through education and exercise therapy. The extent to which non-Western sociocultural beliefs about body representations in health and disease, including Indigenous beliefs, could influence the patient-practitioner dyad and affect the interpretation of pillars of evidence-informed practice, such as patient-centered care and patient expectations, remains unknown. METHODS: our perspective paper combines the best available evidence with expert insights and unique viewpoints to address gaps in the scientific literature and inform an interdisciplinary readership. RESULTS: A COP pan-professional approach tends to marginalize approaches, such as prevention-oriented clinical scenarios traditionally advocated by osteopathic practitioners for patients with non-Western sociocultural health assumptions. The Cynefin framework was introduced as a decision-making tool to aid clinicians in managing complex clinical scenarios and promoting evidence-informed, patient-centered, and culturally sensitive care. CONCLUSION: Epistemological flexibility is historically rooted in osteopathic care, due to his Indigenous roots. It is imperative to reintroduce conceptual and operative clinical frameworks that better address contemporary health needs, promote inclusion and equality in healthcare, and enhance the quality of manual therapy services beyond COP's Western-centered perspective.

The Universal Optimism of the Self-Evidencing Mind.

Karl Friston's free-energy principle casts agents as self-evidencing through active inference. This implies that decision-making, planning and information-seeking are, in a generic sense, 'wishful'. We take an interdisciplinary perspective on this perplexing aspect of the free-energy principle and unpack the epistemological implications of wishful thinking under the free-energy principle. We use this epistemic framing to discuss the emergence of biases for self-evidencing agents. In particular, we argue that this elucidates an optimism bias as a foundational tenet of self-evidencing. We allude to a historical precursor to some of these themes, interestingly found in Machiavelli's oeuvre, to contextualise the universal optimism of the free-energy principle.

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?

Why your doctor is not an algorithm: Exploring logical principles of different clinical inference methods using liver transplantation as a model. / ¿Por qué mi médico no es un algoritmo? Fundamentos lógicos de los diferentes métodos de inferencia clínica a través del ejemplo del trasplante hepático.

The development of machine learning (ML) tools in many different medical settings is largely increasing. However, the use of the resulting algorithms in daily medical practice is still an unsolved challenge. We propose an epistemological approach (i.e., based on logical principles) to the application of computational tools in clinical practice. We rely on the classification of scientific inference into deductive, inductive, and abductive comparing the characteristics of ML tools with those derived from evidence-based medicine [EBM] and experience-based medicine, as paradigms of well-known methods for generation of knowledge. While we illustrate our arguments using liver transplantation as an example, this approach can be applied to other aspects of the specialty. Regarding EBM, it generates general knowledge that clinicians apply deductively, but the certainty of its conclusions is not guaranteed. In contrast, automatic algorithms primarily rely on inductive reasoning. Their design enables the integration of vast datasets and mitigates the emotional biases inherent in human induction. However, its poor capacity for abductive inference (a logical mechanism inherent to human clinical experience) constrains its performance in clinical settings characterized by uncertainty, where data are heterogeneous, results are highly influenced by context, or where prognostic factors can change rapidly.