Saturday, October 23, 2010

Virtue Epistemology and Democracy (Part 1)

For the past month I have been busy working on completing a draft of a new paper on virtue epistemology and democracy. So I thought I would "float" a couple of the ideas I am developing in a series of blog posts here.

The literature on virtue epistemology has really taken off in the past few years. "Virtue epistemology" is the name given to theories that make intellectual agents and communities the primary source of epistemic value and the primary focus of epistemic evaluation(source). The main work that influences the argument I am developing is Zagzebski's Virtues of the Mind (and also Greco's Achieving Knowledge).

The attractive feature of virtue epistemology is that, much like virtue ethics, it places the primary emphasis on intellectual agents and communities. And so I think it would be fruitful to explore what virtue epistemology might have to offer political theorists in terms of offering an epistemic defence of (Deweyan) democracy.

So first, some context. The motivation for writing this paper comes from my interest in formulating a response to Estlund's excellent work Democratic Authority. Estlund argues that his goal is to show that “a concern for the quality of political decisions, properly constrained by other principles, supports democratic arrangements”(1). Let’s call this the central goal (CG) of Estlund’s book. His strategy for establishing CG is to argue (a) that democracy has modest epistemic value (i.e. it is better than a coin flip), and (b) that democratic outcomes are legitimate and authoritian in a purely procedural way, by advancing a proceduralist view called “epistemic proceduralism”.

For Estlund, the key question to answer is not “How is democracy the best epistemic device available?”, but rather “How can democracy have some epistemic value in a way that could account for the degree of authority we think it should have?” (7).

Contra Estlund, I believe the key question to answer is “How is democracy the best epistemic device available?”; and it is in answering this question that an attractive and plausible defence of the authority of democracy can be developed.

The strategy I propose for answering this question is a virtue-epistemological one. Adopting a virtue-epistemological approach to the issue of the “epistemic fitness” of democracy has, I believe, many distinct advantages.

In this paper I explore four distinct advantages:

1. because intellectual agents and communities are the primary focus of epistemic evaluation, virtue epistemology offers political theorists the opportunity to develop an epistemic defence of democracy that takes “realism” seriously (e.g. the cognitive limitations and biases of humans).

2. because virtue epistemology conceives of epistemology as a normative discipline, it builds normative criteria into the exercise of assessing the “epistemic fitness” of a political arrangement (e.g. democracy vs epistocracy).

3. by assessing the epistemic powers of democracy from a virtue-epistemological perspective, a more robust (Deweyan) conception of democracy needs to be employed and assessed than the “minimalist” conception employed by the Condorcet Jury Theorem defence.

4. adopting a virtue-epistemological approach provides the basis for an attractive way of linking the epistemic and authoritarian aspects of democracy.

I will have more to say about these points in future posts, but for now let me say something about the "realism" constraint (1).

Estlund eschews taking the constraints of realism too seriously, and comments that “Realism is a vague and dubious constraint when the question is a moral one, when the question at hand is what is right, or just, or legitimate” (15). But if the moral theory we begin from is a virtue-oriented theory, then the constraints of realism will not be viewed as dubious constraints. Quite the opposite. Grappling with these empirical considerations is central to the moral exercise as virtue ethics is a moral theory that is primarily concerned with “how one should live or what kind of person one should be rather than the question of how one should act” (Crisp, 23). One cannot determine how they should live, or what kind of person they should be, if one’s moral analysis does not take place against the background of the context of the realities of the society or world the agent inhabits. So a virtue ethics approach will be much more accommodating of “realism” and have some distinct benefits in terms of the kind of “aspirational theory” it yields.

What kinds of realism constraints do I think an epistemic defence of democracy should seriously consider? I address a variety of cognitive limitations and biases (e.g. our reliance on the availability heuristic, group polarization and prospection errors) which make it clear that the legacy of our Darwinian history is such that humans do not naturally excel in the intellectual virtues. These limitations and biases were good enough for us to ensure the continuity of the species (i.e. survival and reproduction), but we often come up well sort of intellectual excellence. That is the bad news.

The good news is that we have a plastic brain that can, in particular kinds of environments, realize epistemic excellence. And the key is to then figure out which kinds of environments are most conducive to our realizing intellectual virtue rather than vice. This is an empirical issue. And I believe the empirical evidence points us in the direction of--- democracy.

As I will explain in a future post, the conception of democracy I have in mind is not the "minimalist" conception employed by the Condorcet Jury Theorem. The kind of environment needed to help facilitate intellectual virtue is not the kind envisioned by equating democracy with just a form of government (i.e. majority rules). Rather, the kind of environment needed is, to quote Dewey, "a mode of associated living, of conjoint communicated experience". More on this to follow.


Wednesday, October 20, 2010

Your Love is My Drug (...apparently it really is!)

"Your Love is My Drug" is the title of a popular song these days. And a recent paper published in PLoS One seems to substantiate the thesis that love is in fact a drug. More specifically, it can function as a painkiller.

The abstract of the study:

The early stages of a new romantic relationship are characterized by intense feelings of euphoria, well-being, and preoccupation with the romantic partner. Neuroimaging research has linked those feelings to activation of reward systems in the human brain. The results of those studies may be relevant to pain management in humans, as basic animal research has shown that pharmacologic activation of reward systems can substantially reduce pain. Indeed, viewing pictures of a romantic partner was recently demonstrated to reduce experimental thermal pain. We hypothesized that pain relief evoked by viewing pictures of a romantic partner would be associated with neural activations in reward-processing centers. In this functional magnetic resonance imaging (fMRI) study, we examined fifteen individuals in the first nine months of a new, romantic relationship. Participants completed three tasks under periods of moderate and high thermal pain: 1) viewing pictures of their romantic partner, 2) viewing pictures of an equally attractive and familiar acquaintance, and 3) a word-association distraction task previously demonstrated to reduce pain. The partner and distraction tasks both significantly reduced self-reported pain, although only the partner task was associated with activation of reward systems. Greater analgesia while viewing pictures of a romantic partner was associated with increased activity in several reward-processing regions, including the caudate head, nucleus accumbens, lateral orbitofrontal cortex, amygdala, and dorsolateral prefrontal cortex – regions not associated with distraction-induced analgesia. The results suggest that the activation of neural reward systems via non-pharmacologic means can reduce the experience of pain.

And the Globe has the scoop on the findings here. A sample:

“At moderate pain levels, it is very effective. It is at least the equivalent as Tylenol 3, which has a little bit of codeine it in. I don’t know if it would beat out OxyContin, but it could be very close,’’ says Jarred Younger, an assistant professor of anesthesia at Stanford University in Palo Alto, Calif. Dr. Younger recruited volunteers who were in the heady first months of a romantic relationship for a brain-imaging study on love and pain.

Previous research has shown that looking at the photo of a romantic partner can reduce the amount of physical pain someone feels, but this is the first to show the brain regions involved. Love turns on reward circuitry in the brain, as do drugs such as cocaine or codeine, Dr. Younger said. Those drugs kick-start the body’s analgesic systems, he said, and stop pain signals from leaving the spinal cord for the brain."


Wednesday, October 13, 2010

Stratified Medicine: The Dawn of a New Era in Medicine

For the most part, medicine has been deployed on a "one type fits all" mentality to prevent/treat disease. There are of course exceptions and provisos to this. The age or relative health of a patient is often taken into consideration when deciding which course of treatment will be the most safe and effective for a particular patient. A person's medical history (e.g. adverse reactions to a particular treatment, allergies) or lifestyle (e.g. smoker) is also relevant to determining which specific treatment is best for a patient. But beyond those kinds of considerations, prescribing X to treat person Y was based on the evidence that X has proven to be an effective treatment for other people suffering the same thing that afflicts person Y.

But the genetic revolution has opened up a new door of "personalized medicine" that permits doctors to tailor treatments to their patients based on knowledge about their specific biology. And so X might be prescribed for person Y because it has proven to be a safe and effective treatment for a group of people who share the same specific genetic mutations that person Y has. This could increase the safety and efficacy of medical treatment.

Nature@news has this interesting story about how the UK unveiled plans this week to utilize broad genetic testing for selected cancer patients. As the story notes, "this form of 'stratified medicine' uses genetic information to group patients according to their likely response to a particular treatment". A sample from the story:

....The tests, which will look for several dozen mutations in about a dozen genes linked to cancer, will be carried out on people with lung, breast, colorectal, prostate or ovarian cancers, or metastatic melanoma, who are being treated at six NHS hospitals. Therapies that target specific tumour-causing mutations have already been approved, or are on the verge of approval, for most of these conditions, says Peach.

....Peach hopes that the first phase of the cancer programme will pave the way for expanding genetic testing to more patients and other conditions, such as diabetes, AIDS and even psychiatric disorders. Cancer offers a good testing ground for personalized medicine, because numerous targeted therapies already exist, but "there's no reason why this should be restricted to cancer", says Peach.


Tuesday, October 12, 2010

First Clinical Trial of Human Embryonic Stem Cell-Based Therapy

This news release, from Geron, marks an important and bold step forward for the medical sciences. The first clinical trial of human embryonic stem cell-based therapy is now underway and, as a phase 1 trial, will assess the safety and tolerability of the therapy.

I look forward to seeing how things progress with this trial.


Friday, October 08, 2010

David vs Goliath

*originally posted Nov. 2009*

The story of humanity is a fascinating and inspiring one.

Despite the great adversity our species has, and continues to, face, we are capable of great compassion, imagination and inspiration. Indeed, it is perhaps these human traits that have helped us overcome the almost insurmountable obstacles we have faced in our species' evolutionary history.

What we are today reflects the challenges we have had to overcome in the past. From our two eyes and two hands, to our emotions like love, hope and fear, we are a complex history of biological and, more recently, cultural evolution. The inhospitable and unpredictable environments in which our species lived has given us aggression and compassion, emotion and reason, fear and happiness.

To help us overcome starvation we developed tools for hunting and farming. To help us overcome infectious disease we created the sanitation revolution and vaccinations. Our ability overcome diverse and complex forms of adversity is admirable.

The history of humanity is thus one of struggle (with all of its accompanying tragedy) but also one of hope (with all of its accompanying inspiration). Hope for a better state of affairs. One where humans have more opportunities to enjoy health, love and happiness. This aspiration to make things better is, I believe, what makes us truly human. And it is an aspiration that links us to our distant ancestors.

The title of this post is "David vs Goliath". Humanity is David, and Goliath represents all the things that have, and continue to, challenge the health and welfare of humans. The specific form of Goliath alters over time. Reflecting on the causes of death in the 20th Century, for example, we see that Goliath was warfare (including two World Wars), totalitarianism, and, most importantly, infectious disease. The Flu pandemic of 1918, for example, killed an estimated 50 000 000 people, which is more than 3 times the estimated number of deaths caused by four years of “Great War” in 1914-18. And small pox is estimated to have killed between 300 and 500 million people in just the 20th century.

In the 21st century, Goliath is CHRONIC DISEASE (e.g. cancer, heart disease, stroke, etc.). Just 1 year of chronic disease today kills as many people as 300 years of the Black Plague.

In the decade from 2005 and 2015, the World Health Organization estimates that 220 million people will die from chronic illness, 144 million of these deaths will be in lower middle income countries like China and India.

To slay the Goliath of today humanity must be more compassionate, more imaginative, and more inspiring than it has been in the past. Slaying Goliath in the 21st century will require, I believe, an aggressive effort to understand the biology of aging, and then the development of interventions that modulate the rate of aging, so that humans can enjoy more disease-free life and a compression of morbidity at the end of life.

Why we age, and become frail and diseased, is a legacy of our evolutionary history. In short, because life in the state of nature was "nasty, brutish and short" the force of natural selection does not apply to the post-reproductive period of the human lifespan. So most disease and death today are caused by evolutionary neglect. And given the size of today's aged populations, unprecedented numbers of humans will suffer the ravages of chronic disease.

The vision of David battling Goliath came to me today as I happened across the following video this morning and was deeply moved by it. It is an interview with J.M. Smith, an evolutionary biologist who died in 2004. While a student Smith studied fruit fly genetics with J.B. Haldane.

In this interview Smith discusses the illness and death of his teacher, who died of cancer. This brief video moved me in many ways. It captures the human ability to display humour and determination in the face of adversity, as well as love and friendship. It captures humanity's most redeemable qualities, as told by one the greatest scientists of the 20th century.

It is only fitting to quote a passage from Haldane's famous poem on cancer:

I wish I had the voice of Homer
To sing of rectal carcinoma
Which kills a lot more chaps in fact,
Than were bumped off when Troy was sacked

To slay Goliath this century we must build on the work of great minds like Haldane and Smith. We must transcend the "disease model" approach to the medical sciences, and develop Darwinian medicine.

And aging research is at the frontier of this more robust and ambitious vision of medicine. Modifying the biological clocks we have inherited from our Darwinian past would be this century's most important advance in public health. For age retardation would help protect the 2 billion people who will be over the age of 60 by 2050 from the chronic diseases that currently ravage unprecedented numbers of aged people in the world today. In order for this biological revolution to occur we must also undergo a cultural revolution. We need a rational and humane culture. We need more compassion, more imagination and more (new sources of) inspiration.

And we all have a moral responsibility to help spur on this cultural revolution and become 21st century humanists.


Monday, October 04, 2010

Noble Prize in Medicine (2010)

This year's Noble prize in medicine has been awarded to Robert Edwards for the development of IVF. Here is an excerpt from the press release:

Robert Edwards is awarded the 2010 Nobel Prize for the development of human in vitro fertilization (IVF) therapy. His achievements have made it possible to treat infertility, a medical condition afflicting a large proportion of humanity including more than 10% of all couples worldwide.

As early as the 1950s, Edwards had the vision that IVF could be useful as a treatment for infertility. He worked systematically to realize his goal, discovered important principles for human fertilization, and succeeded in accomplishing fertilization of human egg cells in test tubes (or more precisely, cell culture dishes). His efforts were finally crowned by success on 25 July, 1978, when the world's first "test tube baby" was born. During the following years, Edwards and his co-workers refined IVF technology and shared it with colleagues around the world.

Approximately four million individuals have so far been born following IVF. Many of them are now adult and some have already become parents. A new field of medicine has emerged, with Robert Edwards leading the process all the way from the fundamental discoveries to the current, successful IVF therapy. His contributions represent a milestone in the development of modern medicine.