QALYs in 2018—Advantages and Concerns | JAMA

The quality-adjusted life-year (QALY) is a health metric some people love to hate. Concerns include that QALYs are not patient focused,1 may be used as rationing tools by health insurers, and may be perceived as dehumanizing. The Affordable Care Act prohibits the Patient-Centered Outcomes Research Institute from using cost-per-QALY benchmarks. The use of QALYs by policy makers to inform coverage and reimbursement decisions is controversial.

However, QALYs are simply a metric to quantify health. Despite concerns, QALYs endure because they help address a difficult and unavoidable question: how to estimate and compare the benefits of what are often heterogeneous health interventions. Recently, QALYs have received increased interest in the United States from the work of the Institute for Clinical and Economic Review (ICER), a private, nonprofit organization that evaluates pharmaceuticals and other technologies and uses QALYs in its cost-effectiveness assessments. Thus, it remains important to appreciate the strengths and limitations of QALYs, why this metric is not going away, and what QALYs may portend for the future of health policy and medical practice.

How philosophy helped one soldier on the battlefield | Aeon Essays

When I attended the Royal Military Academy Sandhurst in 2002-3, the leadership training was excellent. It included discussion of the British Army’s values and the laws of armed conflict. However, I received no ethics training for the occasions when neither values nor laws would fully prepare me to make complex moral decisions in faraway fields populated by people with very different cultural norms. 

The then prime minister Tony Blair spoke at our pass-out parade just weeks after the invasion of Iraq. Dignitaries usually stop at every third or fourth person on parade to have a few words. Blair stopped at what seemed like every single officer cadet to speak, no doubt driven by good motivation, but inadvertently causing great pain for all on parade who had to stand there much longer than normal. He asked me what I would be doing in the Army. I told him I would be in intelligence. He said: ‘You will be busy.’ And he was right.

How Much Pain Should Animals Endure for Science? - The Atlantic

Each year, according to the U.S. Department of Agriculture, roughly 820,800 guinea pigs, dogs, cats, and other animals covered by the Animal Welfare Act are used in research in the United States; of those, about 71,370 are subjected to unalleviated pain. These stats don’t track the millions of mice and rats that are used in lab experiments and excluded from the animal protection law (although the rodents are covered by other federal regulations). Scientists and their institutions say they’re committed to keeping pain or distress to a minimum in lab animals where they can. But how do you know how much pain a mouse or a zebrafish feels? And who decides how much pain is too much?

The relentless honesty of Ludwig Wittgenstein | Ian Ground

If you ask philosophers – those in the English speaking analytic tradition anyway – who is the most important philosopher of the twentieth century, they will most likely name Ludwig Wittgenstein. But the chances are that if you ask them exactly why he was so important, they will be unable to tell you. Moreover, in their own philosophical practice it will be rare, certainly these days, that they mention him or his work. Indeed, they may very fluently introduce positions, against which Wittgenstein launched powerful arguments: the very arguments which, by general agreement, make him such an important philosopher. Contemporary philosophers don’t argue with Wittgenstein. Rather they bypass him. Wittgenstein has a deeply ambivalent status – he has authority, but not influence.

For the more general reader, Wittgenstein’s status in contemporary philosophy will be puzzling. The general view is that Wittgenstein is surely the very model of a great philosopher. The perception is that he is difficult, obscure and intense, severe and mystical, charismatic and strange, driven and tragic, with his charisma and difficulty bound up with his character and his life. Wittgenstein saw philosophy not just as a vocation, but as a way of life he had to lead. This is perhaps why writers and artists have found him an object of fascination and inspiration. He is the subject of novels, poetry, plays, painting, music, sculpture and films. In the arts and the culture generally, Wittgenstein seems to be what a philosopher ought to be.

Is This the World’s Most Bizarre Scholarly Meeting? - The Chronicle of Higher Education

Start with Noam Chomsky, Deepak Chopra, and a robot that loves you no matter what. Add a knighted British physicist, a renowned French neuroscientist, and a prominent Australian philosopher/occasional blues singer. Toss in a bunch of psychologists, mathematicians, anesthesiologists, artists, meditators, a computer programmer or two, and several busloads of amateur theorists waving self-published manuscripts and touting grand unified solutions. Send them all to a swanky resort in the desert for a week, supply them with lots of free coffee and beer, and ask them to unpack a riddle so confounding that it’s unclear how to make progress or where you’d even begin.

Then just, like, see what happens.

Why scientists created a human-chicken hybrid embryo

One of the biggest mysteries of human life is how we develop from a tiny ball of cells into a being with bones, muscle and organs. The process starts inside the mother’s womb shortly after conception, but legal and regulatory restrictions on research involving human embryonic tissue have stymied scientists’ efforts to explain the process.

Now scientists have found a workaround. By transplanting human embryonic cells onto chicken embryos, researchers at Rockefeller University in New York City have created a hybrid embryo that they say will bring insights into fetal development — and perhaps lead to new cures for several diseases — without bumping up against the so-called “14-day rule” that prohibits research on human embryos more than two weeks old.

The popular media blasted the interspecies mash-up, with one headline reading “Half human-half chicken abomination created in US lab," even though no one is talking about creating a race of human-chicken beings. And the scientists defend their work, saying the hybrid embryo will help them understand why some human cells grow into the brain and nervous system, for example, while others form the trunk and limbs.

Act of love: The life and death of Donna Mae Hill - The Globe and Mail

The morning of May 17, 2018, my mother ate her last meal in the breakfast room of the Passage, a hotel in downtown Basel, Switzerland. Mom had black coffee, a croissant and a piece of cheese. She lingered over a small chocolate truffle that I had picked out for her at 7 a.m. that day in a store in the old quarter of the city. My mother had always had a weakness for chocolate and I had a weakness for indulging her.

Then we waited for Ruedi Habegger to pick us up at the hotel and drive us to the designated apartment in nearby Liestal, Switzerland, where people go to die.

Mr. Habegger – an affable, middle-aged man who co-founded the Eternal Spirit Foundation, an organization which facilitates assisted deaths – offered my mother the use of a walker to get up a flight of stairs when we arrived.

“I still walk perfectly well,” she told him, although she held the railing carefully as she mounted the stairs. Five foot zero, hazel eyes, a white shock of hair and in practical black shoes, my mother climbed slowly but steadily.

Mom died that day. Her name was Donna Mae Hill, and she was 90 years old. She died by her own hand. I was present for her death, along with her 29-year-old granddaughter, my niece Malaika; we had travelled with her to Switzerland to comfort her in the act.

The Consciousness Deniers | by Galen Strawson

What is the silliest claim ever made? The competition is fierce, but I think the answer is easy. Some people have denied the existence of consciousness: conscious experience, the subjective character of experience, the “what-it-is-like” of experience. Next to this denial—I’ll call it “the Denial”—every known religious belief is only a little less sensible than the belief that grass is green.

The Denial began in the twentieth century and continues today in a few pockets of philosophy and psychology and, now, information technology. It had two main causes: the rise of the behaviorist approach in psychology, and the naturalistic approach in philosophy. These were good things in their way, but they spiraled out of control and gave birth to the Great Silliness. I want to consider these main causes first, and then say something rather gloomy about a third, deeper, darker cause. But before that, I need to comment on what is being denied—consciousness, conscious experience, experience for short.

Confronting a manifest injustice: chimpanzee rights | Impact Ethics

The New York Court of Appeals recently denied a motion for permission to appeal submitted by the Nonhuman Rights Project in their effort to see two chimpanzees, Kiko and Tommy, who are currently living alone, transferred to an adequate chimpanzee sanctuary. I was a co-author, in addition to sixteen other philosophers, of a philosophers’ brief that supported the Nonhuman Rights Project’s motion. Though it was denied, Judge Eugene Fahey, one of five judges who ruled on the motion, submitted a striking concurring opinion to explain his decision. Here are some of the details.

Judge Fahey’s decision to deny the Nonhuman Rights Project’s motion was not based on the merits of their case. Indeed, he indicates his discomfort with the initial ruling of the Appellate Division of the New York Supreme Court. Judge Fahey implies that, had he been a judge charged with making the initial ruling, the legal journey may well have been quite different (with, presumably, a more favorable result for Kiko and Tommy).

On Being an Arsehole: A defense | The Point Magazine

A few months into a cushy postdoctoral fellowship at Princeton, where the walls were a soothing yellow and poached salmon was a staple, it dawned on me that I could reasonably be considered an arsehole. This wasn’t the first time the thought had occurred to me: after all, I am the kind of Brit who insists on the difference between a donkey, otherwise known as an ass, and a backside, otherwise known as an arse. But on this occasion my reflection was prompted not by looking in the mirror or by hearing a recording of my voice but by the experience of being a philosopher in a non-philosophical setting. Calling yourself a philosopher already makes you sound a bit of an arse, but the fact remains that I have spent most of my professional life studying, discussing, writing and teaching philosophy—and it is this, I submit, that has made me liable to appear a right royal arsehole.

Panitch: Time to decriminalize payment for sperm, ova and surrogacy | Ottawa Citizen

A private member’s bill has just been proposed that would eliminate Canada’s prohibition on payment for sperm, ova and surrogacy. And it’s about time. The bill, brought forward by Liberal MP Anthony Housefather, takes aim at Canada’s Assisted Human Reproduction Act (AHRA). According to the Act, “trade in the reproductive capabilities of women and men, and the exploitation of children, women and men for commercial ends, raise health and ethical concerns that justify their prohibition.”

Housefather’s bill repudiates this claim, and rightly so. Why should Canadian citizens suffering from infertility be denied the same opportunity to build a family that fertile Canadians enjoy? Bans on payment for sperm, ova and surrogacy decrease the opportunities of Canadians with fertility issues, and of those in the LGBTQ2 community to build families, and this is unfair.

William Saletan: Stop talking about race and IQ. Take it from someone who did.

The race-and-IQ debate is back. The latest round started a few weeks ago when Harvard geneticist David Reich wrote a New York Times op-ed in defense of race as a biological fact. The piece resurfaced Sam Harris’ year-old Waking Up podcast interview with Charles Murray, co-author of The Bell Curve, and launched a Twitter debate between Harris and Vox’s Ezra Klein. Klein then responded to Harris and Reich in Vox, Harris fired back, and Andrew Sullivan went after Klein. Two weeks ago, Klein and Harris released a two-hour podcast in which they fruitlessly continued their dispute.

I’ve watched this debate for more than a decade. It’s the same wreck, over and over. A person with a taste for puncturing taboos learns about racial gaps in IQ scores and the idea that they might be genetic. He writes or speaks about it, credulously or unreflectively. Every part of his argument is attacked: the validity of IQ, the claim that it’s substantially heritable, and the idea that races can be biologically distinguished. The offender is denounced as racist when he thinks he’s just defending science against political correctness.

I know what it’s like to be this person because, 11 years ago, I was that person. I saw a comment from Nobel laureate James Watson about the black-white IQ gap, read some journal articles about it, and bought in. That was a mistake. Having made that mistake, I’m in no position to throw stones at Sullivan, Harris, or anyone else. But I am in a position to speak to these people as someone who understands where they’re coming from. I believe I can change their thinking, because I’ve changed mine, and I’m here to make that case to them. And I hope those of you who find this whole subject vile will bear with me as I do.

Court ruling denies appeal for chimpanzees Tommy and Kiko, but not their rights | Big Think

On May 8, 2018, the New York Court of Appeals Decision once again denied the Nonhuman Rights Project’s (NhRP) petition to appeal a lower court’s ruling on the fate of chimpanzees Tommy and Kiko. Though nominally a defeat, the remarkable concurring opinion by the court’s Associate Judge Eugene M. Fahey constitutes a major step forward, a victory in and of itself. The NhRP characterizes it in its press release as “an historic mark of progress in the fight to secure fundamental legal rights for nonhuman animals.” The opinion begins: "The inadequacy of the law as a vehicle to address some of our most difficult ethical dilemmas is on display in this matter."

The NhRP has been trying to convince New York State courts that the two chimpanzees have a right to habeas corpus protection, and has been seeking permission to have the two relocated from the small, squalid cages in which they’re being held to the Save the Chimps sanctuary in Florida. The court’s problem has been that habeas corpus protection is available only to persons. Given that there are only two possible classifications for the chimps from a legal point of view—as either persons or things—the NhRP has been so-far unsuccessfully trying to persuade the court to bestow legal personhood on Tommy and Kiko. After all, as Fahey writes in his opinion, "While it may be arguable that a chimpanzee is not a ‘person,’ there is no doubt that it is not merely a thing." The judge says further, "The reliance on a paradigm that determines entitlement to a court decision based on whether the party is considered a ‘person’ or relegated to the category of a ‘thing’ amounts to a refusal to confront a manifest injustice."

No death and an enhanced life: Is the future transhuman? | Technology | The Guardian

The aims of the transhumanist movement are summed up by Mark O’Connell in his book To Be a Machine, which last week won the Wellcome Book prize. “It is their belief that we can and should eradicate ageing as a cause of death; that we can and should use technology to augment our bodies and our minds; that we can and should merge with machines, remaking ourselves, finally, in the image of our own higher ideals.”

The idea of technologically enhancing our bodies is not new. But the extent to which transhumanists take the concept is. In the past, we made devices such as wooden legs, hearing aids, spectacles and false teeth. In future, we might useimplants to augment our senses so we can detect infrared or ultraviolet radiation directly or boost our cognitive processes by connecting ourselves to memory chips. Ultimately, by merging man and machine, science will produce humans who have vastly increased intelligence, strength, and lifespans; a near embodiment of gods.

Opinion | It’s Westworld. What’s Wrong With Cruelty to Robots? - The New York Times

Suppose we had robots perfectly identical to men, women and children and we were permitted by law to interact with them in any way we pleased. How would you treat them?

That is the premise of “Westworld,” the popular HBO series that opened its second season Sunday night. And, plot twists of Season 2 aside, it raises a fundamental ethical question we humans in the not-so-distant future are likely to face.

From Westworld to the Rest of the World: Time to Regulate the Mining of Third Party Data |

You do not have control over your ideas, your passions, or even your DNA anymore. Your biological material and your ideas may be taken without your awareness of it. You do not need to consent anymore, for people to take the products of your body or mind. This fact was highlighted in the Season 2 premiere of HBO’s Westworld, a show that echoes many of our high tech, dystopian fears of AI, robotics, and humans relieved of their civil veneer.

Before the show premiered in 2016, their website had a hidden “Terms of Use” for anyone who expressed interest in visiting the fictional park (a great marketing gimmick). According to Slate, under section 7(b):

“The terms state that once you enter Westworld, the company “controls the rights to and remains the sole owner of, in perpetuity: all skin cells, bodily fluids, secretions, excretions, hairsamples, saliva, sweat, blood, and any other bodily functions not listed here.” What’s more, it reserves the right to “use this property in any way, shape, or form in which the entity sees fit.””

In the latest premiere, we see a faceless drone swabbing the genitals of a robot (yes, robots have genitals in this world; a robot who presumably entertaineda human guest). The drone then sequences the sample’s DNA. What the terms of use suggests is that this amusement park is collecting biological samples from guests along with information about where they went and what activities they engaged in. As one of the main characters says, ““Are we logging records of guest experiences and their DNA?”” Since the right to do that is buried in the Terms of Use, the answer to that question is yes.

Scientists Project Holograms Into The Brain To Create Experiences

One day soon you may be filling your lungs with crisp ocean air, your arms bathed in warm light as the sun sets over softly lapping waters and you may wonder, is this real? Or are scientists projecting holograms into my brain to create a vivid sensory experience that isn’t actually happening? A group of researchers at University of California, Berkeley are in the early stages of testing their ability to create, edit and scrub sensory experiences from our brains, both real-time and stored experiences–memories.

The Tragic Case of Alfie Evans - Quillette

Three days after Tom and Kate Evans abandoned their legal fight, their son Alfie has died. Both parents have shown immense courage over the past months and in the final few days they have demonstrated a quiet dignity as Alfie’s death approached.

Inevitably, as he lay dying many have been moved by his plight. In some quarters, this has unfortunately led to denunciations of the doctors, the judges, and the legal system. Ill-informed and prominent voices—from America, in particular—have variously blamed his death on secularism, or the NHS, or ‘government death panels.’ Others in the UK have called for an ‘Alfie’s law’ designed to give parents greater rights over the treatment of their children.

It is at times of the greatest emotion that calls for changes in the law can be at their most seductive and ill-advised, and so it is now. Who, after all, would wish for another case like Alfie Evans or Charlie Gard? The law, and particularly the legal system, is certainly not faultless, but well-intentioned calls to give parents more legal rights over these terrible end of life decisions are fundamentally mistaken.

When Death Is Not the End – The Economist – Medium

Shalom Ouanounou was declared dead in September. The 25-year-old Canadian had suffered an asthma attack so severe that he was taken to hospital in Ontario where he was put on a ventilator. After carrying out tests, doctors found that his brain lacked functions such as consciousness and respiratory reflexes. They issued a death certificate and prepared to disconnect the medical equipment.

Mr Ouanounou would have been declared dead in the same way in almost all rich countries. They tend to treat irreversible loss of all of the brain’s function as constituting death. American states typically demand evidence that the whole brain has stopped working, for example a lack of intracranial blood flow, but there is no national protocol. Britain requires only the death of the brainstem, which runs between the spinal cord and the rest of the brain, and regulates reflexes and functions such as breathing. (Advocates for using brainstem death say it is a proxy for whole-brain death, though others disagree.)

In practice, the question of when someone is dead rarely arises. The heart and lungs usually shut down around the same time as the brain. The lack of pulse and breath is generally considered a biological marker for brain death, not an alternative to it. But determining when death occurs might matter for all sorts of reasons: when is someone widowed? When should a company pay out life insurance? Even, when should a new president be sworn in? As Lainie Ross, a doctor and bioethicist at the University of Chicago, says: “We can’t have someone being considered dead by some people and alive by others.”

Researchers are keeping pig brains alive outside the body - MIT Technology Review

In a step that could change the definition of death, researchers have restored circulation to the brains of decapitated pigs and kept the reanimated organs alive for as long as 36 hours.

The feat offers scientists a new way to study intact brains in the lab in stunning detail. But it also inaugurates a bizarre new possibility in life extension, should human brains ever be kept on life support outside the body.

The work was described on March 28 at a meeting held at the National Institutes of Health to investigate ethical issues arising as US neuroscience centers explore the limits of brain science.

During the event, Yale University neuroscientist Nenad Sestan disclosed that a team he leads had experimented on between 100 and 200 pig brains obtained from a slaughterhouse, restoring their circulation using a system of pumps, heaters, and bags of artificial blood warmed to body temperature.