A blog from the Centre for Research Ethics & Bioethics (CRB)

Author: Pär Segerdahl (Page 8 of 42)

Can consumers help counteract antimicrobial resistance?

Antimicrobial resistance (AMR) occurs when microorganisms (bacteria and viruses, etc.) survive treatments with antimicrobial drugs, such as antibiotics. However, the problem is not only caused by unwise use of such drugs on humans. Such drugs are also used on a large scale in animals in food production, which is a significant cause of AMR.

In an article in the journal Frontiers in Sustainable Food Systems, Mirko Ancillotti and three co-authors discuss the possibility that food consumers can contribute to counteracting AMR. This is a specific possibility that they argue is often overlooked when addressing the general public.

A difficulty that arises when AMR needs to be handled by several actors, such as authorities, food producers, consumers and retailers, is that the actors transfer the responsibility to the others. Consumers can claim that they would buy antibiotic-smart goods if they were offered in stores, while retailers can claim that they would sell such goods if consumers demanded them. Both parties can also blame how, for example, the market or legislation governs them. Another problem is that if one actor, for example the authorities, takes great responsibility, other actors feel less or no responsibility.

The authors of the article propose that one way out of the difficulty could be to influence consumers to take individual responsibility for AMR. Mirko Ancillotti has previously found evidence that people care about antibiotic resistance. Perhaps a combination of social pressure and empowerment could engage consumers to individually act more wisely from an AMR perspective?

The authors make comparisons with the climate movement and suggest digital innovations in stores and online, which can inform, exert pressure and support AMR-smarter food choices. One example could be apps that help consumers see their purchasing pattern, suggest product alternatives, and inform about what is gained from an AMR perspective by choosing the alternative.

Read the article with its constructive proposal to engage consumers against antimicrobial resistance: The Status Quo Problem and the Role of Consumers Against Antimicrobial Resistance.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Ancillotti, Mirko; Nilsson, Elin; Nordvall, Anna-Carin; Oljans, Emma. The Status Quo Problem and the Role of Consumers Against Antimicrobial Resistance. Frontiers in Sustainable Food Systems, 2022.

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Approaching future issues

Fact resistance, human nature and contemplation

Sometimes we all resist facts. I saw a cyclist slip on the icy road. When I asked if it went well, she was on her feet in an instant and denied everything: “I did not fall!” It is human to deny facts. They can hurt and be disturbing.

What are we resisting? The usual answer is that fact-resistant individuals or groups resist facts about the world around us, such as statistics on violent crime, on vaccine side effects, on climate change or on the spread of disease. It then becomes natural to offer resistance to fact resistance by demanding more rigour in the field of knowledge. People should learn to turn more rigorously to the world they live in! The problem is that fact-resistant attitudes do just that. They are almost bewitched by the world and by the causes of what are perceived as outrageous problems in it. And now we too are bewitched by fact resistance and speculate about the causes of this outrageous problem.

Of course, we believe that our opposition is justified. But who does not think so? Legitimate resistance is met by legitimate resistance, and soon the conflict escalates around its double spiral of legitimacy. The possibility of resolving it is blocked by the conflict itself, because all parties are equally legitimate opponents of each other. Everyone hears their own inner voices warning them from acknowledging their mistakes, from acknowledging their uncertainty, from acknowledging their human resistance to reality, as when we fall off the bike and wish it had never happened. The opposing side would immediately seize the opportunity! Soon, our mistake is a scandal on social media. So we do as the person who slipped on the icy road, we deny everything without thinking: “I was not wrong, I had my own facts!” We ignore the fact that life thereby becomes a lie, because our inner voices warn us from acknowledging our uncertainty. We have the right to be recognized, our voices insist, at least as an alternative to the “established view.”

Conflicts give us no time for reflection. Yet, there is really nothing stopping us from sitting down, in the midst of conflict, and resolving it within ourselves. When we give ourselves time to think for ourselves, we are freer to acknowledge our uncertainty and examine our spirals of thought. Of course, this philosophical self-examination does not resolve the conflict between legitimate opponents which escalates around us as increasingly impenetrable and real. It only resolves the conflict within ourselves. But perhaps our thoughtful philosophical voice still gives a hint of how, just by allowing us to soar in uncertainty, we already see the emptiness of the conflict and are free from it?

If we more often dared to soar in uncertainty, if it became more permissible to say “I do not know,” if we listened more attentively to thoughtful voices instead of silencing them with loud knowledge claims, then perhaps fact resistance also decreases. Perhaps fact resistance is not least resistance to an inner fact. To a single inner fact. What fact? Our insecurity as human beings, which we do not permit ourselves. But if you allow yourself to slip on the icy road, then you do not have to deny that you did!

A more thoughtful way of being human should be possible. We shape the societies that shape us.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

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We care about communication

Illness prevention needs to be adapted to people’s illness perceptions

Several factors increase the risk of cardiovascular disease. Many of these we can influence ourselves through changes in lifestyle or preventive drug treatment. But people’s attitudes to prevention vary with their perceptions of cardiovascular disease. Health communication to support preventive measures therefore needs to take into account people’s illness perceptions.

Åsa Grauman and three colleagues conducted an online survey with 423 randomly selected Swedes aged 40 to 70 years. Participants were asked to answer questions about themselves and about how they view cardiovascular disease. They then participated in an experiment designed to capture how they weighted their preferences regarding health check results.

The results showed a wide variety of perceptions about cardiovascular disease. Women more often cited stress as their most important risk factor while men more often cited overweight and obesity. An interesting result is that people who stated that they smoked, had hypertension, were overweight or lived sedentary, tended to downplay that factor as less risky for cardiovascular disease. On the other hand, people who stated that they experienced stress had a tendency to emphasize stress as a high risk of cardiovascular disease. People who reported family history as a personal risk of illness showed a greater reluctance to participate in health examinations.

Regarding preferences about health check results, it was found that the participants preferred to have their results presented in everyday words and with an overall assessment (rather than, for example, in numbers). They also preferred to get the results in a letter (rather than by logging in to a website) that included lifestyle recommendations, and they preferred 30 minutes of consultation (over no or only 15 minutes of consultation).

It is important to reach out with the message that the risk of cardiovascular disease can be affected by lifestyle changes, and that health checks can identify risk factors in people who are otherwise asymptomatic. Especially people with a family history of cardiovascular disease, who in the study were more reluctant to undergo health examinations, may need to be aware of this.

To reach out with the message, it needs to be adapted to how people perceive cardiovascular disease, and we need to become better at supporting correct perceptions, the authors conclude. I have mentioned only a small selection of results from the study. If you want to see the richness of results, read the article: Public perceptions of myocardial infarction: Do illness perceptions predict preferences for health check results.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Åsa Grauman, Jennifer Viberg Johansson, Marie Falahee, Jorien Veldwijk. 2022, Public perceptions of myocardial infarction: Do illness perceptions predict preferences for health check results. Preventive Medicine Reports 26, https://doi.org/10.1016/j.pmedr.2021.101683

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Exploring preferences

Images of good and evil artificial intelligence

As Michele Farisco has pointed out on this blog, artificial intelligence (AI) often serves as a projection screen for our self-images as human beings. Sometimes also as a projection screen for our images of good and evil, as you will soon see.

In AI and robotics, autonomy is often sought in the sense that the artificial intelligence should be able to perform its tasks optimally without human guidance. Like a self-driving car, which safely takes you to your destination without you having to steer, accelerate or brake. Another form of autonomy that is often sought is that artificial intelligence should be self-learning and thus be able to improve itself and become more powerful without human guidance.

Philosophers have discussed whether AI can be autonomous even in another sense, which is associated with human reason. According to this picture, we can as autonomous human beings examine our final goals in life and revise them if we deem that new knowledge about the world motivates it. Some philosophers believe that AI cannot do this, because the final goal, or utility function, would make it irrational to change the goal. The goal is fixed. The idea of such stubbornly goal-oriented AI can evoke worrying images of evil AI running amok among us. But the idea can also evoke reassuring images of good AI that reliably supports us.

Worried philosophers have imagined an AI that has the ultimate goal of making ordinary paper clips. This AI is assumed to be self-improving. It is therefore becoming increasingly intelligent and powerful when it comes to its goal of manufacturing paper clips. When the raw materials run out, it learns new ways to turn the earth’s resources into paper clips, and when humans try to prevent it from destroying the planet, it learns to destroy humanity. When the planet is wiped out, it travels into space and turns the universe into paper clips.

Philosophers who issue warnings about “evil” super-intelligent AI also express hopes for “good” super-intelligent AI. Suppose we could give self-improving AI the goal of serving humanity. Without getting tired, it would develop increasingly intelligent and powerful ways of serving us, until the end of time. Unlike the god of religion, this artificial superintelligence would hear our prayers and take ever-smarter action to help us. It would probably sooner or later learn to prevent earthquakes and our climate problems would soon be gone. No theodicy in the world could undermine our faith in this artificial god, whose power to protect us from evil is ever-increasing. Of course, it is unclear how the goal of serving humanity can be defined. But given the opportunity to finally secure the future of humanity, some hopeful philosophers believe that the development of human-friendly self-improving AI should be one of the most essential tasks of our time.

I read all this in a well-written article by Wolfhart Totschnig, who questions the rigid goal orientation associated with autonomous AI in the scenarios above. His most important point is that rigidly goal-oriented AI, which runs amok in the universe or saves humanity from every predicament, is not even conceivable. Outside its domain, the goal loses its meaning. The goal of a self-driving car to safely take the user to the destination has no meaning outside the domain of road traffic. Domain-specific AI can therefore not be generalized to the world as a whole, because the utility function loses its meaning outside the domain, long before the universe is turned into paper clips or the future of humanity is secured by an artificially good god.

This is, of course, an important philosophical point about goals and meaning, about specific domains and the world as a whole. The critique helps us to more realistically assess the risks and opportunities of future AI, without being bewitched by our images. At the same time, I get the impression that Totschnig continues to use AI as a projection screen for human self-images. He argues that future AI may well revise its ultimate goals as it develops a general understanding of the world. The weakness of the above scenarios was that they projected today’s domain-specific AI, not the general intelligence of humans. We then do not see the possibility of a genuinely human-like AI that self-critically reconsiders its final goals when new knowledge about the world makes it necessary. Truly human-equivalent AI would have full autonomy.

Projecting human self-images on future AI is not just a tendency, as far as I can judge, but a norm that governs the discussion. According to this norm, the wrong image is projected in the scenarios above. An image of today’s machines, not of our general human intelligence. Projecting the right self-image on future AI thus appears as an overall goal. Is the goal meaningful or should it be reconsidered self-critically?

These are difficult issues and my impression of the philosophical discussion may be wrong. If you want to judge for yourself, read the article: Fully autonomous AI.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Totschnig, W. Fully Autonomous AI. Sci Eng Ethics 26, 2473–2485 (2020). https://doi.org/10.1007/s11948-020-00243-z

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We like critical thinking

Individualized treatment from the patient’s perspective

Individualized treatment, where the right patient receives the right dose of the right drug at the right time, could be interpreted as a purely medical task. After genetic and other tests on the patient, the doctor assesses, from a medical point of view, which drug for the disease and which dose should work most effectively and most safely for the patient in question.

Individualization can also be interpreted to include the patient’s perceptions of the treatment, the patient’s own preferences. Rheumatoid arthritis is a disease with many different symptoms. Several drugs are available that have different effects on different symptoms, as well as different side effects. In addition, the drugs are administered in different ways and at different intervals. Of course, all of these drug attributes affect the patients’ daily lives differently. A drug may reduce pain effectively, but cause depression, and so on. In individualized treatment of rheumatoid arthritis, there are therefore good reasons to ask patients what they consider to be important drug attributes and what they want their treatment to aim for.

In a study in Clinical Rheumatology, Karin Schölin Byvall and five co-authors prepare for individualized treatment of rheumatoid arthritis from the patient’s perspective. Their hope is to facilitate not only joint decision-making with patients who have the disease, but also future quantitative studies of preferences in the patient group.

This is how the authors (very simplified) proceeded. A literature review was first performed to identify possible relevant drug attributes. Subsequently, patients in Sweden with rheumatoid arthritis ranked nine of these attributes. In a third step, some of the patients were interviewed in more detail about how they perceived the most important attributes.

In a final step, the interview results were structured in a framework with four particularly relevant drug attributes. The first two are about improved ability to function physically and psychosocially in everyday life. The latter two are about serious and mild side effects, respectively. In summary, the most important drug attributes, from the patients’ perspective, are about improved ability to function in everyday life and about acceptable side effects.

If you want to know more about the study, read the article: Functional capacity vs side effects: treatment attributes to consider when individualizing treatment for patients with rheumatoid arthritis.

The authors emphasize the importance of considering patients’ own treatment goals. Individualized treatment not only requires medical tests, but may also require studies of patient preferences.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Bywall, K.S., Esbensen, B.A., Lason, M. et al. Functional capacity vs side effects: treatment attributes to consider when individualising treatment for patients with rheumatoid arthritis. Clin Rheumatol (2021). https://doi.org/10.1007/s10067-021-05961-8

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In dialogue with patients

Digital twins, virtual brains and the dangers of language

A new computer simulation technology has begun to be introduced, for example, in the manufacturing industry. The computer simulation is called a digital twin, which challenges me to bring to life for the reader what something that sounds so imaginative can be in reality.

The most realistic explanation I can find actually comes from Harry Potter’s world. Do you remember the map of Hogwarts, which not only shows all the rooms and corridors, but also the steps in real time of those who sneak around the school? A similar map can be easily created in a computer environment by connecting the map in the computer to sensors in the floor of the building that the map depicts. Immediately you have an interactive digital map of the building that is automatically updated and shows people’s movements in it. Imagine further that the computer simulation can make calculations that predict crowds that exceed the authorities’ recommendations, and that it automatically sends out warning messages via a speaker system. As far as I understand, such an interactive digital map can be called a digital twin for an intelligent house.

Of course, this is a revolutionary technology. The architect’s drawing in a computer program gets extended life in both the production and maintenance of the building. The digital simulation is connected to sensors that update the simulation with current data on relevant factors in the construction process and thereafter in the finished building. The building gets a digital twin that during the entire life cycle of the building automatically contacts maintenance technicians when the sensors show that the washing machines are starting to wear out or that the air is not circulating properly.

The scope of use for digital twins is huge. The point of them, as I understand it, is not that they are “exact virtual copies of reality,” whatever that might mean. The point is that the computer simulation is linked to the simulated object in a practically relevant way. Sensors automatically update the simulation with relevant data, while the simulation automatically updates the simulated object in relevant ways. At the same time, users, manufacturers, maintenance technicians and other actors are updated, who easily can monitor the object’s current status, opportunities and risks, wherever they are in the world.

The European flagship project Human Brain Project plans to develop digital twins of human brains by building virtual brains in a computer environment. In a new article, the philosophers Kathinka Evers and Arleen Salles, who are both working in the project, examine the enormous challenges involved in developing digital twins of living human brains. Is it even conceivable?

The authors compare types of objects that can have digital twins. It can be artefacts such as buildings and cars, or natural inanimate phenomena such as the bedrock at a mine. But it could also be living things such as the heart or the brain. The comparisons in the article show that the brain stands out in several ways, all of which make it unclear whether it is reasonable to talk about digital twins of human brains. Would it be more appropriate to talk about digital cousins?

The brain is astronomically complex and despite new knowledge about it, it is highly opaque to our search for knowledge. How can we talk about a digital twin of something that is as complex as a galaxy and as unknown as a black hole? In addition, the brain is fundamentally dynamically interactive. It is connected not only with the body but also with culture, society and the world around it, with which it develops in uninterrupted interaction. The brain almost merges with its environment. Does that imply that a digital twin would have to be a twin of the brain-body-culture-society-world, that is, a digital twin of everything?

No, of course not. The aim of the project is to find specific medical applications of the new computer simulation technology. By developing digital twins of certain aspects of certain parts of patients’ brains, it is hoped that one can improve and individualize, for example, surgical procedures for diseases such as epilepsy. Just as the map from Harry Potter’s world shows people’s steps in real time, the digital twin of the brain could follow the spread of certain nerve impulses in certain parts of the patient’s brain. This can open up new opportunities to monitor, diagnose, predict and treat diseases such as epilepsy.

Should we avoid the term digital twin when talking about the brain? Yes, it would probably be wiser to talk about digital siblings or digital cousins, argue Kathinka Evers and Arleen Salles. Although experts in the field understand its technical use, the term “digital twin” is linguistically risky when we talk about human brains. It easily leads the mind astray. We imagine that the digital twin must be an exact copy of a human’s whole brain. This risks creating unrealistic expectations and unfounded fears about the development. History shows that language also contains other dangers. Words come with normative expectations that can have ethical and social consequences that may not have been intended. Talking about a digital twin of a mining drill is probably no major linguistic danger. But when it comes to the brains of individual people, the talk of digital twins can become a new linguistic arena where we reinforce prejudices and spread fears.

After reading some popular scientific explanations of digital twins, I would like to add that caution may be needed also in connection with industrial applications. After all, the digital twin of a mining drill is not an “exact virtual copy of the real drill” in some absolute sense, right down to the movements of individual atoms. The digital twin is a copy in the practical sense that the application makes relevant. Sometimes it is enough to copy where people put their feet down, as in Harry Potter’s world, whose magic unexpectedly helps us understand the concept of a digital twin more realistically than many verbal explanations do. Explaining words with the help of other words is not always clarifying, if all the words steer thought in the same direction. The words “copy” and “replica” lead our thinking just as right and just as wrong as the word “twin” does.

If you want to better understand the challenges of creating digital twins of human brains and the importance of conceptual clarity concerning the development, read the philosophically elucidatory article: Epistemic Challenges of Digital Twins & Virtual Brains: Perspectives from Fundamental Neuroethics.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Evers, Kathinka & Salles, Arleen. (2021). Epistemic Challenges of Digital Twins & Virtual Brains: Perspectives from Fundamental Neuroethics. SCIO: Revista de Filosofía. 27-53. 10.46583 / scio_2021.21.846

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Minding our language

Inspired

What does it mean to be inspired by someone? Think of these inspired music albums where artists lovingly pay tribute to a great musician by making their own interpretations of the songs. These interpretations often express deep gratitude for the inspiration received from the musician. We can feel similar gratitude to inspiring people in many different areas.

Why are we inspired by inspiring people? Here is a tempting picture. The person who inspires us has something that we lack. To be inspired is to want what the inspiring person has: “I also want to be able to…”; “I want to be as good as…” and so on. That is why we imitate those who inspire us. That is why we train hard. By imitating, by practicing, the inspiring person’s abilities can be transferred to us who lack them.

This could be called a pneumatic picture of inspiration. The inspiring one is, so to speak, an air tank with overpressure. The rest of us are tanks with negative pressure. The pressure difference causes the inspiration. By imitating the inspiring person, the pressure difference is evened out. The pressure migrates from the inspiring to the inspired. We inhale the air that flows from the tank with overpressure.

This picture is certainly partly correct, but it is hardly the whole truth about inspiration. I am not a musician. There is a big difference in pressure between me and any musician. Why does this pressure difference not cause inspiration? Why do I not start imitating musicians, training hard so that some of the musicians’ overpressure is transferred to me?

The pneumatic picture is not the whole truth, other pictures of inspiration are possible. Here is one. Maybe inspiration is not aroused by difference, not by the fact that we lack what the inspiring person has. Perhaps inspiration is aroused by similarity, by the fact that we sense a deep affinity with the one who inspires us. When we are inspired, we recognize ourselves in the one who inspires us. We discover something we did not know about ourselves. Seeds that we did not know existed in us begin to sprout, when the inspiring person makes us aware that we have the same feeling, the same passion, the same creativity… At that moment, the inspiration is aroused in us.

In this alternative picture of inspiration, there is no transfer of abilities from the inspiring one to the inspired ones. Rather, the abilities grow spontaneously in the inspired ones themselves, when they sense their affinity with the inspiring one. In the inspiring person, this growth has already taken place. Creativity has had time to develop and take shape, so that the rest of us can recognize ourselves in it. This alternative image of inspiration also provides an alternative image of human history in different areas. We are familiar with historical representations of how predecessors inspired their successors, as if the abilities of the predecessors were transferred horizontally in time. In the alternative picture, history is not just horizontal. Above all, it has a vertical depth dimension in each of us. Growing takes place vertically in each new generation, much like seeds sprout in the earth and grow towards the sky. History is, in this alternative image, a series of vertical growing, where it is difficult to distinguish the living creativity in the depth dimension from the imitation on the surface.

Why am I writing a post about inspiration? Apart from the fact that it is inspiring to think about something as vital as inspiration, I want to show how unnoticed we make pictures of facts. We do not see that it is actually just pictures, which could be replaced by completely different pictures. I learned this from the philosopher Ludwig Wittgenstein, who inspired me to examine philosophical questions myself: questions which surprisingly often arise because we are captured in our images of things. Our captivity in certain images prevents us from seeing other possibilities and obvious facts.

In addition, I want to show that it really makes a difference if we are caught in our pictures of things or open to the possibility of completely different pictures. It has been a long time since I wrote about ape language research on this blog, but the attempt to teach apes human language is an example of what a huge difference it can make, if we free ourselves from a picture that prevents us from seeing the possibility of other pictures.

Attempts to teach apes human language were based on the first picture, which highlights the difference between the one who inspires and the one who is inspired. It was thought that because apes lack the language skills that we humans have, there is only one way to teach apes human language. We need to transfer the language skills horizontally to the apes, by training them. This “single” opportunity failed so clearly, and the failure was so well-documented, that only a few researchers were subsequently open to the results of a markedly more successful, at least as well-documented experiment, which was based on the alternative picture of inspiration.

In the alternative experiment, the researchers saw an opportunity that the first picture made it difficult to see. If apes and humans live together daily in a closely united group, so that they have opportunities to sense affinities with each other, then language seeds that we did not know existed in apes could be inspired to sprout and grow spontaneously in the apes themselves. Vertically within the apes, rather than through horizontal transmission, as when humans train animals. In fact, this alternative experiment was so successful that it resulted in a series of spontaneous language growths in apes. As time went on, new-born apes were inspired not only by the humans in the group, but also by the older apes whose linguistic creativity had taken shape.

If you want to read more about this unexpected possibility of inspiration between species, which suggests unexpected affinities, as when humans are inspired by each other, you will find a book reference below. I wrote the book a long time ago with William M. Fields and Sue Savage-Rumbaugh. Both have inspired me – for which I am deeply grateful – for example, in this blog post with its alternative picture of inspiration. That I mention the book again is because I hope that the time is ripe for philosophers, psychologists, anthropologists, educationalists, linguists, neuroscientists and many others to be inspired by the unexpected possibility of human-inspired linguistic creativity in our non-human relatives.

To finally connect the threads of music and ape language research, I can tell you that two great musicians, Paul McCartney and Peter Gabriel, have visited the language-inspired apes. Both of them played music with the apes and Peter Gabriel and Panbanisha even created a song together. Can we live without inspiration?

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Segerdahl, P., Fields, W. & Savage-Rumbaugh, S. 2005. Kanzi’s Primal Language. The Cultural Initiation of Primates into Language. Palgrave Macmillan

Segerdahl, P. 2017. Can an Ape Become Your Co-Author? Reflections on Becoming as a Presupposition of Teaching. In: A Companion to Wittgenstein on Education. Pedagogical Investigations. Peters, M. A. and Stickney, J. (Eds.). Singapore: Springer, pp. 539-553

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We write about apes

Co-authorship when not everyone’s research is included in the paper

Questions about authorship are among the most sensitive professional issues for researchers. Apart from the fact that researchers live and make careers on their publications, it is important for scientific and research ethical reasons to know who is responsible for the content of the publications.

A feature of research that can create uncertainty about who should be counted as a co-author of a scientific publication is that such publications usually report research that has mainly already been carried out when the paper is being written. Many researchers may have contributed to the research work, but only a few of them may contribute to the writing of the paper. Should everyone still be counted as an author? Or just those who contribute to the writing of the paper?

The International Committee of Medical Journal Editors (ICMJE) has formulated a recommendation that creates greater clarity. Simplified, the recommendation is the following. Authorship can be given to researchers who clearly meet four criteria. You must: (1) have made substantial contributions to the research study (e.g., designing the study, or collecting, analysing and interpreting data); (2) have contributed to drafting the paper and revising its intellectual content; (3) have approved the final version of the article; (4) have agreed to be responsible for all aspects of the work by ensuring that issues of accuracy and integrity are investigated.

Furthermore, it is recommended that researchers who meet criterion (1) should be invited to participate in the writing process, so that they can also meet criteria (2)(4) and thus be counted as co-authors.

However, research does not always go according to plan. Sometimes the plans need to be adjusted during the research process. This may mean that one of the researchers has already made a significant research effort when the group decides not to include that research in the writing of the paper. How should co-authorship be handled in such a situation, when someone’s results fall out of the publication?

The issue is discussed by Gert Helgesson, Zubin Master and William Bülow in the journal Science and Engineering Ethics. Considering, among other things, how easily disagreement about authorship can disrupt the dynamics of a research group, it is important that there is an established order concerning authorship, which handles situations such as this.

The discussion in the article is based on an imaginary, concrete case: A research group includes three younger researchers, Ann, Bo and Choi. They have all been given individual responsibility for different parts of the planning and execution of the empirical work. They work many hours in the laboratory. When the research group sees the results, they agree on the content of the article to be written. It then turns out that Ann’s and Bo’s analyses are central to the idea in the article, while Choi’s analyses are not. Choi’s results are therefore not included in the article. Should Choi be included as a co-author?

We can easily imagine Choi contributing to the writing process, but what about criterion (1)? If Choi’s results are not described in the article, has she made a significant contribution to the published research study? Helgesson, Master and Bülow point out that the criterion is ambiguous. Of course, making a significant contribution to a research study can mean contributing to the results that are described in the article. But it can also mean contributing to the research process that leads up to the article. The former interpretation excludes Choi as co-author. The latter interpretation makes co-authorship possible for Choi.

The more inclusive interpretation is not unreasonable, as research is a partially uncertain exploratory process. But do any strong reasons support that interpretation? Yes, say Helgesson, Master and Bülow, who state two types of reasons. Firstly, it is about transparency and accountability: what happened and who was involved? Excluding Choi would be misleading. Secondly, it is a matter of proper recognition of merit and of fairness. Choi worked as hard in the laboratory as Ann and Bo and contributed as much to the research that led to the article. Of course, the purpose of the article changed during the process and Choi’s contribution became irrelevant to the content of the article. But her efforts were still relevant to the research process that led up to the article. She also did a good job as a researcher in the group: it seems unfair if her good work by chance should not be recognized in the same way as the other researchers’ work.

The proposal in the article is therefore that the first criterion for authorship should be interpreted as a significant contribution to the research process leading up to the article, and that this should be clarified in the recommendation.

The article also discusses possible counter-arguments to the more inclusive interpretation of the authorship recommendation. If you want to study the reasoning more closely and form your own opinion, read the article: How to Handle Co-authorship When Not Everyone’s Research Contributions Make It into the Paper.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Helgesson, G., Master, Z. & Bülow, W. How to Handle Co-authorship When Not Everyone’s Research Contributions Make It into the Paper. Sci Eng Ethics 27, 27 (2021). https://doi.org/10.1007/s11948-021-00303-y

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Conceptual analysis when we get stuck in thoughts

When philosophers are asked what method we use when we philosophize, we are happy to answer: our most important method is conceptual analysis. We apply conceptual analysis to answer philosophical questions such as “What is knowledge?”, “What is justice?”, “What is truth?” What we do is that we propose general definitions of the concepts, which we then fine-tune by using concrete examples to test that the definitions really capture all individual cases of the concepts and only these.

The problem is that both those who ask for the method of philosophy and those who answer “conceptual analysis” seem to assume that philosophy is not challenged by deeply disturbing problems, but defines concepts almost routinely. The general questions above are hardly even questions, other than purely grammatically. Who lies awake wondering “What is knowledge, what is justice, what is truth, what is goodness, what is…?”

In order to get insomnia from the questions, in order for the questions to become living philosophical problems, in order for us to be disturbed by them, we need more than only generally formulated questions.

Moreover, if there was such a thing as a method of answering philosophical questions, then the questions should already have been answered. I mean, if we since the days of Socrates had a method that answers philosophical “What is?”-questions by defining concepts, then there cannot be many questions left to answer. At most, we can refine the definitions, or apply the method to concepts that did not exist 2600 years ago. Basically, philosophy should not have many questions left to be challenged by. Since ancient times, we have a well-proven method!

To understand why philosophers continue to wonder, we need to understand why questions that superficially sound so uninteresting that we fall asleep can sometimes be so deeply perplexing that we lie awake thinking. Let me give you an example that gives a glimpse of the depths of philosophy, a glimpse of that disturbing “extra” that keeps philosophers awake at night.

The example is a “Swedish” disease, which has attracted attention around the world as something very strange. I am thinking of what was first called apathy in refugee children, but which later got the name resignation syndrome. The disease affects certain groups of children seeking asylum in Sweden. Children from the former Yugoslavia and from Central Asian countries of the former Soviet Union have been overrepresented. The children lose physical and mental functions and in the end can neither move nor communicate. They become bedridden, do not respond to pain and must be fed by tube. More than 1000 children have been affected by the disease in Sweden since the 1990s.

Confronted with this disease in refugee children, it may seem natural to think that the condition is reasonably caused by traumatic experiences in the home country and during the flight, as well as by the stress of living under deportation threat. It is not unreasonable to think so. Trauma and stress probably contribute to the disease. There is only one problem. If this were the cause, then resignation syndrome should occur in refugee children in other parts of the world as well. Unfortunately, refugee children with traumatic experiences and stressful deportation threats are not only found in Sweden. So why are (certain groups of) refugee children affected by the syndrome in Sweden in particular?

What is resignation syndrome? Here we have a question that on the surface does not sound more challenging than any other generally formulated “What is?”-question. But the question is today a challenging philosophical problem, at least for Karl Sallin, who is writing his dissertation on the syndrome here at CRB, within the framework of the Human Brain Project. What is that “extra” element that makes the question philosophically challenging for Karl Sallin?

It may seem natural to think that the challenging aspect of the question is simply that we do not yet know the answer. We do not know all the facts. It is not unreasonable to think so. Lack of knowledge naturally contributes to the question. Again, there is only one problem. We already consider ourselves knowing the answer! We think that this extreme form of despair in refugee children must, of course, be caused by traumatic experiences and by the stress that the threat of deportation entails. In the end, they can no longer bear it, but give up! If this reasonable answer were correct, then resignation syndrome should not exist only in Sweden. The philosophical question thus arises because the only reasonable answer conflicts with obvious facts.

That is why the question is philosophically challenging. Not because we do not know the answer. But because we consider ourselves to know what the answer must be! The answer seems so reasonable that we should hardly need to do more research on the matter before we take action by alleviating the children’s stressful situation, which we think is the only possible cause of the syndrome. And that is what happened…

For some years now, the guidelines for Swedish health care staff have emphasized the family’s role in recovery, as well as the importance of working for a residence permit. The guidelines are governed by the seemingly reasonable idea that children’s recovery depends on relieving the stress that causes the syndrome. Once again, there is only one problem. The guidelines never had a positive effect on the syndrome, despite attempts to create peace and stability in the family and work for a residence permit. The syndrome continued to be a “Swedish” disease. Why is the condition so stubbornly linked to Sweden?

Do you see the philosophical problem? It is not just about lack of knowledge. It is about the fact that we already think we have knowledge. The thought that the cause must be stress is so obvious, that we hardly notice that we are thinking it. It seems immediately real. In short, we have got stuck in our own thoughts, which we repeat again and again, even though we repeatedly clash with obvious facts. Like a mosquito trying to get out of a window, but just crashing, crashing, crashing.

When Karl Sallin treats the issue of resignation syndrome as a philosophical issue, he does something extremely unusual, for which there are no routine methods. He directs his attention not only outwards towards the disease, but also inwards towards ourselves. More empirical research alone does not solve the problem. As little as continuing to collide with the glass pane solves the mosquito’s problem. We need to stop and examine ourselves.

This post has now become so long that I have to stop before I can describe Karl Sallin’s dissolution of the mystery. Maybe it is good that we are not rushing forward. Riddles need time, which our impatient intellect rarely gives them. The point about the method of philosophy has hopefully become clear. The reason why philosophers analyse concepts is that we humans sometimes get caught up in our own concepts of reality. In this case, we get stuck in our concept of resignation syndrome as a stress disorder. Perhaps I can still mention that Karl Sallin’s conceptual analysis of our thought pattern about the syndrome dissolves the feeling of being faced with an incomprehensible mystery. The syndrome is no longer in conflict with obvious facts. He also shows that our thought patterns may have contributed to the disease becoming so prominent in Sweden. Our publically stated belief that the disease must be caused by stress, and our attempts to cure the disease by relieving stress, created a cultural context where this “Swedish” disease became possible. The cultural context affected the mind and the brain, which affected the biology of the body. In any case, that is what Karl Sallin suggests: resignation syndrome is a culture-bound disease. This unexpected possibility frees us from the thought we were stuck in as the only alternative.

So why did Socrates ask questions in Athens 2600 years ago? Because he discovered a method that could answer philosophical questions? My guess is that he did it for the same reason that Karl Sallin does it today. Because we humans have a tendency to imagine that we already know the answers. When we clearly see that we do not know what we thought we knew, we are freed from repeatedly colliding with a reality that should be obvious.

In philosophy, it is often the answer that is the question.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Sallin, K., Evers, K., Jarbin, H., Joelsson, L., Petrovic, P. (2021) Separation and not Residency Permit Restores Function in Resignation Syndrome: A Retrospective Cohort Study. Eur Child Adolesc Psychiatry, 10.1007/s00787-021-01833-3

Sallin, K., Lagercrantz, H., Evers, K., Engström, I., Hjern, A., Petrovic, P. (2016) Resignation Syndrome: Catatonia? Culture-Bound? Frontiers in Behavioral Neuroscience, 10:7. 10.3389/fnbeh.2016.00007

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We challenge habits of thought

Our individual responsibility for antibiotic resistance

Antibiotic resistance is a global threat to public health, as the chances of treating infections decrease when antibiotics lose their effect on bacterial growth. But who is responsible for antibiotic resistance and what is the responsibility?

We may believe that the problem is too big and complex for us as individuals. Antibiotic resistance is a problem for governments and international organizations, we think. Nevertheless, it is not least our individual use of antibiotics that drives the development. For example, we may take antibiotics when it is not really necessary, or perhaps we do not follow the doctor’s prescription but discontinue the antibiotic treatment prematurely and throw leftover pills in the dustbin. Then we go on a journey and spread bacteria that are resistant to the antibiotic that we did not use properly. Or we ignore getting vaccinated because we think that there are antibiotics if we get sick. Well, maybe not for long!

If we have an individual moral responsibility to act with awareness of environmental problems, then it is not unreasonable to think that we also have a responsibility to act with awareness of the antibiotic problem. Mirko Ancillotti (who recently defended his dissertation at CRB) examines this possibility in an article in Bioethics. Do we have an individual moral responsibility for antibiotic resistance and how should the responsibility be understood?

Mirko Ancillotti immediately points out that not all people have the same opportunities to improve their antibiotic behaviour. Apart from the fact that many people lack information about antibiotic resistance, not everyone finds it as easy to change their antibiotic use. Some have less access than others to correctly prescribed treatments, for example, if they live far from a hospital but can easily buy antibiotics without a prescription. In addition, not everyone has the same financial means to stay at home if they are ill.

Another thing that makes it difficult to talk about individual responsibility for antibiotic resistance, is that you can hardly determine how much the pills you threw in the dustbin actually contributed to the problem. We know that people die due to antibiotic resistant bacteria, but it is difficult to determine the consequences of your particular antibiotic behaviour.

For these reasons, Mirko Ancillotti proposes a virtue ethical concept of responsibility. He suggests that we as individuals cultivate personal qualities and habits, which support responsible antibiotic use as a virtue. If I understand him, this means cultivating certain norms about antibiotics use, which we try to meet, such as following the doctor’s prescription, not using antibiotics unless necessary, not persuading the doctor to prescribe antibiotics, and making sure that we are vaccinated. However, since the conditions for acting with this normative sensitivity vary with human circumstances, there is in many cases a need to improve the conditions and institutional support for responsible antibiotic use.

A comparison: We have learned that we should preferably not travel by air, that it is irresponsible and perhaps even shameful to fly if it is not necessary. To be able to meet this new norm, new societal conditions are needed in the form of better international train connections and simpler ticketing systems. In the same way, new normative sensitivities regarding antibiotics can be developed, simultaneously with improving the opportunities for meeting the norms, Mirko Ancillotti suggests.

If you want to read more about Mirko Ancillotti’s virtue ethical concept of an individual responsibility for antibiotic resistance, read the article in Bioethics: Individual moral responsibility for antibiotic resistance.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Ancillotti, M., Nihlén Fahlquist, J., & Eriksson, S. (2021). Individual moral responsibility for antibiotic resistance. Bioethics, 1– 7. https://doi.org/10.1111/bioe.12958

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