The Paris, COP 21, Climate Change Policy Deal

The news's just flowing out of Paris that a global deal on climate change policy has been struck. The draft agreement (as it is called), can be found here. As so many agreements at this level it is virtually unreadable for a lay person, and the first 19 pages are only about the background, earlier deals and formal stuff about adoption, how to sign up, etc.

The real stuff – the actual deal – starts in the so-called Annex, on page 20, and on page 21, in article 2, we find the nitty-gritty:

Article 2

1. This Agreement, in enhancing the implementation of the Convention, including its objective, aims to strengthen the global response to the threat of climate change, in the context of sustainable development and efforts to eradicate poverty, including by: 

(a) Holding the increase in the global average temperature to well below 2 °C above pre-industrial levels and to pursue efforts to limit the temperature increase to 1.5 °C above pre-industrial levels, recognizing that this would significantly reduce the risks and impacts of climate change;

(b) Increasing the ability to adapt to the adverse impacts of climate change and foster climate resilience and low greenhouse gas emissions development, in a manner that does not threaten food production;

(c) Making finance flows consistent with a pathway towards low greenhouse gas emissions and climate-resilient development. 

2. This Agreement will be implemented to reflect equity and the principle of common but differentiated responsibilities and respective capabilities, in the light of different national circumstances.

The rest is detail. Not unimportant, as it stresses, e.g., the strong responsibility of rich countries to present the main bankrolling regarding mitigation, adaption, compensation,  technology transfer, etc. But article 2 is what sets the level of political ambition: the point of all the rest. The fact that the agreement has now clearly stood against all attempts to abandon the 2°C target for a higher one, has now been not only been scrapped, but reversed to aim for a lower level is very good news for anyone who has inspected the dire global consequences in all areas of life and society of already a 2°C rise of the global temperature.

Addendum Re. Using Medical Methods to Determine the Age of Unaccompanied Refugee Children

After my post on this issue a few days ago, I've debated the issue with a number of people from within medicine and also bioethics in different fora.

Due to the presence of significant uncertainties of the methods debated, my suggestion was that use of this methods should be amended by the following methodological rule (assuming 18 to be the age of adulthood, if it is different we may simply insert another variable for that):

... for any method, M, for the assessment of the age of a person, P, with a margin of error +/- X years, M is taken to indicate adulthood if, and only if, its result is 18+X years or higher, and otherwise taken to indicate childhood

Here are a few points that may be added to the complexities of this particular issue:

1. The nature of the uncertanties
Some have argued to me that the methods are not only uncertain in a way possible to describe in terms of a margin of error. One reason for this put to me is that besides the usual margin of error within the dimension of a variable, there is also the background confidence interval behind this margin, and the known effect of having this confidence deteriorate considerably when aggregated population probabilities are projected onto individual cases. I, of course, do not deny that there is also this source of uncertainty, but as far as I can see, my formula above can easily include that: X can be the aggregation of both these uncertainties (this was my original thought as well). This probably means that X becomes considerably larger than 4 (the number used in the example in the original post, based on claims by critics of the model). However, this in no way undermines my suggestion, as this will probably mean that all unaccompanied refugee children will most likely be determined to be children (and, if there are any people like that, in addition a number of refugee adults who falsely claim to be children). That is, the best interest of children, as well as the proper priority of legal provisions is upheld. Suppose, for instance, that the margin of error, accounting for all sources of uncertainty, becomes +/- 15 years. Then my rule says that P is to be considered an adult if, and only if, M finds P to be 33 years or more.

Another claim has been that some of the methods depend on the existence of relevant tables and charts or background data, and that such are missing in this case, meaning that the methods are not really uncertain, there is no method at all. The bewildering thing is that the same people are at the same time officially repeating the argument that the methods are uncertain and have unacceptably wide margins of error. These two claims are, of course, inconsistent; if it's not possible to have any result at all, there is no margin of error, and if there is a margin of error there is some results that create this margin. If it turns out that, in fact, the variable X (accounting for all kinds of sources of uncertainty), cannot be given any empirically based numerical estimate, I concede that my rule is inapplicable. However, if even an interval numerical estimate can be grounded, my rule can be used, by simply adding (supported by the same basic principles as before) that, the high extreme of this interval should be used to define X (in order to err in the right direction). Again, this may mean that the method will determine all tested as children, but, as already argued, it is difficult to see what the ethical or legal problem with that would be.

2. Professional Health Care Ethics and Ethics
Another aspect that has been raised is the fact that my suggestions means that health care professionals pragmatically accommodate to flawed public policies in the best interest of concerned parties (i.e. the children). This is wrong, some say, health care professionals should demand to regulate themselves and never do anything they themselves collegially don't find suitable to do, not even if this is harming third parties. Some have even gone so far at to claim that it is irresponsible of a health care professional to ever act the slightest in any other interest than his or her patient's.

The latter would, of course, mean that we would have to abandon all public health practices, communicable disease management, forensic medicine, large segments of insurance and sports medicine, and not least the involvement of doctors in issuing certificates underlying decisions by public authorities, such as sick leave or work-related disability benefits, and so on. Since health care professional organisations have as yet made no move whatsoever in such directions, I trust that this is not the line underlying the criticism in the present case. In other words, formalised professional health care ethics already accepts a number of cases where medical methods are used to other ends than the best interest of patients and many of these uses are being pragmatically accommodated to still make the best out of an imperfect thing. A very clear illustration is the assessment of "ability to work" nowadays made routinely by medical doctors in many countries, strategically adapted not to harm their patients while still abiding by required formalities.

It is thus unclear to what extent the principle of never doing anything to right the wrongs of public policies is a part of professional health care ethics. Even more unclear is if, had it been such a part, it would have been ethically defensible. To illustrate with the issue at hand, suppose that the health care professional community was to refuse to participate in the practice decided by the Swedish government. This may have three outcomes: (a) the government and parliament creates a legal room for some other class of officials to use the methods (not using my rule), (b) no method is used, (c) alternative suggested methods based on psychological models are used.

• If (c) is the outcome, the issue reappears, as also these methods can be expected to have margins of error, sources of uncertainty and so on. Then my rule can be used to secure that determinations err in the right direction.

• If (a) is the outcome, the results for the persons concerned, namely the children, is worse than if the profession had chosen to participate, using my rule to secure that they act solely in the best interest of the children, although also accommodating societal requests.

• If (b) is the outcome, the situation stands that unaccompanied refugee children where there is uncertainty as to whether or not they are children, will not be given their rights as children.

Now, compare this with (d): health professionals decide to pragmatically accommodate, and use the methods, amended by my rule.

• If (d) is the outcome, the concerned children's interests and Sweden's legal needs are better served than if any of (a) and (b). If these children are seen as patients, it would then be in their best interest to go for (d) rather than (a) or (b). If there is an option (c), this is even better, provided that my rule is used, but if not it may be better for the patients to go for (d).

3. The Ethics of Clean Hands, Politics of Power and Professional Integrity as Strategic Tool
Against this form of reasoning, some debaters I've talked to have claimed that the downsides for refugee children of the options (a) and (b) (as well as (c) without my rule) cannot be laid at the door of health professionals, but is the sole moral responsibility of the government. That is, they apply the standard of an "ethics of clean hands", denouncing responsibility for bad outcomes they could have avoided by acting differently just because the same is true of some other acting party (here, the government). This is like when the car driver, displeased with the rule that gives pedestrians priority at crosswalks, blames the government while electing to run people over, who cross motivated by the rule. Not very splendid ethics, I'd say.

Another version of this reasoning instead comes in the form of a political power bidding in the name of professional autonomy. It is simply the claim that health professionals should insist on the right to decide for themselves what standards they act on. While this is understandable (we all would like the privilege not to give a damn about the opinions of others, don't we?), it either comes without any underlying defense, or is compatible with sometimes choosing to compromise with other parts, interests and powers in society. As mentioned, the latter seems what in fact is happening in a number of areas, so then the question moves to what reasons pro or contra are present in the area at hand. Here, I have argued that (d) is the superior position.

The same outcome seems to ensue when analysing a final (and, to my view, better) variant of this sort of argument. Instead of an empty insistence on professional autonomy at all cost, this argument points to the political importance of professional integrity as a strategic tool in certain areas. The most obvious of these are torture, capital punishment and military interrogation. Here, the profession has adopted zero tolerance policies, which are thought to have an accumulated preventive effect, as these practices in various ways "need" the participation of doctors. However, this point does not demonstrate that age determination of unaccompanied refugee children belongs to this set of absolutely prohibited practices. As those who criticise the presently proposed methods also say that they could accept methods with a better degree of precision and exactness, it doesn't seem that they are trying to argue this in the present case. Which is understandable, as that would mean arguing against any claim to special considerations of the interests and rights of children.

In sum, therefore, unless it is demonstrated that there is no method at all that could produce any sort of empirically grounded numerical estimate (even in the form of a wide interval) in this area, my suggestion holds up to scrutiny. In fact, it is better supported by both professional health care ethics and more general ethical analysis, than alternative suggestions.

***

On Using Physiological or Biomedical Methods to Determine the Age of Unaccompanied Refugee Children

  In my country, there has for some time been a lot of political debate around how to handle the rising number of refugees from, primarily, Syria/Iraq, Afghanistan and North Africa. This as the pressure on border EU member states, and the impossible situation of trying to hold back people on the run from intolerable circumstances that I blogged about not so far ago, has meant that much more people are now entering Sweden to seek asylum in a short time, as most other member states are unwilling to participate in a scheme of sharing the economic and logistical load it means to process these requests in a way required by human rights and international agreements, as well as legal security. For, while there is no such thing as a right to have asylum, to seek it is an absolute international legal right, and already this means that a receiving country has a lot of obligations. And one group of refugee people towards which such obligations are especially strict are unaccompanied children, and many of these who actually arrive to Sweden are mostly in their teens, usually lacking certifiable identity documentation.

Now, yesterday, the Swedish government, pressed by the logistic and organisational pressure, declared that the already announced difficulties had now become intolerable, and that a number of measures was to be put into place to complement the already a few weeks back instigated active border controls (which, until then, had been non-existent in accordance with the so-called Schengen accord on free internal EU mobility). The move is very controversial, and many doubt that the logistical and organisational reasons cited are the only ones behind it, if nothing else, worries about how political opinion will shift in the presence of my country's anti-immigration, semi-racist party, the Sweden Democrats (see here, here and here), are bound to have played a part, as these are presently laying mostly low to wait things out after some botched attempts to take the initiative, and being actively ignored by the other parties, as it has announced that its only idea is to close the borders entirely. One thing is entirely clear, though, the problem behind the decision is neither one of money, nor one of space, Sweden has plenty and plenty of both of those, and neith is it about "volumes", as the term goes, but mostly about flow; not how many people arrive, but how many arrive in a short time.

 One of the measures decreed by the Government concerns the unaccompanied refugee children, and it is to (re)start using certain physiological or biomedical methods to ascertain the age of these children. No one is debating the need for such ascertaining, but the debate is about this particular proposal, as many Swedish medical specialists (for two international sources, see here and here) also the medical research specialist organisation Swedish Society of Medicine, point out that the proposed methods are very uncertain and have wide margins of error, up to 4 years plus or minus. This means that the risk is imminent that a child of 14 is determined to be an adult, and that Sweden would thus knowingly risk to default on its particularly strong and demanding obligations towards children. The fact that there is also a risk that some 21-year olds come to enjoy these special protections and care is a non-issue in that light. However, the government seems insistent, so what should be done? General refusal of doctors and other medical staff to participate in what has been proved to be unprofessional practice? (as they would seem to be required to do by the Swedish health and Medical Services Act)? This is certainly a live option from a medical ethical standpoint as well, although it also means that most unaccompanied refugee children are left without proof of age.

However, there is another solution, which would satisfy both the government's decree, the worries from the point of view, the need for unaccompanied refugee children to have their age ascertained, and the overwhelming reason to have Swedish policy abide by its own legal standards. This solution is, moreover, applicable to any method for this purpose. It rests on the assumption that for Sweden to meet its own legal requirements is a primary consideration that trumps other reasons and interests in this area. This means that overestimating a refugee child's age and assess this person as adult is far worse than underestimating a refugee adult's age and assess this person as a child. Based on this premise, we may now argue that, therefore, using a method for age assessment in this area that is uncertain, we should use it in a way that makes us err in the right direction. That is, to the extent that we draw faulty conclusions, these should rather be the wrongful classification of adults as children than the wrongful classification of children as adults. this rules gives us access to a simple mathematical solution to the conundrum: we simply adjust the conclusions drawn with the help of the method in light of its uncertainties, so that we are certain to err in the right direction. Thus, for any method, M, for the assessment of the age of a person, P, with a margin of error +/- X years, M is taken to indicate adulthood if, and only if, its result is 18+X years or higher, and otherwise taken to indicate childhood. Regarding the methods cited earlier, this would mean that a person who is apparently an unaccompanied refugee child (who lacks reliable documents), is concluded to be a child, as long as these methods do not declare the age to be 22 years or higher.

As said, this solution makes it possible to abide by the governmental decision, while acting inside medical professional and ethical boundaries, and while both securing the need of refugee children to have their age determined to claim their rights, and the paramount need for the state of Sweden to honour its own legal and international obligations.

Due to debates related to this post in other fora, here's an addendum I made a few days later.

***

New Cross-disciplinary Antiobiotic Resistance Research Centre at my University

Yesterday, I received the delightful news that a big bid, in which I am one of several co-applicants, to establish a centre for research, education, innovation and change in the area of antibiotic resistance research, CARe at my university has been awarded a more than €5 million base funding for the coming 6-7 years in an internal university competition called the UGot Challenges, that's been going on for about 2 years.

The lead applicants of CARe are Joakim Larsson, professor of environmental biomedicine, and Fredrik Carlsson, professor of environmental and behavioural economics, and the co-applicants involve many senior researchers from the medical field, industry and societal collaborators, and several social scientists and humanities scholars, in the latter case, also my departmental colleagues philosophy professor Bengt Brülde and theory of science senior professor Margareta Hallberg. The aim of the centre is thus outspokenly and strongly cross-disciplinary, involving 6 faculties, acknowledging the challenge of antibiotic resistance, like many other broad challenges such as climate change, to involve many crucial aspects beyond those covered by natural and medical science and technology development. The primary scientific and technological target of CARe will moreover be what is presently considered as the last straw and stage of antibiotics to fight multi-resistant bacteria, so-called carbapenems, the development and use of which, of course, imply a large number of complex ethical issues, e.g. with regard to the need for highly restricted prescription in order not to boost further the current destructive trend in resistance development among bacteria, or exceptional need for haste in introducing new substances in spite of knowledge gaps or uncertainties.

Here is the official announcement from the university:

UGOT Challenges information (English)

Stage 2 decision
The university Vice-Chancellor has made the decision on the outcome of UGOT Challenges Stage 21 based on external evaluation. All 12 groups that were invited to stage 2 submitted a proposal before the deadline. 6 of the proposals have been approved.

Approved proposals
Centre for Antibiotic Resistance Research at University of Gothenburg. Joakim Larsson and Fredrik Carlsson
Centre for Collective Action Research. Sverker C Jagers and Sam Dupont
The Swedish Mariculture Research Center at University of Gothenburg. Kristina Sundell
Centre for Ageing and Health – studies on capability in ageing – from genes to society. Ingmar Skoog
Center for Critical Heritage Studies. Kristian Kristiansen and Ola Wetterberg
Centre for Future Chemical Risk Assessment and Management Strategies at the University of Gothenburg. Thomas Backhaus and Jessica Coria

Documents supporting the decision are available at www.gu.se/ugotchallenges.
The host departments have been assigned to submit a formal application to establish the centres in early 2016. When funding has been granted for an existing centre the operational plan should be updated.

About UGOT Challenges
University of Gothenburg will invest 300 million SEK in research under the theme "global societal challenges" over the next years. The aim is that a number of new centres will be started from 2016.

What Is A Terrorist Threat, And How Should One Respond To It?

The other day, following the recent horrid events in Paris, linked to several temporally closely aligned similar attacks by Daesh, e.g., in Lebanon and Iraq, apparent intelligence on several other planned attacks throughout Europe, and specifically that a possible Daesh operative had entered Sweden to organise a large.scale attack of some sort, my country raised its official terrorist threat level from 3 to 4 on a scale that ends at 5. One named suspect of preparation of terrorist crime has now been apprehended, but the police and security organs apparently continue to search for others, and the government has been clear that this single factor will not by itself motivate downgrading the threat level. At the same time, several voices criticise the development either for coming much too late (claiming, among other things, that the knowledge of the presence of Daesh sympathisers in the country should have been enough), or for being misdirected, as actual terror attacks in Sweden (save one) tend mostly to be domestic extreme right wing nationalist/racist (targetting refugees and street begging EU migrants, people of visibly Muslim or Roma identity or Middle East or African descent, their living quarters, and so on), or is exaggerated and bound to create more problems than what it prevents or fixes. It struck me that many of these reactions seem based on ignoring or fixing on only selected aspects of what is technically known as a risk analysis. For this is basically what the assessment of the level of terrorist threat by a state is about: assessing certain risks and cost of events classified as terrorist attacks, as well as various actions possibly to take in response to various such levels of risk, and to evaluate on that basis what to do.

A disclaimer before I start: the putative facts about the seriousness of typical types of terrorist attacks, and the likelihood of different types of such attacks, are, of course, open to revision in the face of facts – although, as will become clear, less obviously according to what standard of evidence. All of the aspects described are part of the discussion of the ethical basis of environmental and technological risk policy that I undertake in my book The Price of Precaution and the Ethics of Risk.

First, there is the two main dimensions of the concept of risk itself: the probability and harm dimensions. A risk is always the possible (and to some extent likely) occurrence of some type of variably harmful event. In risk analysis, the magnitude of a risk is determined by a combination of these two dimensions, so that a low probability may be balanced by a serious harm-level, and the other way around. Already this simple analytical unpacking points to a factor that may seem to be at work in the reaction to the raised Swedish terror threat level. Some people focus mainly on the likelihood dimension, and then would hesitate to criticise that new evidence and circumstances changes the assessment, or would rather have seen an earlier raised level in view of the actual wave terror attacks in the form of typical "lone wolf" deeds, and thus a concentration on extreme right wing violence rather than its Islamistic sibbling. Others focus instead on the harm dimension, and then lets the demonstrated vastness of the damage of attacks such as the one in Paris dictate the risk assessment, also when the evidence of likelihood is very weak. This may then motivate the position that, knowing that Daesh and similar groups do have had attacks such as the one  in Paris on its theoretical agenda for a long time (and carried out i the Iraq and Syrian theaters). With the notable exception of Anders Behring Breivik, although much more frequent and actually realised rather than merely theoretically imagined, the right-wing extremist deeds, while clearly terrorism in the sense of attempting to spread fear for political purposes through the use of violence against civilians, tend to be more restricted in its consequences than the large scale massacres that have now occurred and known to be on the Daesh agenda.

Second, there is the way in which different such combinations and magnitudes of risk are evaluated, or seen to support various courses of action. Here, a number of additional issues linked to the assessment of the risk magnitude is actualised, namely:

Third, how the constituents of the risk (its probability level and its harm level) are evaluated in terms of how much we should care about it. This gives another way in which we may get a similar output that was just described above, even if all agree of the risk magnitude. This since risks with the same magnitude may still be evaluated differently, e.g. due to being made up of very low probability, or very serious potential harm. here, one may also want to pay attention to the context, such as if one is making the assessment from the position of already being burdened by much risk of different kind. So if the potentially worst terror threat are the least likely, and the most likely ones the least serious (relatively speaking, of course), we may again get differences of opinion of a similar sort, but now more clearly based on differences of values rather than appraisal of fact.

Fourth, how the opportunity costs of different actions in response to a risk assessment are evaluated, that is, what is lost and risked by taking these various actions rather than other ones. Here we may spot a number of ways in which assessments may differ, although not basically disagreeing on the risk assessment (such disagreements may, of course, also be added to other disagreements). For instance, several argued against extensive action in face of the wave of apparently extreme right wing nationalist attacks against Swedish actual or in preparation asylum shelters that it would not be worth the costs it would mean to have effective guarding of each one of them. At the same time, there has been no or very little hesitance to mobilise extensive police and security forces to guard potential targets and just demonstrate the presence of the state organs to effect public calm in the wake of the new threat level. But there has been some criticism, for instance, from one of the country's most prominent terrorist experts, Magnus Norell, who claimed that even if there is a raised threat, the actions in response to it and the very act of public threat level raising itself mostly creates unnecessary worry and fear, that is the very effect aimed for by terrorists. One may also wonder how effective the guarding by police of places like train stations and main squares of large cities are, provided that combatants such as those responsible for the Beirut and Paris attacks are set on targeting them. In both cases, this would also mean that these resources are, in fact, wasted. In that light, posting armed guards outside every asylum shelter to guard against a wholly different kind of terrorists targeting these may suddenly seem as a more effective and less costly measure. This aspect, of course, has many more sides, but this only goes to show how the evaluation of options in response to a described threat, and the opportunity costs attached to them may be used to inject the issue with limitless complexity.

Fifth, there is the issue of the evaluation of evidence, underlying the probability estimates at work in all of the considerations pointed to above Here, we may see a number of differences on what type of evidence is to be given the most credence: Actual similar past events is one model, following the "frequentist" ideal in decision theory. That would, in the present case, probably speak in favour of a much higher probability for more extreme nationalist right wing terrorism against refugees, migrants and their quarters in Sweden, as this is what wa have mostly had in the past (especially the very close past). Another model is to instead trust qualified estimates, by appointed experts, who may then, if they so prefer, let other reasons than frequentist ones affect the probability estimate. For instance, even if there has been no, or relatively very few, attacks of the type known to be on the Al-Qaeda and Daesh agendas, the fact there are such attacks on this agenda combined with the presence of people who sympathise with these movements in the country, and maybe witness statements that some such person in the country has been mentioned to plan or want to plan such an attack, may be used as evidence. Some of that evidence may be broken down into an indirect frequentist argument, as it points to factors believed to have been active in relevantly similar past events elsewhere. But a substantial portion would also seem to be about subscribing to certain qualitative and evaluative assessments, such as choosing to trust certain bearers for information as credible, viewing certain events as relevantly similar in spite of notable dissimilarities, and so on. The point is that the more of this latter sort of probability grounding is used, the more room to assess as probable also events of which there have been no very similar precedent.

Sixth, there is the issue of the how much evidence (given some standard of its quality of the sort just described) should be required for a credible estimate, and for taking action. This factor is basically about how long we should wait and amass evidence to have a more well-founded risk assessment, in view of the potential costs of being to late to act effectively against the threat (if there is any). Also this aspect seems to be at work in the Swedish debate, as those who complain about the threat level not having been raised and associated action taken earlier seem to be prone to care less about the evidence of the threat, and rather have action on looser grounds to be "better safe than sorry", but the of course also downgrade or ignore the opportunity costs of this. Those who require more evidence will, on the other hand, want to wait longer even in the face of potential dangers such as the present ones, and some of these might be content with the balance made by Swedish authorities, while others would find the actions premature and would prefer more evidence to assess the raised level and the linked actions justified.

The idea that, inside this vastly variable complex of factors and possible positions on how to do a risk analysis and act on its results there exists one, simple and self-evident alternative is, of course, utterly ridiculous.

***

Not In My Name!

This is inspired by my colleague in mathematics, over at the Chalmers Institute of Technology, Olle Häggström (forthcoming with this book about existential risks, soon to be out on Oxford University Press), who writeson his blog:

The flyer depicted below, containing slander against and blatant lies about the country of Sweden, is currently being distributed at a refugee camp on the Greek island of Lesbos and at many other places on the borders of the European Union. Representatives of the extreme and anti-immigrant right-wing Sweden Democrats party confirm that their party is behind the campaign.

Notice, among the signatories, "The People of Sweden". That is forgery. The people of Sweden includes myself. I have (along with the vast majority of my compatriots) not been consulted about the letter, neither in person, nor via legitimate proxy. I do not stand by its disgraceful content.

The Sweden Democrats party has its roots in Nazism and the white supremacy movement. Since 2010 it is represented in the Swedish Parliament (and is currently holding 49 of the 349 seats).

Adding for myself: a self-professed "nationalist" and essentielly populist party, currently representing slightly more than 12% of the voters, slanders its country and claims to represent the entire "people of Sweden". Together with the blatant lies, this says all about the arrogance, hypocracy and view of democracy to be expected of these people, should they ever gain actual political power. To this may be added, their recent slippery passive support of a wave of arsonist attacks against premises for asylum seekers, following fiery rhetoric about using "all means available" to fight the current wave of refugees arriving in Sweden and supporting the online posting of maps showing the locations of asylum seeker lodgings, albeit these have been classified by the national Migration Agency due to the wave of terrorist attacks. These people are clearly desperate and on the defensive, as it is the only one with no solutions whatsoever for handling the current political crisis in Europe regarding refugees (besides the totally unrealistic and economically catastrophic idea of shutting off the country from the surrounding world and weed out those residents who are not "Swedish" enough). This I could see for myself when its leader was pressed about the untrue statements (regarding "coming bans" on niquab etc.) on national TV yesterday, and behaved quite deranged; repeating as a robot that this is what his party wishes to see happen and therefore it will happen. Apparently he is unable to distinguish between his own political wishes and actual reality, which is another reminder about the nature of these kinds of political parties. I suppose that this is also what makes him think that he represents the Swedish people, albeit his 12% in the parliament has gained him no influence, since the other parties, of course, sees though the thin laquer of apparent democratic alegiance and spot the fascism and racism underneath. Again, this is a reminder what kind of leaders we would gain should these people ever gain any political influence: arrogant liers, unable to distinguish between reality and dream, with a political program that would sink the country into an economic slump and their only remedy to shrink and shut it off further.

 Not in my name!

PS. Should you so wish, I made my own analys of the new racist/nationalist ideology currently held out by several parties like this around Europe a few years back: here, here and here.

How to Read News About Science and Research (Very Brief Abbreviated Checklist Edition)

Step 1
Does the headline or introduction contain any of the following expressions: "might", "should", "expected to", "suggest", "can", "hoped", "may" or some equivalent?

Step 2
Don't bother reading and enjoy yourself while waiting for when there is some actual evidence on anything.

Watch the videos of our symposium Reconsidering Humanity: Big Data, the Scientific Method and Images of Humans

This symposium was organised and chaired by Urban Strandberg (political science and CERGU at the University of Gothenburg), with myself as co-organiser and -chair. Funded by Riksbankens Jubileumsfond, it took place June 25-26, 2015, at the Visual Arena venue of the joint Lindholmen campus of Chalmers Institute of Technology and the University of Gothenburg, featuring keynote speakers from anthropology, philosophy, music, neuroscience, digital design, cogntive science, robotics, computer science, digital humanities, and politics from universities and research centres in Denmark, Spain, Sweden, the UK and the USA, represented by Palle Dahlstedt, Paula Droege, Carry Figdor, Staffan I Lindberg, Dawn Nafus, Anil Seth, Irina Schklovski, Barry C. Smith, Patrik Svensson and Paul Verschure.

The videos also include the introduction and the final discussion, as well as the comment and question sessions in connection to each lecture. Please feel free to link and share the material as much as you like!

The Essay on Reproductive and Population Ethics that Vox.com Commissioned from Torbjörn Tännsjö, But Didn't Dare Publish

Indeed. For the informed in philosophical ethics, the ideas argued by professor of practical philosophy at Stockholm University and formerly my colleague in Gothenburg and once doctoral supervisor Torbjörn Tännsjö is no news. Apparently, though, it scared the socks off the Vox.com editors, who decided to give in a to a perceived heckler vote and scrap a commissioned piece popularly presenting one of several well-known standard positions in population and reproductive ethics. Of course, this is very good reason to spread the article as widely as poosible, so please download it here. Naturally, this has nothing to do with whether or not you agree with Tännsjö on the issue.

Brian Leiter has the backgroundstory here, including link to a response from the Vox editors, apparently produced in a panic at being faced with a minor uproar around Twitter and other places. Read it, and I think you'll agree that it only strengthen the reasons to continue having their underwear pulled down in public. Apparently it is Vox's official position that if a person holds what they take to be a pro-life opinion on abortion (which ironically Tännsjö don't, he's radically pro-choice! and pro-life positions on the politics of abortion is in no way implied by his argument), they cannot be published in Vox provided the editors don't feel sufficiently "comfortable" about they themselves promoting the view in question. I suppose they universalize this maxim, and publish only opinions they themselves personally feel comfortable promoting – good luck with that sorry excuse for publishing policy! That in addition to their more carefully elaborated exposition of their own  lack of journalistic spunk.

Alice Dreger Resigns from Northwestern University Following Pathetic Censoring by Management

Today, I learned that Alice Dreger, professor of clinical medical humanities and bioethics at Northwestern University's Feinberg School of Medicine, internationally celebrated for her work on the practices and policies around intersex and ambiguous sex conditions, especially in small children, yesterday chose to hand in her letter of resignation, following a pathetically prude and spineless piece of ham-handed censorship of her and a colleagues' work by her own medical school dean,  Eric Nielson last year, and subsequent lack of university provost, Daniel Linzer, to assure her that anything like that would never occur again.

Read it all in Alice's own words, including the letter of resignation itself, at her website and blog, here.

As Alice has just published and already won acclaim for the book, Galileo's Middle Finger, which centers around exactly the issue of censorship and supression of academic publication and scientific ideas, the development has a bizarre twist to it, indeed. Today, apparently, it is not the clerics or the many versions of politburos that academics and scientists have to fear will silence what they have to tell the world, but the leaders of the very institutions supposed to sternly guard against anything in that vein.

New Article Presenting Framework for Identifying Ethical Aspects in Health Technology Assessment

I'm happy to announce the publication of a new article, available for free download and reading online, that presents a novel framework for systematic identification of ethical aspects in so-called Health Technology Assessment (HTA). This is the organised and systematiced discipline of assessing the evidence for the value of new treatments and methods for health care purposes (pharmaceuticals, new procedures, technical tools, diagnostic tests, and so on). The idea of having ethical issues integrated into such assessment has been seriously discussed for about ten years, and I have the last two of these been fortunate to take part in a project to this effect, organised by the Swedish national health technology assessment agency, SBU. This work produced a new guideline in Swedish and an update of the ethics section of the SBU method handbook. We then continued to develop a presentation of what we think are both novel and useful results also in an international perspective, which can increase the ambition and quality of attempts to integrate ethical aspects in HTA work, into an international publication, which we are now happy to have out in the International Journal of Technology Assessment in Health Care:

And the abstract runs:

Objectives: Assessment of ethical aspects of a technology is an important component of health technology assessment (HTA). Nevertheless, how the implementation of ethical assessment in HTA is to be organized and adapted to specific regulatory and organizational settings remains unclear. The objective of this study is to present a framework for systematic identification of ethical aspects of health technologies. Furthermore, the process of developing and adapting the framework to a specific setting is described.
Methods: The framework was developed based on an inventory of existing approaches to identification and assessment of ethical aspects in HTA. In addition, the framework was adapted to the Swedish legal and organizational healthcare context, to the role of the HTA agency and to the use of non-ethicists. The framework was reviewed by a group of ethicists working in the field as well as by a wider set of interested parties including industry, interest groups, and other potential users.
Results: The framework consists of twelve items with sub-questions, short explanations, and a concluding overall summary. The items are organized into four different themes: the effects of the intervention on health, its compatibility with ethical norms, structural factors with ethical implications, and long term ethical consequences of using the intervention.
Conclusions: In this study, a framework for identifying ethical aspects of health technologies is proposed. The general considerations and methodological approach to this venture will hopefully inspire and present important insights to organizations in other national contexts interested in making similar adaptations.

The article is so-called open access, meaning that it can be freely downloaded and read online by anyone. You are also free to re-use, distribute, and reproduce in any medium, provided the original work is properly cited. Find out more here or download the pdf directly here!

The Pinker Stinker And The One Bioethicist That Really Should Get Out of the Way

Back from summer holidays, I was greeted by what has seemingly been the big news in bioethics this and the last month: Steven Pinker's article in the Boston Globe, where he tells the field of bioethics and bioethicists to "get out of the way" and stop debating new technologies, such as the CRISP/Cas9 "genome editing", which I commented on earlier this year – seemingly because Steven Pinker himself has already done all of the bioethics needed doing on this and related subjects (apparently by saying that these technologies will become very good, albeit we don't know much about them yet). That is, he seems at first glance to be performing the very act he urges so strongly against: doing some (rogue elephant) bioethics in this sacred area and, in effect, revealing himself as a ghastly closet bioethicist – who, according to his own logic, should then get out of the way, I presume.

But this is not the end of the folly of Pinker's article, as he seems to be confusing a great number of things, such as bioethics (the academic field where various aspects of bioscience and biotechnology is debated and probed in ethical terms using intellectual tools of moral philosophy and social science), legal and semi-legal regulation of science and technology (adopted by governments, international bodies and professions to control how new ideas and gadgets are introduced and used), and the idea of a temporary moratorium on particular applications of new technologies while exploring them further in more controlled settings (like the  1974 Asilomar consensus on recombinant DNA technology) decided not by bioethicists, but by the concerned scientists themselves – albeit based (one presumes) on views on bioethical issues. Read my distinguished colleagues Richard Ashcroft, Alice Dreger and Julian Savulescu, who I admire for their extreme charity and patience, in turn pointing to several others, to unveil many more subtle incoherent twists apparently resting inside Pinker's stinker, and how these, at the end of the day, leaves him even worse off in terms of  consistency than what the initial impression holds out.

On my own part, I can't free myself from the reflection that if there is one bioethicist who really should get out of the way, it is the one who thinks that the fact the he/she has formed an (no matter how badly argued) opinion on something is a reason for others not to voice and argue their own.

American Psychology Profession and Speciality and Its Central Association Completely Disgraced By Independent Report on Complicity in and Abetting of Military Torture

This post was slightly added to July 12, 2015.

Big news today on an issue within the US psychology profession and academic speciality that has been bubbling for quite some time – I posted about some of the brave and persistent activism that has been driving it a few years back, here. It is thus all about the completely disgraceful role of the American Psychological Association (APA) in actively aiding and abetting both the practice itself of so-called enhanced interrogation techniques – retrospectively declared even by the US government itself to be torture – in military and intelligence operations post 9/11, and the actual complicity of professional psychologists in these practices.

In an independent report (online readable here, and downloadable here), specially commissioned by the APA, former federal prosecutor David Hoffman reveals the APA involvement not only to be quite extensive, but also involving outrageous manipulation of internal processes and skewed application of guidelines and regulation of several high ranking APA officers and representatives. One of these, the director of ethics Stephen Behnke, has already been fired. Besides the pointing out of several individuals besides Behnke, whose heads deserve to be set rolling with equal enthusiasm, a central recommendation coming out of the report is that APA should adopt the same policy as the American Medical Association and ban members from participating in military interrogations, and this suggestion is reported to have been quickly picked up by the APA board of directors. Most fitting, and let us all hope that bill carries all the way through. Not least in the light of an independent comment in The Guardian by long-standing anti-torture activist, medical doctor and bioethicist Steve Miles – who among other things run the Doctors Who Torture Accountability Project – that the APA complicity with the US torture policies has been a general impediment for the general fight against torture practices globally. An extensive public apology and list of actions, among these the mentioned ban, has been published by the APA on its website, although it also contains some seemingly desperate attempts to flee responsibility by highlighting some less important findings, e.g., that the motive seems not to have been outright support of the torture program or US policy in this area, but "to curry favors" with the federal government and its agencies. That is: "we only did it for the money and the glory, not at all because we thought it was the right thing to do". As if that would make any difference for the better!

A less partial, extensive and popularised summary of the essentials of the report by New York Times reporter James Risen, who has helped push the uncovering of the heinous APA practices with his book Pay Any Price, can be found here.

The Ethics of Pharmaceutical Pricing

I don't think I'm alone in having noticed in my own country – as well as throughout that part of the developed world where states run reasonably expansive publicly financed health service schemes – an increased political and general societal problematisation of the costs of new pharmaceuticals.* The background to this increased focus is doubtlessly complex, but four aspects stand out as especially relevant explanatory factors. First, there is the generally splendid public health situation in these countries, with ever increasing average life expectancy and declining morbidity rates at the population level,** but with the side-effect of more and more of this increase being effected by reparative treatment of chronic, aging-related health problems, rather than primary prevention of basic health problems. Second, there is the next step in pharmacological development strategy, whith drugs targeting more and more specific and limited groups of patients and conditions, as a side-effect also providing treatment for extremely rare and serious diseases which have before been a dire fate to bear, with very limited treatment opportunities (many of these monogenic diseases which have been virtually untreatable). Third, there is the increased focus on rationality and ethics of public spending and the organisation of health services, effecting a greater transparency, control and regulation of the assessment, introduction and prioritarisation of new treatments. Fourth, there is the pricing policies of pharmaceutical companies, in extension reflecting the chosen expectations of return on investments of their owners. This post is about the fourth of these factors.

In most discussions of public policy in this area, this fourth factor is and has for a long time been treated as an immovable state of nature. There are three basic reasons usually presented in favour of that stance: First, commercial businesses have to be assumed to act as commercial businesses and strive to maximise profit for their owners, and are – in fact – in most jurisdictions required by law to do so. Second, if pharmaceutical companies would not be allowed to act in this way, they would soon be deprived of investor capital (as this would move to more profitable areas), and this would cripple the development of new drugs. Third, states are not capable of taking on the task performed by pharmaceutical businesses today; if they would, the result would soon be either an even worse cost crisis, or declining development and production. I think that the third argument is worth some critical discussion, especially in some areas of particular societal importance – such as vaccines – but in the present context, I will let it stand unquestioned for the sake of discussion. That is, I assume in the following that states are indeed dependent on private business solutions to have an effective development and production of pharmaceuticals.

But what about the other two arguments? Lately, these have been questioned in the context of debates in several countries about the pricing of a drug called Soliris by its manufacturer Alexion, targetting the rare and very serious hereditary disease Atypical hemolytic-uremic syndrome, or aHUS. In several countries, agencies responsible for assessing the evidence base, cost-efficiency and priority of new drugs have expressed serious complaints about the high price (here, here, here, here). In several of these cases, the national health services have eventually chosen to introduce this drug any way, in order not to have heavily burdened patients caught in the fight between health institutions and drug companies. But the change of tune with regard to pharmacological companies is notable, and raises the more general question of the plausibility and validity of the two arguments above.

I will claim that, given that the thesis supposed to be backed up by the arguments is that national health services, governments and related agencies have no reason to apply normative (ethical or political) judgement regarding the pricing of pharmaceuticals, my assessment is that while both arguments are plausible (as in likely to be true), they are invalid (as in not supporting the conclusion). I will support that claim with two arguments, one ethical and one political, and then sign off by pointing to some complicating factors that I think are mostly overlooked in health policy debates.

1. Even if commercial companies lack moral obligations, their owners don't
It may be debated to what extent commercial companies have moral obligations and, if so, which these are. Most countries have set up a system where, in Milton Friedman's famed words, 'the business of business is business' – that is, beyond keeping to the limits of criminal and necessary civil, and administrative law, commercial companies are not to mind about anything else than meeting the profit expectations of its owners. Based on this, a company may, of course, chose to abide by one or the other moral judgement, but only to the extent that it is thought to be a sound commercial strategy as defined above. Also, while thus using business only for its expected good outcomes of business (usually increased productivity of goods and services), a state may take political action to compensate for its bad side-effects, e.g., with regard to public health. In recent decades, this 'separation thesis' regarding the obligation of commercial companies (to maximise profits for its owners inside the realm of the law) has been questioned as both increasingly irrelevant (due to globalisation, which enables companies to move freely between jurisdictions in an amoral manner, thus emptying the content of the requirement to abide by the law) and for its inability to reply to increased arguments coming from the area of business ethics, corporate social responsibility and political philosophical observations that the separation thesis assumes a demarcation between the realms of business and that of basic public concerns which is simply not to be had.

However, even if we would grant the idea that companies have no other moral obligations than meeting the profit expectations of their owners inside the realm of the law, it doesn't follow that national health services, governments and related agencies have no reason to apply normative (ethical or political) judgement regarding the pricing of pharmaceuticals. This since the separation thesis does not in any way undermine the claim that owners of businesses have moral obligations and ethical reasons to behave considerate towards other people beyond what the law may require. Or, it may do so in the first instance, as many owner's are institutional business parties (banks, funds, and so on), but at the end of the day, there will be actual and quite ordinary people, and these have the same moral obligations as anyone else. In fact, it would seem that the whole idea of the separation thesis rests on the assumption of a well-functioning society within which businesses may operate, and a core part of such a society is that people act decently towards one another. This implies, e.g., the recognition  of basic and reciprocal civic obligations of due diligence, duty of care and general consideration to other people – all stretching beyond what is strictly required by law. Just start to imagine what walking along a street in a city would be like absent such basic cultural arrangements in place. Likewise, imagine a society were no individual assisted another in need according to such principles. I take it that no one would disagree that we hold these sort of moral obligations to one another. However, if we do, these don't just magically disappear if we happen to open a shop or purchase some company stock. Even if not required by law, as owners of businesses, we are still bounded by ethical considerations to other people, e.g., to care for those in dire and undeserved circumstances.***

So how does one discharge these moral obligations in the role as owner of commercial enterprise? Well, since the enterprise itself – a company – works according to the main principle of realising the profit expectations of the owners, the lever available to an owner seems to be exactly these expectations. That is, the material outcome of the duty of the company towards its owners being discharged can be manipulated by the owners' communication into the company structure of what level and rate of return on invested capital is being expected. This creates ample room for an owner to have ethical reasons to adjust such expectations in view of reasons beyond those of "pure business". Transferred to the case of pharmaceuticals, this line of reasoning results in the conclusion that, to the extent that this is required by our normal set of ethical reasons to be considerate towards each other, an owner of such a company has a reason to decrease his or her expectation of return on invested capital, whether in terms of level or rate. In both cases, such an adjustment will enable the company to adjust its pricing downwards without defaulting what it owes its owners. To be true, such a reason need not always be available, but in the case of drugs for very serious diseases, it seems quite reasonable to claim that it does. Note also, that the reasoning can be applied also to argue against withdrawing investment, thus diffusing the argument that reducing profit margins to enable lower pricing would effect investment flight. Maybe it would, but it still holds that investors should not thus flee a slightly less profitable investment that would mean meeting one's general moral obligations to other people. I made this argument myself, in the Swedish debate around Soliris.

In conclusion, the idea that there are sound and valid normative (ethical) claims to make with regard to the pricing of effective drugs for very serious diseases holds up to scrutiny. The (assumed) facts that "the business of business is business" and that (potential and actual) owners of pharmaceutical companies do as a matter of fact not currently seem to act in accordance with their moral obligations (maybe partly because these have not been recognised) do nothing to undermine this claim. Owners of pharmaceutical companies owe it to very sick people to adjust their profit expectations to enable more modest pricing, and potential owners owe the same people not to withdraw from investment due to this obligation.  

2. States owe their citizens not to be money pumps
The second argument does not target individual people in their role as (potential) owners and investors, but rather state institutions in their roles as counterparties in business negotiations. This argument is entirely independent of the first one, and will hold up even if the former would be shown to be somehow faulty. The argument does, however, assume that pharmaceutical companies are behaving more or less according to "the business of business is business" pattern, with owners who as a matter of fact do not moderate their expectations on return on invested capital as they should. Should owners start to behave more in line with their moral obligations, the validity of the present argument will be undermined (although it is still sound).

The behaviour of pharmaceutical companies with regard to pricing of drugs as just sketched means that they try in every instance to find an optimal equilibrium between the price per sold item and the number of items sold. This is the reasons why the so-called "list price" of new drugs is in most cases much higher than the price eventually paid by public health services; the company sets an exaggerated price as it expects a negotiation where the price will be decreased in light of consumer demand, as expressed by the public agencies doing the state's bidding. In my own country, where up till recently, this bargaining has been undertaken by each single county government (responsibly for its health care service region), companies have thus been very savvy at, insisting on commercial secrecy around the agreed price, play all these counties against the middle to maximise bargaining outcome. From a political ethical standpoint, to have state or county agencies – and ultimately tax payers – thus being allowed to be played for suckers is simply unacceptable. For what it means is that the state – in view of the never ever ending demand for health care – allows commercial parties to milk its treasure chest dry. In more technical sense, the state thus allows itself to be what experts on economic bargaining rationality and game theory call a money pump – someone who applies a bargaining or game theoretical choice strategy that systematically leads to a losing position, albeit each single move may appear winning, given the circumstances.**** The argument that one should avoid such strategies (technically, to avoid dutch book strategies) has given raise to the discipline of dynamic choice theory, and is a standard motivation, e.g., for why it is irrational to apply decision strategies that make one succumb to blackmail – as each concession of a black mailer's demands (no matter of well motivated in the single instance) makes it rational for the blackmailer to continue the blackmail and increase the demands. In the case of negotiations about the price of pharmaceuticals, the state or responsible public agency becomes a money pump by being overwhelmed by the reason to accept the offered price presented by needs of single patients, and thus not considering the option of declining the offered product as a live option. Just as the blackmailer in the analogous situation receives increased reasons to continue the blackmail and up the stakes, the pharmaceutical companies are thereby reinforced in their reasons in terms of business logic to increase prices even more, and thus increasingly bleed the public health services budget.

I take it that everyone agrees that a state and its agencies owe it to their people to avoid such positions. As a matter of fact, since the rationality of avoiding being a money pump is so basic, this would seem to hold even on the super-thin libertarian idea of the state as a security business enterprise of its citizens (which I take most people would want to go beyond). But to do that, the state has to create a bargaining situation where the counterparty counts a declining of its offer as a live option to be calculated with. And to create that situation, the state needs to actually decline offered services also when they are necessary to meet important needs.If they don't, the companies will not view such a declining as a live option, and will thus be motivated to increase the stakes. Now, this does not necessarily mean that it is in case of effective orphan disease products such as Soliris, where the most urgent need for such demonstration of actual bargaining power is called for. Rather, one would find it more acceptable to decline state subsidising of treatments for far less serious, albeit more widespread conditons, although that may not harvest much of political popularity. But if the state never says "no" to anything, the money pumping result will eventually affect the entire public health service supply, and it is not unlikely that before long the willingness of citizens to fund very expensive treatments for conditions that strike only very few will falter as a result. Moreover, as more and more drugs for all sorts of condition (many of which will not be as extreme as aHUS) can be expected to become "orphan" in the sense of targeting only very specific patient groups, or add only very minor therapeutic effects (and often considerable side-effects) to serious conditions which are inevitably killing patients very shortly (as is the case with many new cancer medications), the fact that the targeted condition is either rare or very serious cannot by itself be a disclaimer from applying a rational bargaining strategy that also takes into consideration therapeutic effect, cost and opportunity costs in terms of what other treatments to other conditions may may be funded by the same money.

In any case, however, the many difficult priority setting issues which follow from the state and responsible agencies thus taking its responsibility to citizens are handled, the fact remains that the state does have such responsibilities. As much as society has reasons to allocate resources to be able to offer its members publicly available health care services, it has strong obligations to the very same members not to unnecessarily waste these resources. Avoiding the money pump position in relation to pharmaceutical companies seems like an elementary part of performing that duty.

3. Where we are in all of this
In conclusion, there are two separate arguments for the existence of valid and sound normative reasons to apply to the pricing of pharmaceuticals by commercial companies. Both assume only a very minimal idea of ethical and political reasons, which should be acceptable across most otherwise competing ethical and political positions and ideologies. However, there is an interesting dialectic between the arguments, hinted at when I wrote above that the second argument gains in validity to the extent that the first argument is ignored by the acting parties – owners of and investors in pharmaceutical companies. But who are these owners? As pointed out, in the first instance they are probably mostly banks, investment and holding companies, funds and so on, but at the end of the line there will of course be actual people (who hold the ethical obligations claimed in section 1 above). Some of these will, of course, belong to the fabled 1% of repugnantly rich, but most of them won't. In fact, most of them will be like you and me, people who has a bit of insurance, a bank account, a small slice of a pension fund (no matter how modest), loans, maybe even some stock. And even if our possessions of this sort are very modest, we are benefiting from a public health services system, which include funds where the capital to pay for and subsidise pharmaceuticals and public health care investments is stored and managed, and we may even be due for a bit of minimal public pension from funds equally so taken care of to be able to deliver what was originally promised. In other words, we who gasp at the indecent pricing of pharmaceutical companies are the very same people who in section 1 above were claimed to have moral obligations to lower their expectations of return on invested capital. In view of the apparent fact that this seems to imply that most people have to lower their pension-, insurance, savings- and welfare demands, one may quite plausibly doubt our collective capacity to effect such an adjustment, no matter how persuaded we are of its rationale on a theoretical level.

Therefore, as in so many other cases, the most rational solution would seem to be the second one: to press the reasons for the state and involved public agencies to apply effective and rational bargaining strategies against the pharmaceutical companies. Of course, to have effective such systems, it is rational to abandon the subsidiarity system, where each county government make their own bargain, and centralise the process nationally. But that's only the first step, of course, as the same logic tells us to accept multinational bargaining cartels, possibly across the entire EU. That will probably have quite a bit of bite, although it will also necessitate difficult issues of health care policy priorities, due to the need of sometimes actually saying no to the offered goods. Moreover, it will, as in so many other cases where we are unable to do collectively what we should be doing together, force us to accept the concessions (in terms a lowered returns on investments, savings, pension fund, insurance benefits, what have you) we were obliged to accept by ourselves, but failed to do.
  

*) There is, of course, a comparably much more pressing issue about the cost of and access to pharmaceuticals in developing and/or economically deprived settings. This issue has attracted the attention of ethical reflection for a long time, and there is a rich debate addressing its many levels to dip into for whoever feels like it – just make some searches using "orphan drugs", "orphan disease", "ethics" and "access to healthcare in developing countries", and you're set.

**) Granted, there is also in many of these countries stark health inequalities. However, if we plot the curves from the start of these modern health policies at the beginning of the 20th century, even the worst of worst-off groups of today come out considerably better. This is not to say that inequalities of the present are unimportant or that it shouldn't be a priority to decrease them, and to lift the worst off even higher (it should!). But the point remains that also the worst off of today cannot be made much better by primary prevention, but will also need the same shift to expensive reparative treatment of basically incurable conditions and mere aging. 

***) The qualification of "undeserved" is inserted merely to silence objections based on considerations of desert.

****) The classic "money pump argument" regards only the case when such a strategy is the result of a choosing party entertaining intransitive or "cyclical" preferences, and used to motivate why a rational actor must avoid such preference structures. However, the argument apparently rests on the assumption that being "pumped of one's money", as may result in this instance, is a general fault to be avoided by a rational actor, no matter the explanation.

Follow our live-streamed symposium: Reconsidering Humanity: Big Data, the Scientific Method, and the Images of Humans

One of the things I do since a number of years is to partake in the multi-disciplinary and cross-sectorial Technology, Institutions and Change working group of the major independent Swedish humanities and social science research funder Riksbankens Jubileumsfond, RJ. This groups is involved in a number of initiatives, among these book projects, research network funding, support of research education and conference-organisation. Within this context, members expose one another to aspects of the group theme, and initiate educational forays by site-visits to relevant research environments. A number of these inspired political scientist Urban Strandberg and me to start pondering some of the more visionary sides of a wave of so-called Big Data approaches which have been flooding both the sciences and the humanities in recent years. In particular, we centred on the most ambitious research visions with regard to areas of scientific and humanities inquiry into the basic aspects of humanity, society and their respective natures, where cross-disciplinary big data approaches have been held out promises of groundbreaking advances on basic challenges, such as bridging the gaps between the subjective and the objective perspectives on human experience, the individual/singular and collective/general aspects of society, and the materialistic and abstract stances of perceiving the essence of human and social nature. To address these visions and perceptions and – let's admit it – hopes and fears, with a simultaneously critical and constructive eye, we ventured to assemble, with the kind support of RJ, a selected multi-disciplinary and qualified assembly of researchers – and to some extent artists – all working in fields related to the grand Big Data visions, with philosophy, computer science, robotics, anthropology and neuroscience as some of the base disciplines.

The result is the symposium:

To make things manageable, we had to make the event invite only, but starting 9:30 CET the entire event will be streamed live on the web, here. More information, the program, abstracts, speaker presentations and more can be accessed here. Later, edited versions of the presentations will be made available as online videos. Please, spread the word! And if you're interested in the subject, don't hesitate to drop in virtually and become part of the flood of big data making up the core of the symposium's subject matter!

Remembering Ornette Coleman

So, Ornette Coleman has died (here, here, here) – suddenly and unexpected it seems, in spite of his 85 years. You can read all about his fantastic importance to modern music, and the many players and turns of jazz that he inspired in the obituaries, and keep browsing here.

I bought my first Ornette record long before I knew anything about his legendary status in jazz - the Of Human Feelings album from 1979, featuring a pretty early version of the Prime Time band. I thought it was a fusion/jazzfunk group I hadn't heard before, the name of the front man vaguely familiar, so imagine my shock when the angularly crazy, indeed funky, but more than strangely so rythm, the almost naivistic repetitive melodies, the totally off the chart guitar of Bern Nix, and – on top – the most haunting sax sound, I'd ever heard at the time – not even 20 years of age. This is insane, I said to myself, you can't make music like this, but couldn't stop listening, and it opened my eyes and ears to a whole new universe of music.

A few years later, at the time writing reviews, reports and in depth articles for the Swedish jazz magazine, Orkester Journalen, I decided to do an extended piece on the whole harmolodics (Ornette's own theoretical conception about his music) scene of the 1980's – incl. also James Blood Ulmer, Jamaaladeen Tacuma and, of course, Ronald Shannon Jackson's bands. Bold as ever, I wrote (that means a letter written on paper, using a mechanical portable typewriter and sent by regular mail – what you did in those days) to Ornette – using an address provided by one of the main men at Down Beat (Art Lange or Nat Hentoff, I think), whom I also had written asking for it – telling him about the article, and asking him to do a telephone interview. Swiftly (meaning within a few weeks) he wrote back and suggested a date (in the middle of the night in Sweden), and the magazine editor set it up for me to do it from the small editorial office. I was extremely nervous, but Ornette picked up when I called at the agreed time and shocked me again – first by the sheer sound of his mellow, high-pitched voice but soon immensely more by his extremely sweet and generous treatment of someone whom I'm sure he recognised for just what it was: an overly enthusiastic rookie, blind to his own shortcomings. But he treated me as seriously as a scholar and answered all of my questions, some rather theoretical (I was in my start of taking academic philosophy seriously at the time), with the utmost sincerity, taking his time to elaborate complex answers. Then, at the end, I asked about the absence of extended improvisation in his later works, and he told me: well, these were studio-things I had heard, like rehearsals of a concept in its early stages of development, and that if I got to hear the band live now, I would get another picture. A few years later, Prime Time finally visited Stockholm for the first (and I think only) time, and boy was he right.This video is probably from that tour, or the one they did a year before hitting Stockholm:

Of course, as so many others, I also probed historically Ornette's enormous contribution to jazz and improvised music since more than 50 years. But in the end – today when I hear about his passing – what echoes inside of me is that voice on the phone so many years ago; it merges with the melody to Lonely Woman (the Ornette tune everyone knows, if one knows only one), and it tells me even today That – I'm – Worth – Something.

Thanks Ornette, for that and for everything else – thanks and peace!