Reinforcer pathology,probabilistic choice,and medication adherence in patients with multiple sclerosis

The reinforcer pathology model posits that core behavioral economic mechanisms, including delay discounting and behavioral economic demand, underlie adverse health decisions and related clinical disorders. Extensions beyond substance use disorder and obesity, however, are limited. Using a reinforcer pathology framework, this study evaluates medical adherence decisions in patients with multiple sclerosis. Participants completed behavioral economic measures, including delay discounting, probability discounting, and a medication purchase task. A medical decision-making task was also used to evaluate how sensitivity to mild side effect risk and efficacy contributed to the likelihood of taking a hypothetical disease-modifying therapy. Less steep delay discounting and more intense (greater) medication demand were independently associated with greater adherence to the medication decision-making procedure. More generally, the pattern of interrelations between the medication-specific and general behavioral economic metrics was consistent with and contributes to the reinforcer pathology model. Additional research is warranted to expand these models to different populations and health behaviors, including those of a positive health orientation (i.e., medication adherence).     

Reinforcer pathology II: Reward magnitude,reward delay,and demand for alcohol collectively relate to college students' alcohol related problems

The reinforcer pathologies model of addiction posits that two characteristic patterns of operant behavior characterize addiction. Specifically, individuals suffering from addiction have elevated levels of behavioral economic demand for their substances of abuse and have an elevated tendency to devalue delayed rewards (reflected in high delay discounting rates). Prior research has demonstrated that these behavioral economic markers are significant predictors of many of college students' alcohol-related problems. Delay discounting, however, is a complex behavioral performance likely undergirded by multiple behavioral processes. Emerging analytical approaches have isolated the role of participants' sensitivity to changes in reinforcer magnitude and changes in reinforcer delay. The current study uses these analytic approaches to compare participants' discounting of money versus alcohol, and to build regression models that leverage these new insights to predict a wider range of college students' alcohol related problems. Using these techniques, we were able to 1) demonstrate that individuals differed in their sensitivity to magnitudes of alcohol versus money, but not sensitivity to delays to those commodities and 2) that we could use our behavioral economic measures to predict a range of students' alcohol related problems.     

The First Church of Christ, Pragmatist: Christian Science and Responsible Optimism

A common criticism of Christian Science is that it is neither Christian nor scientific. American psychologist and philosopher William James would not, I believe, share this view, even though he does make critical comments about Christian Science's orginator and her dogmatic followers. Following a suggestion of James, I distinguish two types of critical inquiry into Christian Science-outsider criticism and insider criticism-and show that the latter yields the better results. A pragmatic version of Christian Science can be offered that is distinct both from the myopic critics who malign it and from the dogmatic followers who recklessly adhere to it.     

Fruits of Health; Roots of Despair: William James, Medical Materialism and the Evaluation of Religious Experience

In The Varieties of Religious Experience, William James introduces the term “medical materialism” to describe the fallacious attempt by some scientists to argue against the value of spiritual ideas. Two literary case studies will be considered for purposes of better understanding James’ idea. What’s more, it will be shown that, in addition to James’ three criteria for the appropriate evaluation of religious experience, there is another factor not made explicit, namely that of hopefulness. This factor serves to distinguish ordinary from pathological morbid-mindedness, the latter of which has no religious significance.Tadd Ruetenik teaches philosophy at Penn State Altoona. He received his Ph.D. from the English and Philosophy program at Purdue University. Correspondence to Tadd Ruetenik, tlr18@psu.edu.     

给予老年人体面的照护：为什么尊严很重要——欧洲经验

在医学哲学领域以及相关领域中,“尊严”的概念越来越受到关注。最近,在生物伦理学的国际会议中很流行这个概念。同时,在欧洲的许多国家中,“尊严”的概念也被引入到有关卫生保健的国家立法和政策制定中。本文将从检验一个在关于尊严和老年人的欧洲计划中产生的尊严理论模型开始。然后根据参与这个计划的老年人和卫生及社会保健的专业人员那里得到的经验进行研究,有6个国家参加这项研究。结果证明尊严是一个非常重要的事情,尤其是对那些弱势群体来说。本文结论认为对于虚弱的老年人,相对于那种强调自主的医学伦理,长期的保健需要注重一个范围更为广泛的伦理内容。