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I Did You a Favor By Taking Your Work: Reconsidering the Harm-Based Approach To the Fourth Fair Use Factor
No full textAmerican copyright law is predominantly utilitarian. Fair use—codified to promote copyright’s utilitarian goals—has emerged as one of the most nebulous doctrines in American law. This is partially by design. Passing the Copyright Act of 1976 (the “Act”), Congress sought to endorse “the purpose and general scope of the judicial doctrine of fair use,” but made clear that “there is no disposition to freeze the doctrine in the statute, especially during a period of rapid technological change.” This judicial deference—combined with the case-by-case nature of fair use determinations—has led to evolving and inconsistent applications of section 107.
Interpretation of section 107(4), which instructs courts to consider “the effect of the use upon the potential market for or value of the copyrighted work,” is illustrative. Though a plain reading of section 107(4) leaves room for consideration of all market effects, most courts and commentators agree that the inquiry into this factor concerns only deleterious effects on the copyright owner’s actual or potential markets. Some have expressed hostility toward consideration of positive market effects on the ground that an infringing use that might improve sales of a copyrighted work is also likely to invade the market for derivative works.
In limited circumstances, courts and commentators have recognized the relevance of an unauthorized use providing financial gain for a copyright holder. In Authors Guild, Inc. v. Google Inc., Judge Chin indicated that Google Books increased exposure and sales for the copyright holders, concluding that “the fourth factor weighs strongly in favor of a finding of fair use.” While the Second Circuit declined to adopt Judge Chin’s explicit reasoning, Authors Guild remains a powerful endorsement of the plain reading of section 107(4). In Google LLC v. Oracle Am., Inc., the Supreme Court indicated that analysis of the fourth factor should weigh public benefits against private harms, endorsing a more holistic balancing of interests. In the wake of a reinvigorated fourth factor, it is worth reassessing whether economic benefits from infringement have any place in the market impact inquiry.
This Note addresses the current status of market benefits: monetary gains conferred upon a copyright holder by a third party’s unauthorized use of a copyrighted work. While courts are still unwilling to treat market benefits as dispositive, they are moving away from the view that the fourth factor concerns only market harm. Expanded analysis of a fourth factor now balances private economic effects, public benefits, and in some cases, non-monetary concerns related to the value of a work. Market benefit proponents assert that their inclusion is more in line with the text and history 1976 Act, as well as the overall goals of copyright. Further, weighing market benefits against market harms helps to address problems related to circularity.
This Note considers the viability of market benefits as both a dispositive and a relevant component of fourth factor interpretation. Part I provides a basic overview of the traditional approach to the fourth factor before defining and distinguishing between different types of market benefits. Part II analyzes recent caselaw acknowledging market benefits and proposes a framework for proving market benefits as part of a reinvigorated fourth factor. Part III addresses the viability of market benefit arguments across different sectors of copyrighted works and the possible implications of increased acceptance. It concludes that, despite enhanced recognition, market benefits still lack widespread applicability and are unlikely to change the outcome of any present fair use determination
Notes from the Field Preface Spring 2023
No full textDeveloping and Supporting Teachers' Mathematical Pedagog
AI and Incidental Findings: A Retrospective Duty?
No full textPhoto by Accuray on Unsplash
INTRODUCTION
Delayed and missed follow-up on incidental findings threatens patient health and is a major financial risk for healthcare systems. The healthcare industry spends $43 million annually settling lawsuits for missed follow-ups on lung findings alone.[1] Radiology reports document incidental findings, but they often go unnoticed. The practitioner who ordered the radiology may fail to inform the patient and recommend the follow-up, allowing the patient’s disease to develop unchecked. Natural language processing (NLP) makes it possible to review documents for missed incidental findings. By saving time, NLP changes an important ethical calculus. Radiologists now can more easily detect incidental findings that were in the report but not conveyed specifically and find and disclose actionable incidental findings noted in recent past radiology reports. We argue that the duty of a practitioner or radiologist to rescue a patient by informing them of recent actionable incidental findings exists due to this technological ease. This paper argues that NLP used on existing radiology reports can catch overlooked incidental findings and ensure that the practitioners who ordered the reports note the incidental finding, inform the patient, and oversee the scheduling of follow-up.
I. Background and Definitions
Incidental findings are masses or lesions detected on imaging performed for a reason unrelated to the reason for the imaging.[2] For example, radiologists may see a lung nodule on the first slices of an abdominal CT performed for abdominal pain. Radiology guidelines define the incidental finding characteristics for which disclosure and follow-up would provide a potential medical benefit. For example, decades of research demonstrate that incidentally discovered simple pancreatic cysts should be initially re-imaged in six months, while incidentally discovered renal masses less than one centimeter should be initially re-imaged in three to six months.[3]
Fortunately, the radiology community developed advancements in artificial intelligence (AI) to streamline the screening, reporting, and tracking of follow-up on incidental findings based on best practice advisories.[4] A recent study at Northwestern University established the usefulness of prospectively applying AI to screen, report, and track certain incidental findings warranting follow-up.[5] AI can easily be applied to look back at recent imaging studies lying dormant in hospital databases to ensure that all significant incidental findings warranting follow-up care have been reported and tracked to completion. However, retrospective applications of AI have not been widely implemented.
Natural language processing (NLP) is a subfield of AI in which computers are programmed to analyze a text’s contents and context.[6] NLP can be programmed into electronic health records to identify radiology reports containing incidental findings requiring follow-up based on best practice advisories. Additionally, NLP can automatically guide reporting of these findings to referrers, patients, and tracking to confirm if patients have received follow-up care.[7] A recent study from Northwestern University found that after one year of prospective implementation, the AI NLP software flagged 5.15 percent of all images (68 per day) as containing lung follow-up recommendations.[8] Results demonstrated 77.1 percent sensitivity, 99.5 percent specificity, and 90.3 percent accuracy for follow-up on lung findings.[9] NLP has the potential to significantly improve reliable follow-ups of incidental findings.[10]
II. The Duty to Report Actionable Incidental Findings
When radiologists discover significant incidental findings, they have a duty to disclose them and recommend follow-up and further screening.[11] Radiologists have this ethical duty due to beneficence and non-maleficence: a duty to do good and prevent harm. There is also a duty as part of the physician-patient relationship. The physician-patient relationship in radiology is unique as radiologists often do not have direct contact with patients and therefore do not report abnormal imaging findings directly to them. Rather, radiologists read and interpret imaging studies in a non-patient area of the hospital or even remotely and then dictate their findings. The radiology report should include any incidental findings and recommendations for follow-up care. It used to be that the radiologist uploaded this document to the patient’s medical record for the ordering provider to read and relay to the patient. Alternatively, the radiologist could directly contact the ordering provider regarding his or her findings depending on the urgency of the finding or the nature of the radiologist’s professional relationship with the ordering provider. Recently, due to both patient advocacy and the 21st Century Cures Act, the reports are generally uploaded to a patient portal. The availability of the report to the patient does not mean the patient would notice or understand an incidental finding in the report. Physicians must protect the interests of patients whose health depends on their decisions. The simple act of a radiologist dictating the significant incidental finding on his or her report and attempting to communicate the finding with referring physicians can have massive benefits for protecting patient health.
However, radiologists are not tasked with closing the loop to ensure their recommendations for follow-up are pointed out directly to patients or seeing that the patient completes the recommended follow-up care. Some centers have used NLP technology on newly dictated studies to pick up actionable incidental findings that the referring physician could overlook. The technology also can track the follow-up care to completion. There is a positive impact on patient health if the findings are more consistently communicated and follow-up care is obtained.[12] Thus, NLP technology can help radiologists fulfill their duties to report actionable incidental findings.
However, radiologists do not usually look back in their imaging study databases to check that the ordering provider closed the communication loop to patients for incidental findings on previous imaging studies that warrant follow-up or to ensure that the patient completed previous recommendations for follow-up care.
III. The Duty to Easy Rescue
While the duty to easy rescue is not the basis for reporting incidental findings normally, it may provide an ethical basis for the retrospective use of NLP to find actionable incidental findings that were not properly communicated or that did not lead to follow-up care. Philosopher Peter Singer described the duty to easy rescue through this famous thought experiment:
“If I am walking past a shallow pond and see a child drowning in it, I ought to wade in and pull the child out. This will mean getting my clothes muddy, but this is insignificant, while the death of a child would presumably be a very bad thing.”[13]
The duty to easy rescue, a refinement of the rule of rescue which is an imperative people feel to rescue individuals facing avoidable death,[14] specifically asserts that when the benefits of performing an act for someone are significant and the cost to the person performing the act is minimal, then the person should perform the act.[15] We can apply the duty to easy rescue to situations where we see a child drowning in a shallow pond or broadly to any situation where we can offer others a significant benefit at a nominal cost to ourselves. Like the drowning child example, using NLP to review documents does not take much employee time or financial resources. Retrospectively applying AI to screen past patient imaging studies can be an easily automated task, and its application may improve patient access to their healthcare information and protect patient health.
IV. The Duty to Retrospectively Screen, Report, and Track
This paper argues that the duty to easy rescue compels radiologists to apply NLP to screen, report, and track the follow-up on recent studies in their databases. Using NLP to address incidental findings could add another degree of transparency, ensuring patients have all the information they should. The extra effort could close the loop on dropped communications and may help guide follow-up care and therapies for past care that patients didn’t receive. If initial experiences reveal that retrospectively applying AI helps improve patient autonomy and health outcomes while bolstering the beneficent and non-maleficent goals of radiologists, then continuing to do so may be ethically justified. Based on how well the technology works for current radiology reports, we expect that some retrospective applications will be useful, and even lifesaving.
Before the NLP developments, reviewing past radiology reports was prohibitively burdensome, and would subvert the radiologist’s duties to current patients. A technologist or other employee might run the NLP technology. The ethical justifications arise from the ease with which the NLP performs these tasks. Therefore, the duty to easy rescue calls for radiologists to go beyond their normal responsibilities and retrospectively apply NLP.
How far back radiologists apply AI to screen past reports for actionable incidental findings should be considered in the context of the physician-patient duties and the duty to easy rescue. Reporting actionable incidental findings they missed on studies interpreted years ago, for example, may preclude the radiologist’s duty to beneficence as the incidental finding may have developed into a malignancy that already caused them grave harm. At that point, the rescue may not be that easy. Similarly, incidental findings on studies interpreted years ago may preclude the radiologist’s duty to non-maleficence, as many of these findings may have ended up being benign and reporting them now may cause the patient great angst. However, there may be real benefit to screen more recent studies radiologists can ensure patients get the care they need.
V. Limitations on the Duty
Additionally, if the “catch-up” follow-up care and communications are too time-consuming and would distract radiologists from their current patients’ needs, arguably, the retrospective look would no longer fall within a duty of easy rescue. At smaller or less-resourced centers, radiologists may be inundated with patient follow-up care requests and referring physicians regarding those abnormalities, which may subvert their duties to current patients. Further, an inundation of follow-up care requests has the potential to overwhelm referring physicians and the healthcare system. We would expect to find few missed incidental findings compared to the current number of total incidental findings found by NLP, assuming most past incidental findings were reported and followed-up. Our duty to easy rescue ethically justifies consideration of previous imaging only if the measures we take neither impose unreasonable costs nor cause greater harm than good. In all, radiologists and institutions do not have a duty to screen previous imaging studies if the resource cost is disproportionately high and subverts our duties to current patients.
CONCLUSION
The duty to screen, report, and follow up on significant incidental findings on the studies that come across our workstations today might be the same duty to screen, report, and follow up on incidental findings on previous studies sitting dormant in our databases. Applying NLP will make checking old radiology reports for unreported incidental findings easier and may benefit patients. Due to the ease with which radiology entities can run the AI to scan recent reports, radiologists should have a duty to do so. However, we acknowledge that the duty of radiologists to look back has limits and must not distract from our duty to current patients.
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[1] PR Newswire.com. Using Artificial Intelligence to Solve One of Health Care’s Most Enduring Problems [Internet]. 2022. Available from: https://www.prnewswire.com/news-releases/using-artificial-intelligence-to-solve-one-of-health-cares-most-enduring-problems-301504387.html
[2] American College of Radiology Clinical Resources. Incidental Findings [Internet]. Available from: https://www.acr.org/Clinical-Resources/Incidental-Findings
[3] Berland, L. L., Silverman, S. G., Gore, R. M., Mayo-Smith, W. W., Megibow, A. J., Yee, J., Brink, J. A., Baker, M. E., Federle, M. P., Foley, W. D., Francis, I. R., Herts, B. R., Israel, G. M., Krinsky, G., Platt, J. F., Shuman, W. P., & Taylor, A. J. (2010). Managing incidental findings on abdominal CT: White paper of the ACR Incidental Findings Committee. Journal of the American College of Radiology, 7(10), 754–773. https://doi.org/10.1016/j.jacr.2010.06.013
[4] PR Newswire.com, p.1; Carrodeguas E, Lacson R, Swanson W, Khorasani R. Use of Machine Learning to Identify Follow-Up Recommendations in Radiology Reports. Journal of the American College of Radiology. 2019 Mar;16(3):336–43; Domingo J, Galal G, Huang J, Soni P, Mukhin V, Altman C, et al. Preventing Delayed and Missed Care by Applying Artificial Intelligence to Trigger Radiology Imaging Follow-up. NEJM Catalyst [Internet]. 2022 Mar 16 [cited 2022 Oct 18];3(4). Available from: http://catalyst.nejm.org/doi/10.1056/CAT.21.0469
[5] PR Newswire, p. 1; Domingo, p. 1
[6] IBM Cloud Education. IBM Cloud Learn Hub What is Natural Language Processing? Natural Language Processing (NLP) [Internet]. 2020. Available from: https://www.ibm.com/cloud/learn/natural-language-processing
[7] Domingo, et al., p. 1
[8] Domingo, p. 1
[9] Domingo, p. 1
[10] Domingo, p. 1
[11] Mabotuwana T, Hall CS, Tieder J, Gunn ML. Improving Quality of Follow-Up Imaging Recommendations in Radiology. AMIA Annu Symp Proc. 2017;2017:1196–204.
[12] Domingo, p. 1
[13] Singer, P (2016). Famine, affluence, and morality. Oxford University Press: 231
[14] Jonsen, A. (1986). Bentham in a box: Technology Assessment and Health Care Allocation. Law Med Health Care; 14(3- 4): 172-174
[15] Singer, p, 231-23
An Exploration of the Effects of Gene-Editing Technology on Human Identity
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INTRODUCTION
Genes are the most foundational physical unit of a human, coding for every phenotypic characteristic that a human exhibits.[1] Thus, some view the editing of genes as the alteration of one’s physical nature. The extent to which gene-editing, using technology such as CRISPR, alters one's identity is an open issue. Answering this question requires exploring what constitutes human identity (physical or mental forms, or both) and the role DNA plays. This philosophical question concerns the role of the body in the conception of oneself and how fundamental changes to one’s body alter that conception. As gene-editing technologies continue to be refined and implemented in humans, this question is especially relevant. Its answer can alter the decisions society makes about the use of gene-editing technology in humans. Alterations to one’s physical form through gene-editing change one’s physical makeup. Gene-editing causes modifications that span both realms of one’s sense of self because physical identity can affect mental identity. This paper explores philosophical approaches to identity and the relationship between body and mind, arguing that physical changes have significant capacity to alter emotions and mental status in ways that may shape identity.
I. CRISPR and Gene-Editing Capability
Scientists can use gene-editing to rectify the genetic flaws that cause genetic disorders. Trisomy 21, or Down Syndrome, for example, is caused by an additional 21st chromosome in a person’s genome. Deletion of this extra chromosome through gene-editing would erase the disease, changing the person’s genomic foundation and life. They would no longer need to manage the effects of trisomy 21. Gene-editing in the case of trisomy 21 impacts identity. An analysis of perspectives on the link between trisomy gene-editing and identity revealed a split between those who viewed trisomy as separate from identity and those who viewed it as fundamental. Participants favoring a connection between trisomy and identity were more likely to oppose gene-editing, as they believed it would bring fundamental changes to who the person is.[2] Discussion of the extent to which gene-editing impacts identity is important in informing these opinions and, in turn, the policies society implements on the use of gene-editing. Somatic gene-editing, performed in existing people rather than an embryo, proposes a unique case. Many view somatic editing as “similar to other medical treatments” rather than a complete alteration to one’s identity because it is only used in cells in specific tissues to fix symptoms, not the entire disease. For trisomy 21, somatic gene-editing will only be possible in specific tissues and cells of the body, such as in the nerve cells that cause muscle weakness in Down Syndrome patients, since it is not yet possible to change every cell carrying the genetic flaw.[3] Researchers can treat other diseases more completely with gene-editing. To fix the single nucleotide mutation that causes sickle cell disease, for example, researchers can edit the red bone marrow cells extracted from patients, edit them using CRISPR, and reintroduce them into the patient.[4] Gene-editing enables a more comprehensive solution for sickle cell disease in existing people, but it entails the same genome editing as with trisomy. Regardless of the disease or somatic or germline cell targeting, gene-editing alters the DNA a human carries. By exploring the most basic implications of that alteration on human identity, this paper will define the relationship between gene-editing and identity.
II. Views on Physical Identity
Some may view a human’s physical nature as their only nature and thus the sole component of identity. Reductive physicalism proposes that the world is made of only physical components.[5] Reductive physicalists challenge the existence of the mind or a higher power by arguing that all processes can be broken down into their physical components. By this reasoning, humans are a collection of atoms and molecules compartmentalized into cells that perform all human functions. By suggesting that humans are entirely physical in nature, this theory proposes that one’s physicality must constitute identity. In A Treatise of Human Nature, David Hume alludes to the essential role of physicality in identity. Although Hume also discusses the role of a non-physical mind in the processing of perceptions, Hume states that “after the dissolution of my body, I should be entirely annihilated.”[6] The destruction of one’s being, one’s identity, when one ceases to physically exist reinforces the idea that humans are solely physical in nature. Applying reductive physicalism, the dependence of identity on physicality supports that changing one’s physicality through gene-editing will change one’s identity.
In Being and Nothingness, Jean-Paul Sartre argues that a human confirms his existence when he sees “the other” looking at him, becoming an object rather than a subject. Describing one’s sudden self-consciousness and resulting shame, Sartre poses “the look” as essential in one’s formation of a sense of self.[7] Since the body is recognized by “the other,” the pre-reflective cogito suggests that, without the body, one would not be able to recognize their own existence. Under Sartre’s argument, a physical body is a precursor to identity. However, gene-editing by altering the physical characteristics of a human, such as the shape of red blood cells in sickle cell disease patients, generally leaves the body intact. One would still be perceived by “the other” after gene-editing and have their identity confirmed. Sartre’s “the look” reinforces the importance of the body. Yet gene-editing would not impact one’s being an object of another.
III. Mind and Body Combine in Human Identity
In philosophy, mind-body dualism means that humans are composed of mental and physical substances. These forms of an individual are distinct yet inextricably interconnected.[8] René Descartes introduced mind-body dualism to argue the existence of a mind without disputing the existence of a body. In his Cogito Theory, Descartes states, “I think, therefore I am.” According to Descartes, the mind is an indivisible substance that coexists with but is distinct from the body because it lacks shape and physicality.[9] Descartes confirms his existence by the fact that his mind is a “thinking thing” rather than by the other’s recognition of one’s body, as Sartre does. The idea of a non-physical aspect to humans challenges reductive physicalism and provides the space for something more than the body to define a human. The mind confirms existence and thereby grants identity, suggesting not only that the mind exists, but also that it is more central to identity than the body. This view aligns with current views about identity. Since Descartes regards the mind and body as two distinct substances, in his view, the physical changes caused by gene-editing do not directly influence the mind. Gene-editing alters the molecules in genes, but according to dualism, the mind is not composed of atoms like the body is. A genetic change would not penetrate the mind. The distinction between the mental and physical aspects of identity demonstrates how gene-editing may not have substantial power over one’s identity. Since Descartes prioritizes the mental aspect of identity over the physical, gene-editing’s effect on identity appears even more limited.
IV. Mind-Body Philosophies
Other philosophical viewpoints further support a mental aspect of human identity. In De Anima, Aristotle delineates that the body is a manifestation of the mind, which is a manifestation of the soul.[10] Although the mind and body are two essential, coexistent aspects of a human, the body comes from, and thus relies on, the mind. Aristotle frames the mind, the origin of the body, as more central to human existence. This postulates that the changes to physical identity induced by gene-editing technologies may not directly influence the mental aspect of identity because the mind does not stem from, and thus is not dependent on, the body. The mind’s more direct connection to the soul cements its larger role in identity because non-secular philosophy views the soul as the core, eternal aspect of a human. The superiority of the mind over the body regarding identity demonstrates gene-editing’s limited influence on identity.
In A Treatise of Human Nature, Hume suggests that identity is formed based on perceptions, reinforcing the role of the mind. Perceptions, which originate as a physical sensation, inspire feelings and thoughts, an aspect of one’s mind. Hume gives the example of feeling the warmth of a fire.[11] The emotions that arise are processed and stored in the mind. The accumulation of perceptions from different experiences shapes one’s identity. A traumatic event or significant accomplishment often becomes part of one’s sense of self because of the perceptions one acquires. Hume’s proposition that successive perceptions forms the mind, which are important to identity, further demonstrates that the mind is an aspect of identity. Under such a viewpoint, gene-editing would appear restricted in its ability to change identity, as it alters the body but not the mind. DNA cannot change the experiences and thoughts encoded in one’s mind. One may argue that scars on one’s body, rather than thoughts in one’s mind, are the marks of one’s perceptions, like a burn mark from touching a hot stove. However, the memories and emotions of an experience that a scar represents are deeper than the scar itself. A scar on a person has more meaning than a scar on a wax figure, a purely physical being, because of the mental associations with the scar in the person’s mind. Thoughts residing in the mind contribute to one’s identity, highlighting the role of the mind in a human's sense of self.
Although gene-editing in non-neuronal cells cannot directly alter one’s thoughts, the processing of perceptions to form mental identity depends on the physical aspect of humans. Hume proposes that the body mediates the outside world and the mind, detecting stimuli and relaying information to the mind. This communicative relationship between the mind and the body, expressed in mind-body dualism, proposes that physical changes caused by gene-editing could affect how and when external stimuli are detected. This indirect consequence that gene-editing can have on the mind opens the discussion of how physical genetic changes could affect mental identity despite the immaterial nature of the mind.
V. Current Scientific Understanding of the Mind-Body Relationship
There is significant medical research on the relationship between the physical body and emotions like happiness, anger, and depression. Modern science sees many emotions as linked to the physical. Although gene-editing does not directly change the mind, it can be affected by those physical changes. It is well-known that there is a “functionally integrated relationship between mind and body.”[12] This “relationship” suggests that the mind and body do not function separately but rather influence each other. For example, replacing bad gut bacteria with good gut bacteria in animals and humans can “significantly alter mood and emotional functions.”[13] Gut bacteria is a purely physical component of the body, while mood and emotion are more mental. The influence of the physical on the mental illustrates the effect of the body’s state on the mind. The two-way communication that the mind and body exhibit have important consequences for the role of DNA in identity. Genetic alterations caused by CRISPR, for example, may affect the mental aspect of identity. Researchers can use CRISPR to cure a sickle cell disease patient by changing just one nucleotide in a human’s genome.[14] The editing of the patient’s genome changes their physical identity because genes are a physical component of humans, but mental changes can also result. No longer suffering from the debilitating pain of a chronic disease, the patient’s mood and outlook on life may shift. The integrated mind-body relationship suggests that gene-editing may have a broader impact on identity than anticipated, affecting both the body and, indirectly, the mind.
VI. Mind and Brain Philosophy
The effects of gene-editing on the mind can be more direct when the genes edited are associated with the brain. One theory explaining this phenomenon is the Mind-Brain Identity Theory. This theory postulates that “states and processes of the mind are identical to states and processes of the brain” even though the mind is non-physical.[15] Therefore, changes to the brain will correlate with changes to the mind and, in turn, affect mental identity. Using CRISPR to correct the genes that cause Huntington's Disease, for example, would improve the physical conditions in the brain that cause its symptoms. According to the Mind-Brain Identity theory, it would improve one’s mental state as a result. If a mistake occurs and the condition worsens, or researchers edit beyond correcting the disorder, the negative consequences in the brain would correlate with a worsened state of mind. The direct correlation between the mind and brain increases the risks of gene-editing. The Mind-Brain Theory amplifies gene-editing’s effect on identity because it suggests physical changes can not only indirectly, but also directly, impact mental identity.
CONCLUSION
Gene-editing alters the physical body. Due to the integrated mind-body relationship, it can also directly and indirectly modify mental identity. Mind-body dualism, as opposed to reductive physicalism, yields an understanding of identity that parallels the way mind-body connections are currently understood. Current science suggests that mood and emotion may be more squarely tied to the physical. Identity likely depends on some combination of the physical and mental. Framing mental aspects, including emotions, personality, and thoughts, as immaterial and genes as physical could lead to the overuse of gene-editing technology for physical purposes like disease prevention, solutions, or enhancement. Mind-body dualism forms the foundation for gene-editing’s nuanced, far-reaching impact on one’s sense of self. Identity defines an individual, both to themselves and others. The potential for unknown or undesired effects of gene-editing on identity calls for balancing the technology’s benefit to human health with its potentially negative impact on identity. The philosophical and ethical underpinnings should help inform public policy and scientific engagement as gene-editing becomes more influential in medicine.
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[1] “The predominant current day meaning of genotype is some relevant part of the DNA passed to the organism by its parents. The phenotype is the physical and behavioral traits of the organism, for example, size and shape, metabolic activities, and patterns of movement.” Taylor, Peter and Richard Lewontin, "The Genotype/Phenotype Distinction", The Stanford Encyclopedia of Philosophy (Summer 2021 Edition), Edward N. Zalta (ed.), URL = <https://plato.stanford.edu/archives/sum2021/entries/genotype-phenotype/>.
[2] Elliott, Kathryn, et al. “‘I Wouldn’t Want Anything That Would Change Who He Is.’ the Relationship between Perceptions of Identity and Attitudes towards Hypothetical Gene-Editing in Parents of Children with Autosomal Aneuploidies.” SSM - Qualitative Research in Health, Elsevier, Dec. 2022, www.sciencedirect.com/science/article/pii/S2667321522001135.
[3] Watson-Scales, Sheona et al. “Analysis of motor dysfunction in Down Syndrome reveals motor neuron degeneration.” PLoS genetics vol. 14,5 e1007383. 10 May. 2018, doi:10.1371/journal.pgen.1007383
[4] Cross, Ryan. “CRISPR edits sickle cell mutation” C&EN Global Enterprise 94 (41), 5-5, October 17, 2016. https://pubs.acs.org/doi/10.1021/cen-09441-notw1
[5] Stoljar, Daniel. “Physicalism.” Stanford Encyclopedia of Philosophy. Stanford University, May 25, 2021. https://plato.stanford.edu/entries/physicalism/.
[6] Hume, David. “Of Personal Identity.” Essay. In A Treatise of Human Nature. Project Gutenberg, n.d.
[7] Sartre, Jean-Paul. Being and Nothingness, n.d.
[8] Descartes, René. Meditations on First Philosophy. Yale University, n.d.
[9] Descartes, René. Meditations on First Philosophy. Yale University, n.d.
[10] Aristotle. “The Internet Classics Archive: De Anima (On the Soul) by Aristotle.” The Internet Classics Archive | On the Soul by Aristotle, n.d. http://classics.mit.edu/Aristotle/soul.html.
[11] Hume, David. “Of Personal Identity.” Essay. In A Treatise of Human Nature. Project Gutenberg, n.d.
[12] News. “A Neurosurgeon and a Philosopher Debate Mind vs. Body.” Mind Matters, February 28, 2022. https://mindmatters.ai/2022/02/a-neurosurgeon-and-a-philosopher-debate-mind-vs-body/.
[13] Jasanoff, Alan. The Biological Mind How Brain, Body, and Environment Collaborate to Make Us Who We Are. Cambridge: Basic Books, 2018.
[14] Frangoul, Haydar et al. “CRISPR-Cas9 Gene Editing for Sickle Cell Disease and β-Thalassemia.” The New England journal of medicine vol. 384,3 (2021): 252-260. doi:10.1056/NEJMoa2031054
[15] Smart, J. J. C. “The Mind/Brain Identity Theory.” Stanford Encyclopedia of Philosophy. Stanford University, May 18, 2007. https://plato.stanford.edu/entries/mind-identity/
Urgent Listening: A Conversation with Hardi Kurda
Get PDFThis conversation, which took place in Oxford, England, is part of a series of conversations hosted by Gascia Ouzounian on the theme “Countersonics: Radical Sonic Imaginaries.” It has been lightly edited for clarity and length
Anxiety Symptoms in a Community During the COVID-19 Pandemic: A Self-Reported Study
Get PDFThe coronavirus (COVID-19) pandemic has affected many aspects of people’s lives, including their mental health. To better understand its impact, the current study looked at how demographic features and beliefs about the pandemic influenced anxiety during this time. Participants included 221 residents of Michigan who predominantly identified as female and White. They completed the Adaptation to Social Stress Questionnaire, a 105-item self-report questionnaire developed to assess participant characteristics, ability to adapt to stress and opinions, beliefs, and experiences related to the COVID-19 pandemic, and two measures of anxiety (the State-Trait Anxiety Inventory and the Generalized Anxiety Disorder scale). Pearson product-moment correlations and independent samples t-tests were used to determine the relationship between anxiety and other study variables. Results show that religious affiliation and older age were associated with lower anxiety scores while living in the subjects’ close environment as an infected individual was associated with increased anxiety. Interestingly, thinking someone was to blame for the pandemic, being angered by official message regulations, and not thinking lockdown measures were sufficient increased anxiety. This latter finding implies that, consistent with clinical theory, our beliefs about events are connected with our emotional experiences. Recommendations for clinical practice are noted, as it is imperative for clinicians to be consistent and direct regarding any protocol changes that may help minimize client anxiety. Lastly, considerations regarding transparent communication from leaders of organizations that are adjusting their policies due to the COVID-19 pandemic are discussed
The Federal Response to the Opioid Epidemic: Examining 2021 SAMHSA Grant Allocation
No full textThe opioid epidemic has been a major public health crisis since the 1990s but was only declared a federal public health emergency in 2017. Since then, the federal government has increased funding to states for programs to address opioid use and overdose deaths. Despite the increased funding in the past five years, opioid-related overdose deaths continue to rise.
The Substance Abuse and Mental Health Administration (SAMHSA) is the major federal agency responsible for allocating federal funds to opioid use disorder prevention, treatment, and personnel training programs. In 2021, SAMHSA allocated funding for opioid use disorder through eleven grant programs with a total of 330 grant awards, amounting to over $150 million. My analysis of 2021 SAMHSA grants aims to identify how funds for opioid use disorder are allocated, examine the relationship between opioid-related overdose deaths and the amount of funding allocated to states, and suggest potential gaps in funding.
Ultimately, my research has found that treatment-focused programs were prioritized over prevention and education or training programs by SAMHSA funding. In 2021, treatment programs accounted for 223 of the 330 individual SAMHSA grant awards for opioid use disorder and 100% of grant awards received by nonprofit organizations. Medication-Assisted Treatment is the most commonly funded program among these grant awards.
Additionally, states with a higher number of opioid-related overdose deaths are more likely to receive higher funding from SAMHSA grants (p<.001). Conversely, states with higher overdose death crude rates per 100,000 people did not receive adequate funding relative to the size of the population, creating gaps in accessibility to care. Additional gaps in opioid use disorder programs exist due to the downstream focus of funded interventions, neglecting upstream interventions.
The data in my research are limited and therefore cannot draw broader conclusions as to how funding influences overdose deaths over time.
Education as an international export: Marketing elite, English schools as franchises overseas
No full textA growing portion of international schools are franchised branches of schools originally founded in other countries. The first of such schools opened in 1996 and there are now almost 100 globally. Expansionist schools are primarily elite, English private schools, with concentrations of their franchises developing in the Middle East, Southeast Asia, and East Asia over the past quarter of a century—particularly in mainland China over the past decade. This study explores how such schools adapt the language and focus of their marketing and, in doing so, sustain their privilege across various contexts. A qualitative textual analysis is conducted of the websites of 11 schools run by Dulwich College and Harrow School, the first brands to expand overseas and with the most extensive networks of schools today. A lens of international schools as enclosures of privilege is used to demonstrate how schools adapt themselves and their framing. The study finds the promotional focus of the schools depends not just on whether they are the founding school or a franchise, but also on their relative ages, and on their varying locations within specific sociocultural contexts. An emergent hybrid model, catering to both local and international curricula, blends the local with the global and complicates the conventional notion of the international school. Finally, the study suggests that further research is focused on the franchising of elite education, particularly as the focal point of expansion begins to shift away from the mainland Chinese boom of the past decade
What Does It Mean to be Chinese? Diasporic Literature Versus Orientalism in an Anglophone Market
Get PDFIn recent years, more and more English-language literature is being published by Asian diaspora writers, mostly in the genres of fantasy and science-fiction. With the focal audience being young adults, such publications are seen by many as a form of escapism. While most of these works stem from the Sinophone diaspora communities, there remains much debate regarding how their stories and the authors themselves should be labeled. In the face of the pervasive nature of Western Orientalism, Chinese writers have struggled with the balance of inclusion and exclusion regarding both Chinese culture in their works and themselves within the Anglophone literature market. By examining the contemporary authors Andrea Stewart and Xiran Jay Zhao alongside their respective debut publications The Bone Shard Daughter (2020) and Iron Widow (2021), it becomes apparent that Sinophone authors and their works are often misinterpreted by Western audiences. This paper demonstrates how the vague and limiting labels of “Chinese Sci-Fi” and “Chinese Fantasy” are a direct result of Orientalism and do not consider the vast diversity the Sinophone diaspora communities contain. To understand this, it is crucial to lay the foundations of both the dynamic concept of the Sinophone diaspora and the record of science-fiction in Chinese history. While the field of Sinophone literary studies continues to expand, much work remains to better incorporate Sinophone diaspora writers into the Anglophone markets without being questioned, what does it mean to be Chinese