Digressions&Impressions

On Extending a Self onto an Organoid

An organ-on-a-chip is a microfluidic cell culture device created with microchip manufacturing methods that contains continuously perfused chambers inhabited by living cells arranged to simulate tissue- and organ-level physiology. By recapitulating the multicellular architectures, tissue-tissue interfaces, physicochemical microenvironments and vascular perfusion of the body, these devices produce levels of tissue and organ functionality not possible with conventional 2D or 3D culture systems. They also enable high-resolution, real-time imaging and in vitro analysis of biochemical, genetic and metabolic activities of living cells in a functional tissue and organ context. This technology has great potential to advance the study of tissue development, organ physiology and disease etiology. In the context of drug discovery and development, it should be especially valuable for the study of molecular mechanisms of action, prioritization of lead candidates, toxicity testing and biomarker identification.--Sangeeta N Bhatia & Donald E Ingber Nature Biotechnology, 32, pages, 760–772(2014).*

Organ-on-chip research has been promoted for a decade now (see this Scientific American article from 2011). And in recent years, it has become a staple of medical research, and now is entering clinical practice or, if not already, foreseeably so. There is, in fact, increasing public and philosophical interest in cerebral organoids because of their potential for consciousness. See for recent work by Koplin & Savulescu here, who claim that "brain organoid research raises ethical challenges not seen in other forms of stem cell research."+ Let me stipulate that Koplin & Savulescu are right about this. Even so I also think that when reflecting on the ethical and social challenges generated by organ-on-a-chip research, exclusive focus on such mini-brains, understandable and urgent though it may, may also lead to inattention to other interesting issues related to non-brain-organoid research. I would like to sketch some of these. 

At present researchers are working to create 3D patient-specific micro-models facilitating individualized clinical disease prediction, prevention, and intervention. Simultaneously, a new kind of model-organism for basic research into the underlying disease(s) and efficacy of proposed therapeutics is, as Melinda Fagan pointed out in 2017, being created. (I warmly recommend Fagan's article.)** When I am focused on patient models, I use 'organoids;' when I am focused on model-organisms, I use 'organ-on-a-chip.' In what follows, I am interested in organoids/organ-on-a-chip for patients with defective or malfunctioning organs.*

Crucially, organoids resemble are generated from the patient’s own tissue; and so can blur the distinction where an individual begins and ends (this is, in fact, one of Fagan's main points). Since particular organoids may come to be linked to personalized treatment, it is reasonable to suggest that it will constitute their extended self. This is especially the case once the patient associates themselves, their identity, with their disease and/or when society treats their disease as a risk factor. This is, of course, not necessary.

But when a patient is in a hospital environment, a lot of attention is focused on their defective organs and the manner in which these defects constrain/inhibit/limit their lives. (Here i am influenced by, recall, Elizabeth Barnes' work on disability.) So, it is reasonable to expect that patients (and I now adopt Humean language) may project or spread themselves onto their organoids, which may represent or materialize their disease progress. It is, then, them in an artificial environment.

That organoids can be part of their extended self is not self-evident: they are often perceived as just a clinical tool on par with a blood sample or a X-ray. My suggestion is that in a clinical context such organoids will be more like prosthetics than X-rays (see here an interesting article by Hilhorst). I suspect this is especially natural to experience a 3D model as an extended self in the context of hereditary disease, where the ultimate therapeutic or clinical aim is not just to mitigate the effects from, but to modify or correct/repair the underlying genetic error. 

So, I speculate that organoids can become more than just a representation of a part of the patient; they can also play a role in their social identity, e.g. in their interactions with their physicians, care-givers, insurers, family, etc. I am especially curious if their moral phenomenology and language will shift. One relevant question is the extent to which partial identification with an organoid can influence the patient’s decision-making or well-being, even clinical efficacy.++ Another more ethical question is to what degree such identification should influence the role a patient's wishes for the organoid should trump others. 

Even so, organ-on-a-chips,  as model-organisms, must facilitate standardization and share-ability of research and function as epistemic tools of inquiry. The ethics and politics of treating humans, or their parts in artificial environments, as model organisms is, it seems, itself underdeveloped. (I started thinking about this in light of Sabina Leonelli's 2012 paper.) In particular, since stem-cells can be self-organizing and have lineage generating capacity, it is worth asking to what extent the current oversight and consent regulations that cover organ-on-a-chip research do justice to the possible sense of self of donors and patients may experience with their organoids. There may be all kinds of conflicts brewing.

 

On the Crisis of Liberalism (VII): Pandemics and the Strong State

[I]f some day a legislature, having exhausted all other ways of improving mankind, should forbid the scoring of baseball games, it might still be possible to play some sort of game in which the umpire decided according to his own sense of fair play how long the game should last, when each team should go to bat, and who should be regarded as the winner. If that game were reported in the newspapers it would consist of a record of the umpire's decisions, plus the reporter's impression of the hoots and cheers of the crowd, plus at best a vague account of how certain men, who had no specified position on the field moved around for a few hours on an unmarked piece of sod. The more you try to imagine the logic of so absurd a predicament, the more clear it becomes that for the purposes of newsgathering, (let alone the purposes of playing the game) it is impossible to do much without an apparatus and rules for naming, scoring, recording. Because that machinery is far from perfect, the umpire's life is often a distracted one....

Wherever there is a good machinery of record, the modern news service works with great precision. There is one on the stock exchange, and the news of price movements is flashed over tickers with dependable accuracy. There is a machinery for election returns, and when the counting and tabulating are well done, the result of a national election is usually known on the night of the election. In civilized communities deaths, births, marriages and divorces are recorded, and are known accurately except where there is concealment or neglect. The machinery exists for some, and only some, aspects of industry and government, in varying degrees of precision for securities, money and staples, bank clearances, realty transactions, wage scales. It exists for imports and exports because they pass through a custom house and can be directly recorded. It exists in nothing like the same degree for internal trade, and especially for trade over the counter.

It will be found, I think, that there is a very direct relation between the certainty of news and the system of record. If you call to mind the topics which form the principal indictment by reformers against the press, you find they are subjects in which the newspaper occupies the position of the umpire in the unscored baseball game. All news about states of mind is of this character: so are all descriptions of personalities, of sincerity, aspiration, motive, intention, of mass feeling, of national feeling, of public opinion, the policies of foreign governments. So is much news about what is going to happen. So are questions turning on private profit, private income, wages, working conditions, the efficiency of labor, educational opportunity, unemployment, monotony, health, discrimination, unfairness, restraint of trade, waste, "backward peoples," conservatism, imperialism, radicalism, liberty, honor, righteousness. All involve data that are at best spasmodically recorded. The data may be hidden because of a censorship or a tradition of privacy, they may not exist because nobody thinks record important, because he thinks it red tape, or because nobody has yet invented an objective system of measurement. Then the news on these subjects is bound to be debatable, when it is not wholly neglected. The events which are not scored are reported either as personal and conventional opinions, or they are not news. They do not take shape until somebody protests, or somebody investigates, or somebody publicly, in the etymological meaning of the word, makes an issue of them.--Walter Lippmann (1921) Public Opinion, Chapter 23.

The second wave of liberalism (recall) has ended and liberalism may not survive. Some readers will say, good riddance, and to you I say, I hope you do better. This is the seventh post (recall here (I);  here (II); here (III); here (IV); here (V); here (VI) in an open-ended series (see also here, here, here,  here; and here). Critics of liberalism remind their readers during the pandemic that we care for more than "market logic" (Lisa Herzog in the New Statesman) or that there is more to the economy and living than "exchange value" and "how false our beliefs about markets are" (Simon Mair in The Conversation). Indeed, given the intellectual implosion of Richard Epstein this week, one may be forgiven into thinking that a variety of classical liberalism is truly on (ahh) a ventilator. But see these two fine essays by Nick Cowen. here and here; the second one reminds fans of the Non-Aggression Principle  that "natural rights are conceived to protect life as well as liberty and property." 

Friends and critics of markets have been much impressed (recall) by Hayek's argument that markets are impressive epistemic machines. But as is well known, Hayek thinks that the state and evolving common law provides the framework for the market and, at bottom, act as (to use David Schmidtz's phrasing) its impartial umpire. Hayek's friends, the ordoliberals (Ordos), went further (recall here) and claimed that quite a bit of state capacity, expertise, and even a proper ruling ethos is needed for the state to act as an umpire and to help the market function properly. 

More than any other liberal thinker, but drawing on ideas visible in Adam Smith, Walter Lippmann recognized that for markets, the media, and public opinion to function, the state is needed not just as impartial rule-setter and arbiter, but as a generator and storehouse of reliable and usable information. Conveniently he uses the umpire analogy for this. As the quoted passage reveals, Lippmann didn't think that only the state could be a reliable source of information (the stock-market is a private association).  It's compatible with his view that for-profit enterprise can also do so.

A core capacity of the modern state is to be a machinery of record. This is, of course, also recognized by those like Foucault and James C. Scott who argue that legibility of the population is a key feature of state-building and statecraft. This is a feature and not a bug of liberalism. Because (and to combine Lippmann and Hayek) in virtue of having a machinery of record, the market machinery can do its fallible work. That means that one of the distinctive mind-sets and dispositions of the liberal state is to gather data in order to discharge its proper functions. And, as Adam Smith already noted, to "prevent" the "spread" of a most loathsome "disease" deserves the "most serious attention of government" (WN 5.i.f.60.) 

Of course, all states collect information. The distinctly liberal state does so in a rule-following fashion and respecting certain limitations which include the possibility of publicly reconstructing the data-chain and so being contestable.* One reason why modern (neural-networky) AI is causing so much trouble for liberal thinkers is that while it is rule governed its internal workings are also opaque and so difficult to contest.

We see this in the attitude of the German government which started building up the capacity to test early in the pandemic. Germany conducts "50,000 coronavirus tests a day." This is partly due, as the Financial Times reports, to its decentralized testing regime. (The US's reliance on the CDC makes it vulnerable to mismanagement, underfunding or simple errors of judgment.) But partly this is also due to the fact that German liberalism, as represented by the ORDOs, has not treated well-directed state capacity itself with suspicion.

No doubt even well functioning machinery of record can be abused or captured by sinister interests. But, going forward it would be useful for liberals to remember Lippmann's insight that maintaining the Weberian state as a machinery of record with the dispositions to act in the public's interest, remains a vital element of a liberalism worth having.

 

REPORT OF AN EMERGENCY ROOM PHYSICIAN (Guest Post by Natalie Eggermont)

[Natalie Eggermont is a trained moral philosopher (a former student), an environmental activist, politician, and ER physician in West Flanders. This post first appeared in Dutch on March 26, 2020; the translation appears with permission.--ES]

The night shift in the ER. There is no certainty about how the crisis will develop. Keep on fighting. And let off steam together. About the shortage of material and excrutiating political choices.

I know this feeling. I sense the impending impact. Last year I had an accident in a MUG [that is, physician led ambulance].* In the middle of the night we flew through the intersection with screaming sirens. When I saw the other car coming from the right, I knew that a collision was inevitable. After the blow, everything went in slow motion for a few seconds. The airbags inflated, I braced myself. Waiting for things to come. Would we flip? Crushed against a post or facade? Disintegrate? Was this the end?

It is that feeling with which I crawl into the car for the night shift. I recognize it. Only this time it is painfully slow and the end is not yet in sight. The email I just received from management haunts me. We are seeing an exponential increase in patients and expect it to continue for at least two more weeks. "There are no objective reasons to think that doomsday scenarios like those in Italy, Spain and France can be avoided here." I'm trying to master that awkward feeling. The next few weeks are going to be hellish. On the radio, the presenter asks what people do at home against boredom.

In the meantime, the emergency room has been completely redesigned; the flow of “corona” and “non-corona” has been separated. During the handover - where the ten of us in the small kitchen try to keep 1.5 m apart - the last guidelines are listed again and we receive an update on the state of affairs in our hospital. The many questions are answered as best as possible.

Cannon fodder
It is also the time to let off some steam. Someone derides the cabinet-ministers and years of savings in health care: "And now they are clapping hypocritically for us!" The lack of mouth masks is also reviewed: "If we had bought two F-35s less, I would not be here with one mask per shift." Few fans of Maggie tonight.* Management had sent us the new guidelines from the federal government by email: you wear a mask for eight hours, "to prevent and/or limit shortages." According to scientific guidelines, they are no longer safe after four hours.

It is beyond shame. Are we suddenly jointly responsible for preventing shortages? Experts warned the government in 2009 (!) that in our country the stock of masks was “below average” and that “saving on these expenses was ethically unacceptable.” The various governments did nothing for ten years. Even worse: in 2018, Minister De Block decided to destroy and not replace 6 million high-quality mouth masks. Now caregivers, store clerks, home nurses, garbage collectors, cleaners, truck drivers, dockers… must risk their health due to guilty neglect on the part of the government. Just like during the Great War, ordinary people are used as cannon fodder in the fight against the enemy.

Health versus profit
Planned shortages and a sluggish policy. It does not only pertain to face masks. There is a patient in the suture-room, a work accident. "What kind of work are you doing," I ask, inspecting the wound in his palm. "I work in the metal industry." "In the metal industry, why aren't you at home?" I react surprised. "Is that essential work?"+ "Like hairdressers, for sure," he laughs wryly. "I'd rather be home, though."

I do not understand. We have no objective reasons to believe that we can avoid doomsday scenarios, hospital management says. We are short of protective equipment for our healthcare personnel. Then why are so many people still working to make things that we don't need now? That is asking for further spread of the virus. That will translate into deaths we could have avoided. When [medical ethicists at] universities develop guidelines on who should and should not be put on the ventilator and economists call to keep working as much as possible to mitigate the crisis (the economic one), I am caught in a nauseating mix of grief and anger . So I'm going to have to let patients go because some bosses don't want to close their businesses? Patients who may not have had a visit for days and cannot have a dignified funeral. And is that just being said and supported by our politicians without blinking? Now we know how coldly unfeeling our economic system makes its choices. In times of crisis, capitalism shows its true face.

The hidden consequences of social distancing

Back to our kitchen. It is suspiciously quiet in the ER. We fear that many people who should come are afraid to do so. We hear it every day: "My son, my daughter, our home nurse told me to come." People don't like to come to the hospital. Certainly not now. There is fear of corona. People know that no visitors are allowed. And above all, there is no social monitoring anymore. No son or daughter visiting [their aged parents] and sounding the alarm. No caregiver noticing that speaking has become more difficult. For example, there are now three patients on intensive care with severe inflammation and kidney failure who probably would have come earlier in other times. Two of them have since died. The many initiatives, including from city councils, to actively call up vulnerable people are heartwarming and much needed. If anyone ever tries to tell you again that man is a solitary and selfish being, think back to this time. We are thoroughly social beings.

Someone bursts into tears. I want to give her a hug but it is not allowed. Loneliness is beginning to weigh on us too, although we are never alone. People fear us because we come into contact with the virus every day. We all feel it. "You shouldn't give mom kisses or hugs anymore," said one husband. He also kept his distance, bed and bathroom were separated. However, it is the love and support of family that keeps us straight after a long shift.

I hope it doesn't get too hellish tonight. Because during the weekend there is no cleaning crew at night and every potentially infected box is one box less in anticipation of the first rays of the sun. We have to laugh notice that when the ambulance is called, I have to crawl into the trunk of the physician led ambulance, otherwise we are too close together.

We laugh, cry and fulminate at politics. We are concerned about the people. Each in their corner in the small kitchen. With a mouth mask that has to be usable double the duration. On the table are cakes, pralines and pots of apple sauce, made by people who give us a hope

 

On "Brexit, Democracy, and Epistocracy"

This brings us to the central injustice of democracy, and why holding a referendum was a bad idea. Imagine, as an analogy, that you are sick. You go to a doctor. But suppose your “doctor” doesn’t study the facts, doesn’t know any medicine, and makes her decisions about how to treat you on a whim, on the basis of prejudice or wishful thinking. Imagine the doctor not only prescribes you a course of treatment, but literally forces you, at gunpoint, to accept the treatment.

We’d find this behavior intolerable. Your doctor owes you a duty of care. She owes it to you to deliver an expert opinion on the basis of good information, a strong background knowledge of medicine, and only after considering the facts in a rational and scientific way. To force you to follow the decisions incompetent and bad faith doctor is unjust.

But this is roughly what happens in democracy. Most voters are ignorant of both basic political facts and the background social scientific theories needed to evaluate the facts. They process what little information they have in highly biased and irrational ways. They decided largely on whim. And, worse, we’re each stuck having to put up with the group’s decision. Unless you’re one of the lucky few who has the right and means to emigrate, you’re forced to accept your democracy’s poorly chosen decisions.--Jason Brennan "Brexit, Democracy, and Epistocracy"

Jason Brennan can be trusted to never let a good crisis go to waste; he is using Brexit to peddle his anti-democratic sentiments and to offer up his medicine, the rule by experts (or epistocracy). Never mind that referenda are (thankfully) not the norm in liberal democracies, and that the particular referendum that occasioned his remarks was intended by the credentialed and smart (former) prime-minister David Cameron to settle an intra-parliamentary debate within the Conservative party rather than be used as a guide to policy. (Cameron never seriously contemplated losing the referendum which is clear from the fact that he deliberately avoided doing the one thing he promised to do if he lost: to invoke article 5o.) I offer three critical comments on his analysis.

First, regardless if one reflects on direct democracy (i.e., a referendum) or indirect democracy (voting for representatives) Brennan's analogy between going to a doctor and respecting the outcome of a vote is a false one. When one visits a physician the goal is not up for debate: the telos is given; it's health or restoring ordinary functioning as much as possible. Of course, there are exceptions to this (especially in cosmetic surgery and other forms of enhancement). There is a lot of room for nuance and ethical distinctions (not to mention important cases where there is no hope for restoring much of anything), but you don't go to a physician to have a good time or as leisure activity (etc.). By contrast, in democratic life, most of the ends and norms are up for debate and this debate is, in part, one of the aims of the exercise.

That is to say, we don't go to a physician in order to find out how to live and what the proper ends of one's life are. The claim in the previous sentence may be an error of modernity (although Plato's Symposium suggests it was already a problem in Ancient Athens)--maybe we should develop and train our physicians to become wise, too.The dis-analogy makes a huge difference. When ends are given, experts can guide in light of facts and constraints (means-ends rationality: "good information, a strong background knowledge of medicine, and only after considering the facts in a rational and scientific way.") When ends and the rules of the game are up for debate, the experts tend to give very partial advice. When economists tell us what is rational, they tend to assume that growth or full employment is good and they tend to ignore distributional effects, and they do not discuss all kinds of other quality of life issues and other important ends that other experts (e.g., sociologists, psychologists, ecologists, and criminologists (etc.) may focus on.

A striking fact of the British 'leave' vote is that it is concentrated in areas that benefit directly from EU spending, that is, poorer, older, and less educated areas (Cornwall, an area dependent also on tourism, has been used as an exemplar in this discussion). A lot of folk used this as evidence that leave voters are irrational (and ignorant). But that's only true if they understand themselves as aiming to increase their share of European handouts--what self-respecting voter would want that?

In his writings, Brennan simply takes it for granted that the rationality of a decision is based on an evaluation of its social "effects" and that there is agreement about the evaluation of these effects. And that such social consequences needs to be evaluated with "social scientific knowledge." Now, I am all for professional philosophers giving increased respect and hearing to social sciences (I work in a political science department). But we cannot assume that there is agreement over the desirability of effects. Lots of folk who voted 'remain' want open-borders in Europe (let's leave aside the issue of external borders). Let's stipulate that's great for the economy; it's also part of a certain life-style in which Europe's youth explore each other's countries and cultures (in part by working and studying abroad). The Cosmopolitan elites will easily slide into treating their preferences as constituting rationality. But that is not obvious. The 'leave' voters (let's stipulate) want no cross-border traffic (and no immigrants), and, let's stipulate they are harmed economically by their vote. Yet, if one introduces environmental considerations into one's analysis, then harming and reducing traffic is quite rational. (Before the Brexit campaign turned nasty there were quite a few environmentalists on the 'leave' side.)

Second, Brennan loves cherry-picking the facts on voter ignorance. Let me offer one of his favorite Memes:

Political scientists have been studying voter knowledge for the past 60 years. The results are uniformly depressing. Most voters in most countries are systematically ignorant of even the most basic political facts, let alone more the social scientific theories needed to make sense of these facts.

This is not a true state of the art in political science. In his work Brennan systematically ignores criticisms of the research he is relying on (see, e.g., Arthur Lupia) and he relies on the snobbishness of his readers (who themselves are fed a steady stream of ignorant voter stories by the press). In fact, Brennan and his readers are good at passing tests (in which one is quizzed on the "facts"). But voting is not such a test. In a representative democracy it is about selecting representatives and leaders, who are evaluated to echo Manin's Madisonian point along whatever dimension (a majority/plurality of) the electorate deems relevant. The Brexit campaign was very clearly a(n intemperate) debate about an image of Britain not primarily a debate about the facts. It is also a debate about sense-making, but not in the way Brennan uses it, but rather in a wider, diffuse sense. Whatever else 'leave' was about it was a rejection of forms of life and values that have become dominant in educated culture. And this gets me to the final, most important point.

Third, Brennan often pretends that epistocracy is somehow not existing and would be a "new system" worth trying. But many properly political decisions are farmed out to experts already: most obviously monetary and banking policy, which is run by independent central bankers and regulators--look how well that turned out. Brennan shows no interest in epistocratic failures (not to mention the evils of eugenics, etc.).

More important, across the western world, government today is the province of the educated. Long ago are the days when governments were job centers for the (well connected) uneducated. Colleges and universities are credentialing mills for bureaucracies and semi-government bureaucracies. While France may be on the extreme end in entrusting rule largely to a cadre of graduates of De École nationale d'administration (ENA), all liberal democracies are already run, in practice, by (to echo JFK) the brightest and best. These epistemocratic elites have created a two-tier polity: the credentialed are protected by the state and have lots of economic and judicial privileges; the uneducated are, well, left to fend for themselves harassed by law enforcement and technocracy.* Brennan notes that "all across the West, we’re seeing the rise of rise of angry, resentful, nationalist, xenophobic and racist movements, movements made up mostly of low-information voters." What he fails to recognize is that these are the effects of a political culture and institutions that are already highly epistocratic. Why prescribe a double dosage of a medicine that has nearly killed the patient?

 

 

Surgeons must be very careful

Surgeons must be very careful

When they take the knife!

Underneath their fine incisions

Stirs the Culprit,--Life! Emily Dickinson

 

If you don't admire something, if you don't love it, you have no reason to write a word about it. Spinoza or Nietzsche are philosophers whose critical and destructive powers are without equal, but this power always springs from affirmation, from joy, from a cult of affirmation and joy, from the exigency of life against those who would mutilate and mortify it. For me, that is philosophy itself.--Deleuze (1969) "Gilles Deleuze Talks Philosophy"

Because my wife -- a surgeon -- has gone skiing with our son in the French alps, I had time to glance at some poetry; my eye through the hidden magic of association, naturally rested on Dickinson's lines quoted above. I wondered upon reflection, if Dickinson saw her words as a remedy in a fallen world, despite or, perhaps, because of "the mocking sky."

A surgeon can heal or mutilate.

Professional philosophers often use metaphors when describing the skilled deployment of our tool-kit [logic, distinctions, analysis, etc.] that in the more than seven years since I know my wife, often remind me of surgery: we make precise and careful distinctions, that are used in razor-sharp arguments. As it happens, my wife is a retina-surgeon, and so the similarities extend to all the significant metaphors dealing with vision: when we make progress, we philosophers see things; we cut through confusions to gain clarity, which we often value for its own sake.

On a Joke, in an Educated Age

The world needs philosophy more than philosophy thinks. Philosophy is ill, it might be dying, but I am sure that the world (the world, neither a God nor a prophet, but the world) is saying to philosophy: ‘Get up and walk!’ (Alain Badiou 2003a)

I must purify myself. Now for those whose offense lies in telling false stories about matters divine, there is an ancient rite of purification--Homer did not know it, but Stesichorus did. When he lost his sight for speaking ill of Helen, he did not, like Homer, remain in the dark about the reason why. On the contrary, true follower of  the Muses that he was, he understood it and immediately composed these lines:

There is no truth to that story,

You never sailed that lovely ship,

You never reached the tower of Troy

As soon as he completed the poem we call the Palinode ["the recantation,"] he immediately regained his sight. Now I will prove to be wiser than Homer and Stesichorus to this small extent.--Plato, Phaedrus (243a-b). [Translated by Nehemas & Woodruff as reprinted in the Cooper (ed) Plato: Complete Works.]

There is a medical condition, informally known as 'hysterical blindness;'* somebody's physiology and neurology works well, but the patient reports blindness. The syndrome is often induced by stress or an accident (see here on Wikipedia). It's a tricky syndrome to treat for the attending physician because, as Wikipedia,puts it, "attributing physical symptoms to a psychological cause is not accepted by many educated people in western cultures." 

What's it like to have a mini-stroke?

Last Summer on a warm, but not balmy, evening without wind, I was cycling along the stately Keizersgracht on my way to the 24hrs pharmacy on the Leidsestraat in order to buy aspirin. The Prinsengracht would have been a more direct route, of course, but the Keizersgracht attracts less tourists. I was enjoying the Sun, when I recalled a hotter Summer's day at Tufts, Medford, MA. It must have been 1995, or 1996.[+]  The philosophy department had already moved to Miner Hall. I had come to work on a paper with George Smith, but first I went to see Dan Dennett, of course, on the ground floor. European friends have expressed regret to me that Dan sails, because they would otherwise insist he is Santa Claus (the beard, the jolly demeanor, his height, etc.).

To my surprise, Dan was visibly shaken. (I associate Dan with can-do-American-optimism-with-unbounded-faith-in-truth-and-technology.*) He had just learned about his heart condition--we had a brief conversation; I came away with a sense of the fragility of life, and I was touched he would allow me to see his anxiety. Later, after his procedure, he had regained his optimistic, ebullient self, and he excitedly shared with me insights on all the marvelous technology used during the procedure. While paying attention to traffic, I wondered if I seemed frazzled.