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Book Reviews

Sergio Sismondo, Ghost-Managed Medicine: Big Pharma’s Invisible Hands, Mattering Press, 2018

Sergio Sismondo coined the term “ghost-management” to characterize the broad behind-the-scenes activities of the pharmaceutical industry after he successfully infiltrated publication planning conferences and seminars from 2007 to 2017 as sort of academic spy. His academic espionage mission provided valuable intelligence. In addition to revelations from lawsuits against the pharmaceutical industry and accounts from former ghostwriters turned whistleblowers, Sismondo’s information from within has been crucial to understanding the corruption in the conduct and reporting of industry-sponsored medical research. Ghost-Managed Medicine exposes the conspiracy to conceal the players in the marketing of drugs, including ghostwriters, key opinion leaders, patient advocacy organizations, contract research organizations, publication planners, and even medical journal editors and publishers. The credibility of the claims conveyed by the industry depends on the invisibility of these players.

Publication planning of ghostwritten articles is the bedrock of this scheme. It is conducted by pharmaceutical companies working in conjunction with medical communication firms to plant marketing messages in medical journal articles. Medical communication firms also produce continuing medical education programs, medical conference presentations, and lunch and dinner drug talks from the same content that produced the journal articles, all delivered by physicians who have the greatest influence on prescribers, namely, the key opinion leaders or thought leaders.

Sismondo’s main example of the harm done to patients is the case of OxyContin (oxycodone), now infamous for its part in the opioid epidemic in North America which has taken over 200,000 lives (30-31). Sismondo begins his book describing a common scenario in which a patient takes a drug as prescribed by his physician. For prescribing strategies, the physician relies upon an article she read in a medical journal and a presentation at a medical conference. From this point Sismondo describes how the patient and physician’s trust that they are operating rationally is largely misguided because of a system designed to conceal all of the invisible forces of marketing which influenced the information available. But now let us suppose that the patient suffers a serious adverse event or even death as a result of the drug’s side effects. It turns out, as is so common in these situations, that the drug company concealed the adverse event in the articles published in the medical journals and was able to do so because the critical data from the clinical trials is the intellectual property of the company. Neither the ghostwriters nor the nominal “authors” on the articles ever see that data. In the case of OxyContin, one of the influential ghostmanaged medical journal articles was reprinted 10,000 times for distribution to prescribing physicians (34).

One of the most alarming revelations of this book is Sismondo’s discussion of the role of medical journal editors as co-conspirators in the corruption of medicine. Sismondo, who attended meetings of the International Society of Medical Planning Professionals and the International Publication Planning Association, reports that in addition to ghostwriters and medical communication executives, publishers and medical journal editors attended these meetings and gave lectures as stakeholders in the business of publishing the results of industry-sponsored clinical trials. Some medical journal editors gave sales pitches at these meetings, essentially soliciting publication planners to submit ghosted articles to their high-impact journals (91-94). Medical journals in this respect continue to be part of the problem rather than the solution to the problem. Instead of demanding rigorous peer review of submissions and an independent analysis of the data, most editors are eager to publish favorable articles of industry-sponsored trials and rarely publish critical deconstructions of ghostwritten clinical trials. This is due to the simple fact that medical journals and their owners have become dependent upon pharmaceutical revenue that comes in the form of advertising, reprint sales and, more recently, fees for open access.

Commenting on the role of ghostwriters in the process, Sismondo writes:

“Articles are produced by teams, perhaps no one member of which meets requirements for authorship. In this largely unseen process, pharma companies initiate and fund the planning, research, analysis, writing and placing of articles, and typically maintain control of data throughout. In the corporate production of knowledge, medical writers perform their functions, just as planners, company scientists and statisticians do. Authors are there to give a sheen of legitimacy and independence to articles” (104).

If the reader is struck by the distinction between a writer and an author, a distinction that could only make sense in the bizarre world of pharmaceutical publication planning, it is because the “author” is merely a name purchased in the marketing of drugs, typically a key opinion leader who might or might not have had a role to play in the actual research.

Sismondo’s use of the term “corporate production of knowledge” to describe this process throughout the book is particularly noteworthy. Given that the main problems with the ghost-management of corporate-sponsored medical research are the failures to do rigorous testing, manipulation of the efficacy and safety results and outright deception involved in the reporting of results via the ghostwriting of manuscripts, in what sense does this count as knowledge at all? The word “fraud” comes to mind as a more accurate description and the vast number of successful plaintiffs’ lawsuits has demonstrated the point. But here we have stumbled upon a philosophically-sensitive issue, for even when the process functions at its very best, in an uncorrupted, disinterested, rigorous manner, we might still pause at claiming we have arrived at what we might call “knowledge.” Philosophers of science and epistemologists are well aware of the difficulty. Justification remains elusive. Leaving this aside for the moment, however, there is still a common-sense distinction between honest and dishonest testing, accurate reporting and spin, and scientific integrity and scientific fraud. Honest testing, accurate reporting and scientific integrity are the subject matter of epistemology; dishonest testing, spin and fraud have become the subject matter of a new discipline, agnotology, the study of how the public is kept in the dark intentionally by manipulation and deception.

I would classify Sismondo’s work as agnotology. But having done a superb service to exposing the ghost-management of corporate medical research, there is a question of whether he views the corporate production of knowledge as just another social construction, neither better nor worse than non-commercial, academic science. He identifies his approach to these topics from frameworks established in Science and Technology Studies, a field that always treats “knowledge as something constructed, and not just waiting to be found” (10). While he acknowledges that “it is beyond doubt that some of the claims that drug companies make and promote are poorly justified, and some are false in egregious ways,”(12) he views the knowledge produced by these companies as within the medical mainstream. The data produced is “of reasonably high quality using the most valued of research tools; they go on to analyse it using standard statistical means, and construct articles that pass the scrutiny of peer reviewers at many of the best medical journals” (12-13). Yet Sismondo also believes there are serious concerns about the practices of pharmaceutical companies since the medical world is influenced by their agenda. He writes: “The flood of knowledge that companies create and distribute is not designed for broad human benefit, but to increase profits” (13).

Rather than describe the pharmaceutical industry’s business as a ‘corporate production of knowledge,’ I would rather Sismondo had said it has the “appearance of science” since, after all, its prime directive is sales. It is the development of blockbusters that should cause the most alarm, for the recent record shows this is where there is most potential for misrepresentation. Physicist Richard Feynman introduced the term “cargo cult science” during his 1974 commencement address at the California Institute of Technology as a means of exposing the façade of commercial science. This refers to the story that certain Pacific Islanders have been known to build mock airports with control towers, runways and mock airplanes with the expectation that planes will land and bring material wealth, although nothing actually functions as an airport. No planes land even though what is created has the form of an airport. So, with regard to the pharmaceutical industry, all the co-conspirators create the appearance of science, i.e., clinical trials, medical journal articles, scientific posters, speakers at conferences, etc., but there is very little that could count as genuine attempt at knowledge.

If passing peer review demonstrates that the corporate production of knowledge qualifies as mainstream medicine, then something is seriously wrong with peer review in medicine. Indeed I believe that Sismondo himself provides the evidence why this is the case although he does not come to this conclusion in his book; the players involved maintain the status quo in a win-win situation for themselves―except when patients are harmed, the resulting lawsuits reveal the corruption and the industry suffers reputational harm for producing pseudo-science and polluting our scientific record with misrepresentations of the data.

Although I have disagreements with Sismondo over his philosophical perspective, I believe Ghost-Managed Medicine should be read by every physician who prescribes medications and patients who rely on the information conveyed to them by their physicians, as it encourages a healthy skepticism about medicine in a market economy.

Leemon B. McHenry

California State University

Northridge, California

Book Reviews

Shannon Vallor, Technology and the Virtues: A Philosophical Guide to a Future Worth Wanting, Oxford University Press, 2016

Some books can be said to represent ‘new beginnings’, opening up new spaces for academic discourse and new methods and perspectives. Shannon Vallor’s Technology and the Virtues can rightfully be claimed to be one of those books. There is much about this book that is not only laudable but also urgent. First, it has managed to firmly establish virtue ethics as a tradition worthy of consideration in the field of ethics of technology. Other authors have suggested such a turning (Ess 2009, Coeckelbergh 2012), but none have done it so far in a manner that can live up to the comprehensiveness of Technology and the Virtues. Second, the book has served the virtue ethics tradition well in convincingly arguing for its continuing relevance in a time of serious sociotechnical challenges. As our moral critiques of technologies are increasingly entangled in discussions of existential threats that are claimed to be too complex to be handled by common human beings and call for an enhancement of our species, Vallor’s urgent call back to earth, back to our own human capabilities, will be welcomed by many. Third, it establishes a way of approaching matters in moral philosophy that is quite uncommon today, namely drawing from not only the ‘Western’ perspective but also systematic moral philosophies from other cultures: Buddhist and Confucian ethics. This echoes the increasing need in a multipolar world to build bridges between moral traditions, to construct a global dialogue (insofar possible) concerning the good life and the kind of societies we want to live in.

Vallor’s book is structured in a convincing way and guides the reader from foundational questions to a framework of the ‘technomoral’ virtues, and to a series of in-depth case studies of contemporary technologies: social media, surveillance technologies, robots, and human enhancement technologies. In the introduction and Part I of the book, Vallor has three main objectives. The first is to argue for the existence of a so-called state of “acute sociotechnical opacity” (6) in the 21st century, which means that the practical circumstances of our everyday lives are changing so rapidly due to technological innovations that we cannot reasonably anticipate the impact of future states of affairs on our morality. This notion provides Vallor with the resources to argue against the use of utilitarian ethics, due to its false reliance on transparent choices based on the rational calculation of their outcomes, and against Kantian ethics, due to the impossibility of any categorical rule to respond to highly contingent future states of affairs. Virtue ethics is presented as a modest but viable alternative, in that enables us to acknowledge the existence of sociotechnical opacity and at the same time offers us a strategy for self-cultivation that empowers us to manage it prudently. The second objective is to introduce the revival of the virtue ethics tradition, to connect it to contemporary philosophy of technology, and to make the claim that both should be wary of their Western provincialism and engage in a global dialogue because the problems they address (e.g. climate change) are of a global character. The third objective is to lay down the fundamentals of the three virtue ethics traditions used in the book (Aristotelian, Buddhist, and Confucian) and to argue for their convergence on four major issues: a conception of the highest human good, of virtues as cultivated states of character, of a practical path for moral self-cultivation, and of a the existence of an essence of human beings (44).

In Part II of the book, Vallor presents seven “core elements” (64) or perhaps rather conditions of the practices that mediate the cultivation of technomoral virtues. These conditions pertain to the ‘how’ of the cultivation of technomoral virtue, indicating according to what kinds of standards we could for instance evaluate our educational, mentoring, and training practices. Vallor painstakingly discusses the details of the accounts of cultivation of virtue in the three virtue ethics traditions she draws from to formulate a common ground for each core element. Concerning the first element, she argues that our practices should be engaged with habitually: meaning that one repeats them, guided by moral exemplars and eventually gets accustomed to them in a positive sense (74). For the second element, she contends that practices should be engaged with from within a relational understanding: meaning that they should be understood in the context of our relations with other members of the moral community, making them responsive to the particular aspects of these relations (83). The additional five elements she discusses include reflective self-examination, intentional self-direction, moral attention, prudential judgment and appropriate extension of moral concern. Vallor makes a distinction between the first four elements and the latter three, arguing that the first four enable practical wisdom and the latter three complete or conclude it.

Additionally, Vallor presents a list of technomoral virtues that she argues answers the ‘what’ of technomoral virtue. She emphasises that these technomoral virtues should not be understood as radically ‘new’ virtues that somehow resulted from our living with new technologies, but rather as virtues understood in the context of the particular ways in which they are cultivated in the 21st century. For instance, one could consider that the meaning of ‘bravery’ in war has not remained fixed since Homer’s time, but has changed according to the development of technologies of war, signifying different kinds of cultivation for a hoplite and for a jetfighter pilot. As MacIntyre argued, different historical periods and contexts have brought about different heuristics of virtue (MacIntyre 2007, 118), which thereby also implied different theories of virtue. Vallor lists twelve virtues that she argues are of particular relevance for our contemporary human condition in the context of sociotechnical opacity: honesty, self-control, humility, justice, courage, empathy, care, civility, flexibility, perspective, magnanimity, and technomoral wisdom (120). For each of these virtues, Vallor aims to find common ‘roots’ amongst the Aristotelian, Buddhist and Confucian virtue ethics traditions and to clarify their particular relevance in relation with new and emerging technologies. We might illustrate her approach through a discussion of self-control (123). Under the heading of this technomoral virtue, Vallor subsumes Aristotle’s virtue of temperance, the Buddhist virtue of right desire and the Confucian virtue of self-discipline. She contextualises the significance of this technomoral virtue in relation to technology, by discussing how ICTs create an environment in which people are constantly primed and distracted.

In Part III of her book, Vallor presents three illuminating case studies of paradigmatic contemporary technologies – social media, surveillance technology, robotics, human enhancement technology – and evaluates these using her virtue ethics of technology approach. Vallor introduces each case by means of a short historical narrative about the technology in question and relates it to relevant scholarly critiques. She then discusses each technology by invoking relevant technomoral virtues. Accordingly, she offers solutions based on the discussion, usually in terms of what virtues should be cultivated in what way. To illustrate: for her analysis of social media (159) she first discusses the rise of social media in contemporary society and some of the problems it brought according to a number of scholars, for instance with regard to anxiety and loneliness of children and privacy concerns. Second, she analyses social media by discussing the virtues of self-control (social media being addictive), empathy (social media generating less face-to-face contact and attention), humility, honesty and perspective (social media shaping distortions of information) and civility (social media individualising the common good). Thirdly, she presents three ways of dealing with the problems she describes: (1) paying attention to the cultivation of character and not merely to progressing technology, (2) creating better spaces for technomoral education and (3) recognising and promoting individuals and groups who show leadership in promoting technomoral virtues.

Due to its originality, clarity and appealing style, Vallor’s book will be a very useful resource for STEM students, scholars and practitioners who want to engage with normative ethics and for ethicists of technology who want to investigate the ethical issues of new and emerging technologies from a virtue ethics perspective. Nevertheless, I will raise two points of critique. First, I believe there is an issue with the conceptual coherence employed throughout the work. Even though this might well be justified with recourse to the pragmatic aims of the book (Vallor 2017, 214), it invokes uncertainty for the reader as to what is actually claimed. For instance, the term “virtue” itself seems to be deployed rather loosely. Vallor sometimes invokes the commonly used definitions of virtue as “excellence”, “stable trait” (17) and “disposition” (18). However, she also discusses virtue as “discerning skill” (37) in her treatment of Aristotelian ethics, and as “recognition” (126) in her treatment of the technomoral virtue of humility.

I believe that this lack of conceptual coherence points at three problems in the book. First, Vallor does not present any philosophical anthropology even though she argues that virtue ethics theories are all based on a “conception of what human beings are generally like” (44). In contrast, one of Aristotle’s primary concerns in the Nicomachean Ethics seems to be to establish the basic concepts of a philosophical anthropology. He thereby made sure to distinguish virtue (arête) from skill (technê), and state (hexis) from capacity (dunamis), and also to distinguish the virtues of character, corresponding to the non-rational part of the soul that obeys reason, from the virtues of the intellect, corresponding to the part of the soul that has reason. Vallor both accidentally identifies virtue with skill and makes no distinction between the virtues of character and of the intellect, even though some of the technomoral virtues are ambiguously positioned as ‘in-betweens’. For instance, she defines honesty as “an exemplary respect for truth, along with the practical expertise to express that respect appropriately in technosocial contexts” (122). How are we to understand this virtue? Does it correspond with a virtue of the intellect that Aristotle denotes as understanding (nous), or does it correspond with some rhetoric skill (technê), or with some mix between the two?

Certainly, one might argue that such conceptual rigour as Aristotle deploys is actually undesirable in constructing a pragmatic outline for a virtue ethics of technology. However, this leads me to a second problem, namely the fairly uncritical conceptual conflation between terms that are used in different virtue ethics traditions. Others have already offered critiques of the book based on concerns in comparative philosophy (Curzer 2017, Mcrae 2017), arguing that for instance some Buddhist ethical concepts are wrongly interpreted or that the doctrine of the mean essentially differs between the three traditions that Vallor draws from. I will not argue along these lines and I find Vallor’s reply fairly convincing, in which she states that she intends to draw from different traditions as sources of “moral imagination about the virtues” (Vallor 2017, 309). However, I argue that in providing “a broad conceptual footing for a new global ethic” (Vallor 2017, 315), greater conceptual coherence within the confines of Vallor’s framework could be expected. Such conceptual coherence would involve a critical discussion of not only the common ground but also of the conflicts between the different virtue ethics traditions as they are appropriated. Sometimes, I believe, this also will have to involve ‘choosing sides’, and being upfront about this. For instance, if justice is to be a virtue to be incorporated in the conceptual footing of a global ethic, the clear difference between the Confucian notion of justice based on the extension of fatherly rule in the household and Aristotle’s notion of justice based on distribution between equals in the polis should be acknowledged. Though Vallor acknowledges that justice is the virtue that is “perhaps the broadest and most varied in its interpretations” (127), she clearly aligns herself with the Aristotelian interpretation and thereby to a significant extent against the Confucian one. Brushing over this difference is not a case of respecting different cultural traditions, but disregarding differences in conceptualisations of justice.

This brings me to the third problem, according to which I find myself in disagreement with Vallor. Even though she argues in agreement with Nussbaum that the “core meaning of a virtue such as wisdom, courage, or justice is fixed by reference to some enduring domain of human experience”, she nonetheless argues, that “as with all taxonomies of virtue, ours remains subject to open-ended elaboration and revision” (119). On the one hand, she argues this to be the case because the virtues have to evolve according to the technosocial conditions of a certain historical period. How would this fit with the earlier statement, if not pertaining to a change in ‘core meaning’? If their meanings would be fixed, it seems unclear how we can end up with different conceptualisations of the virtues. On the other hand, Vallor seems to suggest that a list of all technomoral virtues would be practically inexhaustible. I also cannot agree with this statement, both because different historical versions of virtue ethics have provided exhaustive lists of the virtues (cf. MacIntyre 2007), and because this somehow suggests that we can arbitrarily come up with new human dispositions that should be designated as virtues because they fit the conventional wisdom of a certain epoch. Instead, I believe that every ‘version’ of virtue ethics departs from a philosophical anthropology that is itself bounded by the being of human beings. Just as we can deliberate for instance about what constitutes a ‘sense’ and at the same time do not see the list of ‘human senses’ as open-ended or inexhaustible, so we can deliberate about what constitutes a virtue without recognising an open-ended list of virtues. Rather, the virtues have to be supported by a certain account of the being of human beings, for instance by relating temperance to the modes of being of pleasure and pain. Different lists of the virtue indeed exist, but they are not inexhaustible and they are not properly speaking open-ended and ‘open to revision’, because to revise the list implies revising the philosophical anthropology that underlies it.

My critique pertaining to the conceptual coherence of Vallor’s work is by no means a criticism of the overall significance and usefulness of the book, but rather points at a readership (i.e. virtue theorists) that will find less resources in the book than it might hope for. A similar concern brings me to a second point of critique, though this suggests a potential avenue for future research rather than something that could have been done differently in the current book. That is, Vallor’s book does not offer us new insights into the phenomenon of technological mediation that is central to the field of philosophy of technology. This is somewhat surprising given that she dedicates a whole section to “virtue ethics and philosophy of technology” (23). In that section, she mentions for example Hans Jonas as an important philosopher in this regard, who indeed in his work on technology points at the importance of the virtues (Jonas 1973, 37). We should note, in this regard, that Jonas ultimately wanted to question the changing nature of human action (praxis) (Jonas 1973, 31). In other words, he saw a need for investigating the ways in which praxis itself changes in the modern epoch1, not merely how the virtues gain a different significations in different technological contexts. However, the reader will find out that Vallor mostly wants to put her approach in line with contemporary philosophy of technology, rather than to contribute to it.

Even though Vallor acknowledges the dual character of the central concern of her book, namely to consider what we can do to live well with technologies and what technologies do to us, the emphasis in Technology and the Virtues clearly lies on the first aspect. A clue to Vallor’s limited emphasis on technological mediation of praxis can be gained from her discussion of the challenge posed to virtue ethics by moral psychology. She discusses the argument that is related to the famous Milgram experiments in which “research subjects were asked to ‘punish’ a screaming ‘victim’ with realistic (but simulated) shocks at the polite request of an experimenter” (Merritt et al., 2010)2. Moral psychologists argue that experiments like this one show “that the difference between good conduct and bad appears to reside in the situation more than in the person” (Merritt et al. 2010, 357 – emphasis added). This is conceived as an attack on the notion of human character that is central to virtue ethics, because our character allegedly should enable us to act morally right in a consistent manner. One can start to criticise this interpretation of the findings by arguing that the concept of “situation” is black-boxed in this approach and that the particular context of the experiment is left un-examined. However, Vallor takes another approach to defend virtue ethics, arguing that her approach holds because virtue is “by definition exemplary rather than typical” (Vallor 2016, 22). The fact that a small minority of research subjects refrained from following the requests of the experimenter is seen as decisive for acknowledging the correctness of virtue ethics. In other words, the agency of the human subjects who resisted the request for engaging in the experiment is taken as a reflection of a categorical form of their strength of character that in turn proves the validity of a virtue ethics approach.

This defence seems to be unsatisfactory for a number of reasons. First, the claim that virtue is cultivated by means of following the practices of exemplary figures does not entail that virtue is by definition exemplary rather than typical. Instead, virtue ethics traditions allow for different degrees in virtuous character (hence, having a degree of virtuous character is typical), in which exemplary members of a certain moral community display the highest degrees. Particular groups or communities can consist of mostly vicious or mostly virtuous people, or can be mixed. Second, different experiments in moral psychology show different levels of “virtuous behaviour” (Merritt et al. 2010, 356-357), understood as consistency in engagement in particular actions, which implies that someone whose virtuous character enables her to cope with one challenging moral setting might be unable to cope with another, depending on the context. This does not mean that such a person’s character is not ‘virtuous’, but instead that whether the degree to which her virtuous character is sufficiently cultivated to deal with a particular situation depends in part on the situation, or is mediated by the situation, and not merely by the agent’s character. If we accept this claim, moral psychologists seem to be at least to some extent warranted in drawing their conclusions. Third, the supposed warrant that a minority of people will be able to deal with situations like the one presented in this experiment, which – importantly – is not technosocially opaque (people are aware of the way in which their actions conducted through technologies have certain consequences) is one that no moral philosophy can be satisfied with and especially not one that introduces the additional factor of technosocial opacity. In a world of technosocial opacity, the virtuous conduct of a small minority is not sufficient for safeguarding the flourishing of humanity; and can even less be expected given the greater complexity and opacity as compared to the Milgram experiment. For instance, we can consider whether a person who is not a digital native with the highest degree of virtuous character would be sufficiently capable of dealing with the novel setting of ubiquitous digital technologies. The answer would probably be negative.

Nonetheless, this does not disqualify the project of constructing a virtue ethics of technology. Rather, it shows that technomoral virtues are co-shaped by both people’s characters and by ‘settings’. A philosopher of technology would criticise the conclusions drawn by moral psychologists on the basis that the factor of technological mediation is fully ‘black-boxed’ by sketching the concept of ‘setting’ as something that is somehow separated from a person. Instead, she would argue that on the one hand ‘setting’ – in contrast to what Vallor argues – should be taken seriously, but that on the other hand the concept of setting should be turned into a concept of technological mediation. Especially in the case of the Milgram experiment, the factor of technological mediation seems important for understanding the ‘situation’. The technology of an electronic system being triggered by a voltage lever constitutes a process of what one might designate as ‘distancing’: the research subject does not simply ‘hurt’ a victim, but seemingly hurts the victim in a mediated way, through a device that presents no feedback with regard to the severity of the harm and in an architecture that separates the research subject from the victim and thereby creates a moral distance between them. Such an interpretation is warranted by some recent discussions of the Milgram experiment. For instance, Haslam et al. (2014) argue that the setup of the experiment, which included aspects like its “location, the appearance and behaviour of the experimenter, and the technical apparatus” (Haslam et al. 2014, 275 – emphasis added) mediated the interpretation of research participants of their actions as taking place in the context of the paradigm of scientific research.

Hence, Vallor seems to emphasise the side of human agency in her book, while not delving into the side of technological mediation of human practices. This tendency can be observed in the solutions she puts forward for problems posed by technology, be-it “improved technomoral education”(204), “cultivating technomoral humility” (207) or cultivating “renewed technomoral courage” (218). More importantly, it can be observed in the almost complete absence of discussions of technology in the elaboration of the core elements of technical practice that cultivates the virtues. Exactly with regard to these conditions, which to some extent sketch the outlines of a theory of practice, Hans Jonas’ question of the changing nature of human action could have come to the fore. For instance, if ‘relational understanding’ is a condition for having practices that cultivate the relevant technomoral virtues, how could we theorise the way that emerging technologies mediate this condition? Knowing this would be of crucial importance for designing systems that are conducive for virtuous practices, setting up education for engineers engaging in technical practices, and so forth.

Notwithstanding the abovementioned two points of critique, Technology and the Virtues represents a very important and timely turn in the field of ethics of technology. It provides the reader with a vast amount of resources to engage with ethics in practices of technology development and challenges us to think about the importance of the cultivation of the right kinds of technical practices in the 21st century, in order to live well with emerging technologies. As Vallor (2017) herself indicates, her book is a first, firm step in an academic journey that connects the virtue ethics tradition with philosophy and ethics of technology. For future research, it could be worth delving into the important distinction made by Aristotle between the virtues and the technai, the crafts; especially in the context of Heidegger’s (1977) highly influential critique of technology that, as for instance Wolff shows (Wolff 2008), draws heavily from Aristotle discussion of the virtues. This might draw discussions of technological mediation in philosophy of technology and virtue ethics closer together. Also, on a more practical note, it might be worth considering how Vallor’s approach could contribute to an ethical design approach such as value sensitive design (Friedman and Kahn 2002), in order to make it responsive to the development of the right kind of technical practices that cultivate the virtues.

 

 

Endnotes

1 This is a topic taken up by philosophers of technology such as Ihde (1990) and Verbeek (2005).
2 Even though the ‘victim’ was an actor who had to pretend that he was hurt by the simulated electric shocks, the experimental setup was sufficiently convincing for the participants to be conceived as being real. The overall outcome of this experiment was that 33 out of 40 research subjects continued the experiment after initial protests of the victim and that 26 of them continued through agonised screaming and a final unresponsive silence.

Wessel Reijers

European University Institute

Florence, Italy

References

Coeckelbergh, M. (2012) ‘Care Robots, Virtual Virtue and the Best Possible Life’, in Brey, P., Briggle, A., and Spence, E. (eds) The Good Life in a Technological Age. New York: Routledge.

Curzer, H. J. (2017) ‘Yesterday’s Virtue Ethicists Meet Tomorrow’s High Tech: A Critical Response to Technology and the Virtues by Shannon Vallor’, Philosophy and Technology. Philosophy & Technology, 31(2), pp. 283–292. doi: 10.1007/s13347-017-0269-z.

Ess, C. (2009) Digital Media Ethics. Cambridge: Polity Press.

Friedman, B. and Kahn, P. (2002) ‘Value sensitive design: Theory and methods’, University of Washington Technical, (December), pp. 1–8. doi: 10.1016/j.neuropharm.2007.08.009.

Haslam, S. A., Reicher, S. D. and Birney, M. E. (2014) ‘Nothing by mere authority: Evidence that in an experimental analogue of the milgram paradigm participants are motivated not by orders but by appeals to science’, Journal of Social Issues, 70(3), pp. 473–488. doi: 10.1111/josi.12072.

Heidegger, M. (1977) The Question Concerning Technology and Other Essays. New York: Graland Publishing, Inc.

Ihde, D. (1990) Technology and the Lifeworld. Bloomington: Indiana University Press. doi: 10.1049/et:20060114.

Jonas, H. (1973) ‘Technology and Responsibility: Reflections on the New Tasks of Ethics’, Social Research, 40(1), pp. 31–54.

MacIntyre, A. (2007) After Virtue: A Study in Moral Theory. Third Edit. Notre Dame, Indiana: University of Notre Dame Press. doi: 10.1017/CBO9781107415324.004.

Mcrae, E. (2017) ‘Finding a Place for Buddhismin the Ethics of the Future: Comments on Shannon Vallor’s Technology and the Virtues: A Philosophical Guide to a Future Worth Wanting’, Philosophy and Technology. Philosophy & Technology, Advance On. doi: 10.1007/s13347-017-0287-x.

Merritt, M. W., Doris, J. M. and Harman, G. (2010) ‘Chapter 11: Character’, in Doris, J. M. (ed.) The Moral Psychology Handbook, pp. 1–504. doi: 10.1093/acprof:oso/9780199582143.001.0001.

Wolff, E. (2008) ‘Aspects of Technicity in Heidegger’s Early Philosophy: Rereading Aristotle’s Techné and Hexis’, Research in Phenomenology, 38, pp. 317–357.

Vallor, S. (2016) Technology and the Virtues: A Philosophical Guide to a Future Worth Wanting. Oxford: Oxford University Press.

Vallor, S. (2017) ‘Technology and the Virtues : a Response to My Critics’, Philosophy and Technology, 31(2), pp. 305–316. doi: 10.1007/s13347-017-0289-8.

Verbeek, P.-P. (2005) What things do; philosophical reflections on technology, agency, and design. Pennsylvania: Pennsylvania University Press.

Book Reviews

John S. Haller Jr., Shadow Medicine: The Placebo in Conventional and Alternative Therapies, Columbia University Press, 2014

Placebos are much discussed in both the medical and philosophy of medicine literatures. Once narrowly defined as inert “sugar pills,” (Holman 2015), they now are now most often taken to be “treatments that appear similar to experimental treatments, but that lack their characteristic components” (Howick et. al. 2013). In addition to their use in the control groups of many clinical trials, placebos are also now widely recognized by medical practitioners to be powerful therapies in themselves, often outperforming conventional drug therapies in these studies.

Given this, I find Haller’s book, which is divided into six chapters, “Evidence Based Medicine,” “Postmodernist Medicine,” “The Powerful Placebo,” “Politics of Healing,” “Complementary and Alternative Medicine’s Challenge,” “Reassessment,” an introduction and an appendix, to be interesting, yet difficult to interpret with regard to his main thesis. As far as I can tell, Haller’s central claim is that, given the currently available evidence, we should understand complementary and alternative medicine (CAM) treatments to be placebos rather than actual treatments. In Haller’s view, CAM is an “opinion-based system,” which is “not unlike faith healing,” (p. 82) and is concerned not with mechanisms of action, but rather solely with patient outcomes. CAM is thus contrasted in the book with evidence based medicine (EBM), which Haller argues relies on scientific evidence (in particular the randomized controlled trial, or RCT) rather than personal belief and is concerned not just with whether or not a treatment works, but also with how it does. On his view, EBM is thus “rationalist” while CAM is “empiricist.”

This characterization of EBM vs. CAM, while central is the book, is problematic. In contrast to what Haller asserts, it is a hallmark of EBM that it is explicitly not concerned with mechanistic evidence. That is exactly the power (or the pitfall) of the much celebrated RCT. RCTs are designed to tell us whether or not a treatment works, not how it does (Kennedy and Malanowski 2018). On the EBM paradigm, mechanistic reasoning is considered to be a far inferior form of evidence to randomized trials, and in some cases is not even considered to be evidence at all. It seems fair to say, then, that both EBM and CAM are primarily concerned with therapeutic effectiveness and patient outcomes, rather than with mechanisms of action. (As an aside, this should mean that, contra to what many CAM practitioners argue, the RCT should in fact be a reliable method for testing the effectiveness of CAM therapies. On the other hand, this means that EBM practitioners cannot dismiss CAM treatments as “sham,” merely on the basis of the lack of a mechanistic explanation that describes how such therapies, such as homeopathy. By its own lights, EBM argues that mechanisms either don’t matter or don’t matter much. Instead, what matters in medicine is whether or a not a treatment is a) safe and b) effective.) The same, it seems, can be said of CAM, but this important similarity between EBM and CAM seems to escape Haller’s notice.

Further, in some parts of the book, Haller seems to contrast “placebos” with actual treatments, while in other parts, he seems to acknowledge that placebos are treatments. On the one hand, he claims that the placebo is “a product of postmodernist medicine,” which he describes a reaction to and against reductionist scientific medicine, because it interjects “subjectivity, uncertainty and ambiguity into the clinical encounter” (63). This seems to suggest that the way placebos work cannot (or at least should not) be understood scientifically. On the other hand, however, Haller argues that placebos are “real,” in that they “affect patients physiologically as well as psychologically. They alter blood pressure, heart, respiratory rate, and even body temperature” (73).

This tension, between the old view of placebos as inert and the newer view that acknowledges that they can be efficacious (and testable) treatments in themselves is certainly an issue well worth exploring – and Haller should be commended for doing so. The book could be much clearer, however, in exactly what it is arguing. Is the claim that placebos can and should be used in medicine (broadly construed so as to include both EBM and CAM)? Or is it that CAM shouldn’t be understood as medicine, properly construed, because it relies on a placebo effect” that cannot be scientifically measured or verified? Or is it that “Western science needs to advance beyond the current reductionist model to some blending of the subjective and social aspects of healing that includes the placebo?” (p. 157) Should or should not placebos be considered as potentially efficacious treatments in either CAM or EBM? And is this something that can be objectively decided? These questions, while hovering under the surface in the book are neither clearly explicated nor adequately answered.

The book does do a good job of giving a thorough history of the evidence based medicine movement and the advent and subsequent widespread acceptance of the randomized controlled trial (in the first chapter), as well as the history of homeopathy (in chapter 5). Readers interested in these topics will find a helpful resource here. For a more complete philosophical and medical exploration of placebos, however, they will likely need to look elsewhere.

Ashley Graham Kennedy

Florida Atlantic University

Boca Raton, FL

 

References

Holman, Bennett. (2015) “Why Sugar Pills are not Placebos” Philosophy of Science, 82 (December 2015) pp. 1330– 1343.

Howick J, Friedemann C, Tsakok M, Watson R, Tsakok T, et al. (2013) Are Treatments More Effective than Placebos? A Systematic Review and Meta-Analysis. PLoS ONE 8(5): e62599

Kennedy, Ashley and Sarah Malanowski. (2018) “Mechanistic reasoning and informed consent.” Bioethics p. 1-7.

Book Reviews

Victoria Pitts-Taylor, The Brain’s Body: Neuroscience and Corporeal Politics, Duke University Press, 2016

The brain matters. Says the opening line from Victoria Pitts-Taylor’s The Brain’s Body: Neuroscience and Corporeal Politics. On the face of it, the human brain matters inasmuch as it is the body’s central information processing organ; the CEO that presides over many of our executive bodily functions. But the brain matters beyond the ways in which it has biologically evolved and currently processes information. The brain also matters in social thought, as neuroscientific research has historically informed widespread perceptions of certain bodies and persons at the social and institutional level. Moreover, the brain is embodied, and bodies accrue social and political meanings beyond what they represent at the level of scientific interest. Pitts-Taylor takes this interplay between science and culture as her starting point, and she investigates the entanglement of brains and bodies with cultures and ideologies (1).

The project of Pitts-Taylor’s book can be broadly situated at the crossroads of feminist theory, neuroscience, philosophy of biology, social epistemology, and queer and disability theory. In the introduction, she limns the broad historical architecture of this varied, interdisciplinary locale. For much of 20th century thought, the brain and the mind had been separately conceptualized as objects of philosophical and scientific inquiry. The brain belonged to the body, for the most part, while the mind was conceived as an epiphenomenal happening of its own. Toward the end of the century, however, such conceptual distinctions began to seriously weaken, as the boundaries between philosophy, cognitive science, and neuroscience started to erode. Soon, the brain and the mind coalesced into a biological whole, and a new conception of the mind as both embodied and deeply social came into prominence among some researchers in the neurobiological sciences. At this juncture, the mind/brain, with its deeply social profile and underpinnings, was no longer regarded as biologically fixed. Instead, the brain was now understood as “the product of embodied experience,” as “the foundation for (and reflected in) social structures,” and as “subject to intervention and transformation” (5).

The Brain’s Body follows in this lineage of naturalistic questioning into, among other things, the mindedness of the body, the bio-materiality of cognition, and the situatedness of cognizing bodies in material cultures. In the spirit of critical rebelliousness, however, Pitts-Taylor’s book turns this lineage on itself, animating its critique and commentary by calling the cultural situatedness of this tradition itself into question. If the brain, qua the object of study, is plastic and can be socially influenced, should we not, qua theorists of the embodied brain, also heed and problematize the ways that such influences configure into our theorizing about the brain and the body? Pitts-Taylor thinks that we should! But this means that our theorizing about the brain is itself deeply plastic and impressionable, and thus open to the influence of social and ideological structures. Pitts-Taylor’s book, in a nutshell, is concerned with this concentric interplay of brains, bodies, and power structures. In a view that the book persuasively argues for, this interdependence is not merely symbolic, but also extends into the ways in which material structures are configured, including the literal structure of the brain. As such, and as the subtitle of the work suggests, “the book is concerned with the corporeal politics of the brain and the neurobiological body,”(5) wherein the interplay of discourse and ideology manifests not merely through symbolisms and at the level of representations, but also in the corporeality of the world around us.

Along these lines, Chapter 1 offers a discussion of the phenomenon of plasticity. The concept of neural plasticity, which refers to the ability of our brains to change and be changed, captures an exciting reprieve from the orthodoxy of neurodeterminism and biological reductionism. But, with the advancement of various forms of biotechnology, plasticity research also now holds potential for different modes of biogovernance and pharmaceutical intervention into contemporary life.1 As such, plasticity is a condition that has to be reckoned with, especially at this late stage of capitalism, where any possibility for modification and transformation is often concomitantly also regarded as a possibility for commercial control. For Pitts-Taylor, confronting such possibilities brings two questions to the fore.

First, is it possible to extract the neural essence of plasticity from its representations in everyday and scientific discourse? For flat-footed social constructionists, this is an impossible task, since the world is nothing but a concatenation of representational acts, and such acts are ideologically inflected through and through.2As such, searching for true objectivity, somewhere out there in the really real world, is fundamentally misguided since ‘objectivity’ is merely a conceptual device that we employ in the service of making sense of our chaotic experiences. This is unconvincing for Pitts-Taylor, and rightly so, because such accounts neglect an important question about how meanings are materialized into matter, or “how they literally modify brains and body-subjects, and, conversely, how they are touched by what they represent” (20). It is undeniably true that our concepts have meaning insofar as we attribute meanings to them. But we are also materially embedded beings, and concept use takes place on this material terrain, populated with things, people, relationships, etc. In other words, our concepts draw on this materiality and in turn shape it. As theorists of the mind and the world, we therefore have to be alert to this interplay and interaction, and the progressive and oppressive possibilities that it entails.

Second, what is the relationship between plasticity and agency? In what sense, asks Pitts-Taylor, is the plastic brain a work, and to whose agency does this work belong? Popular science tells us that the potential of plasticity truly belongs to us; that we are masters of our own neural domain, as it were.3 But as culturally situated agents, many of our actions bear the imprint of cultural influences. The plastic brain is thus no exception to such forms of cultural inscription. But given that cultures are repositories of social and political meanings, this means that the plastic brain is susceptible to the influence of meanings generated by way of social hierarchies and political inequalities. Consequently, the plastic brain can be regarded as a site of both individual and social agency. Such forms of agency are coconstitutively performed in the world, in social practices of relating to others, making use of various tools, interacting with institutions, developing an identity, and so on. The plastic brain, in other words, does not singly represent either the inscriptions of culture or the imprint of nature. Rather, the biosocial plastic brain represents both, as a “configuration of matter and meaning that achieves itself in entanglement with the world” (35).

Chapter 2 pushes this analysis further, and explores the ways in which variegated and discrepant materialities, as they are experienced in and through our different bodies, produce and result in discrepant ways of embodied perceiving and cognizing. The mind is inextricable from the physical body, as has been suggested by embodied theorists of cognition.4 Along similar lines, feminist epistemologists tell us that the body-subject is the vantage point of knowledge, wherein the situated character of knowledge gives rise to differentiated, intersecting, multiple, and even conflicting epistemic truths. Conjoined with such claims is the further claim from disability studies that not only do different bodies afford access to different truths, but that “environments and social investments affect how well bodies and worlds come together” (53). As such, there is no universal direction of fit between embodied minds and the world, for bodies and embodied subjects come in a variety of shapes, colours, abilities, genders, and orientations.  Much of the discussion of Chapter 2 is an attempt at impressing this point on embodied cognition theories, some of whose interlocutors theorize the relationship between brain, body, and world as fundamental to cognition, but also simultaneously understate the importance of bodily differences to embodied cognizing.

Chapter 3 examines and appraises the most dominant model of mirror neurons, according to which mirroring is embodied simulation and serves as the universal basis for empathy and intersubjectivity. In her discussion, Pitts-Taylor calls into question the basic assumptions of this model, especially the commonplace presumption that we are naturally empathic beings and that sociality arises out of our inborn ability to empathize with conspecifics.5 It is in the service of justifying such assumptions that mind reading theories are often proposed and defended. As Pitts-Taylor argues, however, such accounts often understate the role that difference and conflict play in our social interactions. In the absence of a discussion of such complexities, the account that we ultimately get from mind reading theories is a “caricature of sociality,” (83) which in everyday life is often experienced through clashes of perspective, differences of judgment, and non-coordinated action. Take racialization, for example, and the consistently mistaken (and deadly) association between Blackness and criminality among police officers in the United States. What goes wrong with our natural ability to understand the actions of another when, at a traffic stop, a police officer mistakes a wallet for a gun, as a Black man reaches into his pocket to produce ID and is subsequently shot and killed by an officer of law? As Pitts-Taylor asks, can mainstream theories of mind make sense of such an injustice, whose proportions are undoubtedly systemic and institutional, but that arises out of conflicts that are fundamental to how differently situated agents experience the world?6

In Chapter 4, Pitts-Taylor finishes by offering a critique of the standard heteronormative articulations of kinship in the neurobiological sciences. Kinship is a highly contested phenomenon, and how we make sense of this phenomenon will inform almost every aspect of our social lives. Accordingly, the discussion of this chapter draws on many of the themes from earlier in the book. To orient this discussion, Pitts-Taylor contrasts two construals of kinship. On the social constructivist account, culture dictates the rules for kinship, not biology, and thus kinship can be variously rescripted to enable alternative modes of relatedness. Conversely, on the genetic account, kinship evolves out of sexually dimorphic biologies in the service of reproductive imperatives. The biogenetic account is blatantly reductionist and heteronormative; the social constructivists are thereby justified in their criticism of the conclusions that this model’s assumptions invariably terminate in. That said, an understanding of kinship, in Pitts-Taylor’s view, has to also address “the body’s capacities for generating intercorporeal bonds,” wherein affective bonds are not merely rooted in cultural discourse but are also felt, embodied, and biological (98). To motivate such an account, Pitts-Taylor turns toward queer articulations of affective attachment. Such forms of attachment, as queer theorists have claimed, demonstrate the reality of felt, material bonds that cannot be incorporated into the traditional heteronormative script, thereby calling into question the supposed universalism of traditional reproductive narratives. More importantly, however, what such forms of queer kinship attest to are the actionable possibilities for queering nature, as only partially highlighted in the embodiment of queer affect.

In short, what such possibilities attest to is the fact that nature is not fixed and immutable. To the contrary, nature is constantly changing and deeply susceptible to alterations of various sort, and how we make sense of its ability to configure and reconfigure itself matters. Such forms of understanding matter not because of their symbolic and representational significance, but in the very literal sense of the term,insofar as meanings are materialized, and, correlatively, insofar as matter can only be represented through meaningful constructs. In this way, matter and meaning are much more intimately bound up than either constructivists or reductionists have hitherto acknowledged.

Disagreements can abound about the role of culture and biology in the development of the human subject, especially in the context of understanding the interplay of brain, body, and the world. Pitts-Taylor’s book is an attempt to reckon with some of these disagreements, but also to draw attention to and warn against a common tendency among theorists to generalize from privileged standpoints. The zeal with which philosophers and scientists often search for the ideal and the normative, in Pitts-Taylor’s analysis, brings forth ‘onto-epistemological’ problems that theorists of the brain have to confront. At the epistemic level, when science and philosophy ignore experiential heterogeneity, they stymie their own ambitions, since the study of such differences holds intriguing potentials for a richer understanding of the relationship between brain, body, and the world. More importantly, however, real people are harmed when the multiplicity of experience is erased in the name of universal ideals; people whose existences, relationships, and identities will never seem to merit interest, unless they begin to interfere with the normative, in which case they become problems in need of management. As such problems begin to garner intellectual interest, however, they become objects of institutional analysis and understanding; aberrations and anomalies to make scientific sense of; topics of social and political debate; fiscal issues that raise questions about private and public spending; perturbations in the status quo, and so on. Thus, spring into existence whole methodologies, tools, policies, programmes, and institutions for the study of differences, which have now been repackaged as issues, and for which we need solutions before we can reassert the authority of our normative visions. But why not recognize these differences for what they are? Why not acknowledge that they matter, at both the level of everyday experience and in abstract theorizing about persons and their minds? Why not recognize that persons essentially develop out of such differences, instead of proposing theories that understate the essentiality of different ways of being?

Personhood, a notion whose meaning I work out in (Shafiei, forthcoming), is fundamentally social and socialized. None of us are born persons; rather we acquire this status through participating in various forms of social communication, exchange, cohabitation, and connection.7 Furthermore, I maintain that persons constitute and are constituted through cultures. At their core, cultures are material repositories of different social meanings, and they comprise everything from institutions, norms, values, and interpretive frameworks to social media, fads, advertisements, cuisine, etc. In my view, it is only through our interactions with cultures, cultural techné, and the ideologies embedded therein that we become persons, which is a social designation that tracks and refers to our various social entitlements, commitments, statuses, and so on. However, social statuses and entitlements are differentially attributed among different persons. As I see it, this is because social meanings differently attach to different aspects of our material identities, including our bodies. These differences, however, should never be erased, or at least should not be erased in the name of universal ideals. The social meanings that attach to such differences, on the other hand, can be contested and challenged, but that is because these differences are sites of social contestation, confrontation, debate, and development. In other words, it is on the fault lines of these differences where persons acquire a sense of identity, where cultures arise and evolve, and where we organize toward various ends. In short, these differences are key to how we identify as social beings, whose practices are worldly and culturally embedded. That is to say, these differences are fundamental to who we are as persons and how we self-identify. In her book, Pitts-Taylor doesn’t quite make this strong claim, and perhaps we can identify this as a philosophical limitation of her account. Nonetheless, her analysis hits an important target in raising suspicions about the emphasis that, in scientific and philosophical theorizing, is often placed on the undifferentiated and the normative. If our social theories do not attend to the fundamental differences that are constitutive of personhood, and thereby of cultures, they will seem flat and uninformative as theories of social life and experience.

In The Brain’s Body, Pitts-Taylor addresses the limitations of current conceptions of the social brain when it comes to accounting for such fundamental differences; specifically the different ways in which brains and bodies are materialized in different cultures, through different abilities, in accordance with contrasting ways of life, and under the influence of different social and ideological forces. As Pitts-Taylor points out, ‘brain knowledge’ shapes what we think brains are, but brain knowledge informs practices that literally shape our brains, bodies, and the world around us.8 As such, attending to the ways in which ‘difference’ is conceptualized in scientific and philosophical discussions of the brain is a way of intervening into what matters and what does not, and not just at the level of scientific representation, but at the level of actual material influence and development. Pitts-Taylor’s analysis offers some extremely useful tools for carrying out such acts of intervention meaningfully, and perhaps even efficaciously, especially given the historical moment that we presently occupy. For those of us whose theoretical interests are enmeshed in broader projects of social and political justice, this work is an essential read. For others, this work contains some intriguing claims about the relationship between science and politics, and what can happen when the tools of the scientist are responsibly employed. All in all, this work constitutes an important contribution to ongoing conversations in the neurobiological sciences, philosophy of mind, feminist theory, social epistemology, queer theory, disability studies, and other interrelated areas of inquiry.

Keyvan Shafiei

Georgetown University

Washington, DC

 

References

Barad, Karen. Meeting the Universe Halfway: Quantum Physics and the Entanglement of Matter and Meaning. Duke University Press, 2007.

Butler, Judith. “Performative Acts and Gender Constitution: An Essay in Phenomenology and Feminist Theory.” In Performing Feminisms: Feminist Critical Theory and Theatre, edited by Sue-Ellen Case, 270-82. JHU Press, 1990.

Butler, Judith. Bodies That Matter: On the Discursive Limits of “Sex.” Routledge, 1993.

Crockett, Molly. Beware Neuro-Bunk. TED Presentation (2012). https://www.ted.com/talks/molly_crockett_beware_neuro_bunk?language=en

Dayan, Colin. The Law is a White Dog: How Legal Rituals Make and Unmake Persons. Princeton University Press, 2011.

Diamond, Adele, and Kathleen Lee. “Interventions Shown to Aid Executive Function Development in Children 4-12 Years Old.” Science 333, no. 6045 (2011): 959-64.

Huebner, Bryce. “The Interdependence and Emptiness of Whiteness.” In Buddhism and Whiteness, edited by George Yancy and Emily Mcrae. Lexington Books, forthcoming.

Pitts-Taylor, Victoria. “The Neurocultures Manifesto.” Social Text/Periscope (2012). https://socialtextjournal.org/periscope_article/neurocultures-manifesto/.

Shafiei, Keyvan. Behind Enemy Lines: The Harms of Hyper Incarceration. Doctoral Dissertation. Georgetown University, in prep.

Schwartz, Jeffrey, and Sharon Begley.The Mind and the Brain: Neural Plasticity and the Power of Mental Force. HarperCollins, 2002.

Spaulding, Shannon. “Do I See What I see? How Social Differences Influence Mindreading.”Synthese 195, issue 9 (2018): 4009-4030.

 

Endnotes

1 In recent years, for instance, there has been an uptick in spending on programmes targeted at improving executive function development among children ages 4-12 years old. See especially the work of Adele Diamond and colleagues on the nature and aims of such programmes.

2 Judith Butler, for instance, is one prominent proponent of such a view. See Butler (Butler, 1990) and (Butler, 1993) for a discussion of her performativity theory of embodied agency. In recent years, this view has been criticized by some scholars, such as Karan Barad (Barad, 2007), for treating the material body as for the most part passive. In the context of such critique, Barad proposes a view called agential realism, according to which matter, including biological matter, is an active participant in the processes of its own materialization.

3 The work of Jeffrey Schwartz and Sharon Begley (Schwartz and Begley, 2002), on the possibility of self-directed neuroplasticity, stands out here. A quick Google search, however, reveals many other recent publications on the possibility of rewiring your brain, some of whose authors also sometimes promise the possibility of a better life as a result. In other words, the research on plasticity has in some contexts alloyed itself with the self-help industry. For a critique of this proliferating body of scholarship, see the work of Molly Crocket on neuro-bunk.

4 It should be noted, of course, that the embodied cognition programme is still relatively new in the cognitive sciences, and the full implications of the challenge that such views present to cognitivism is a matter of much dispute. See Wilson (Wilson, 2002) and Spaulding (Spaulding, 2012) for an overview of the different approaches to the embodiment debate.

5 It is worth mentioning that in recent years the hype around mirror neurons has abated, and the consensus has now shifted on what kinds of neurons they really are and whether they have a specific evolutionary function when it comes to imitation and understanding. See, among others, Cecilia Heyes’s recent work on the development and function of mirror neurons

6 Along these lines, Shannon Spaulding has recently (Spaulding, 2018) argued that such theories should be able to make sense of the ubiquity of deep everyday disagreements in social interactions. See also Huebner (Huebner, forthcoming) on the ways in which difference-perception informs our practices of racial categorization, which in turn inform our normative appraisals of social status, which then feed back into the perception of salient and non-salient differences.

7 In my work, specifically, I explore the ways in which persons are institutionally made and unmade, especially in the culture of the criminal justice system in the United States, and through institutions like mass incarceration. See also Colin Dayan (Dayan, 2017) for a discussion of very similar themes.

8 See also Pitts-Taylor (Pitts-Taylor, 2012a) on this point.

 

 

Editor's Pick

Editor’s Pick, September 2018: Lauren Freeman and Saray Ayala López

Our Editor’s Pick for our September 2018 issue is Lauren Freeman and Saray Ayala López’s paper, “Sex Categorization in Medical Contexts: A Cautionary Tale.” In this paper, Freeman and Ayala López question the completely standard practice of sorting patients into male and female (and in unusual, ‘abnormal’ cases, ‘other’) as a first step in providing medical care. The authors carefully analyze the empirical and normative effects of this practice and argue that it leads to suboptimal care, as well as having damaging social and psychological effects. They argue that there is no need for such a sorting, and that health care providers can and should focus on more proximate sexed dimensions of their patients, such as having ovaries, having a penis, caring about presenting as feminine, and so forth. This paper brings a crucial public debate into the heart of medical practice, and its consequences are far-reaching.

Download a PDF of Freeman and Ayala López’s paper here.

Book Reviews

Inmaculada de Melo-Martin, Rethinking Reprogenetics, Oxford University Press, 2016

Rethinking Reprogenetics: Enhancing Ethical Analyses of Reprogenetic Technologies is a compact, rigorously argued volume that packs quite a punch. Inmaculada de Melo-Martin aims to provide a crucial corrective to the analyses of bioethicists who have taken to cheerleading the development and use of reprogenetic technologies1 (p.7). She argues that they should instead carefully evaluate the goals that particular nations want to achieve by means of reprogenetic technologies and consider whether there is warrant for the trust placed in social institutions to address the unexpected consequences of the use of those technologies.

To realize those two aims, de Melo-Martin incisively dissects bioethics analyses that uncritically espouse reprogenetic technologies. She exposes their disconnect from scientific facts about human biology and gene function (de Melo-Martin has a master in biology, with a concentration in molecular genetics). She also demonstrates that those analyses either do not take seriously or overlook the harms, risks and uncertainties associated with the use of reprogenetic technologies for women as well as the children who are the ‘product’ of those technologies. Additionally, she makes the case that such bioethics analyses betray a lack of understanding of the moral and socio-political complexities of the use of reprogenetic technologies in gendered, ableist, racist, and classist societies.

Following the introductory chapter, de Melo-Martin carefully explains what currently available reprogenetic technologies can do. Then, in Chapters 3 to 8, she outlines and critiques the arguments made by proponents of reprogenetic technologies, specifically, Nicolas Agar, Allen Buchanan, Nick Bostrom, David DeGrazaia, Ronald Green, John Harris, Guy Kahane, John Robertson, Julian Savulescu, and Lee Silver. de Melo-Martin states that her critique has three prongs. First, it is informed by a scientifically accurate understanding of human biology and the science underlying reprogenetic technologies as well as its potential, risks, harms, benefits and uncertainties. Second, it is attentive to the ways in which the development and use of those technologies is gendered, and third, it recognizes that normative concerns and social contexts shape, and, in turn, are configured by science and technology. As part of her evaluation of bioethics analyses that uncritically endorse the use of reprogenetic technologies, in Chapter Seven, de Melo-Martin argues in some detail that technologies in general are value laden. Proponents of reprogenetics appear to assume that the use of technologies can be value neutral.

In the final chapter of the volume, de Melo-Martin provides her readers with an alternative to bioethics analyses that ignore relevant particulars. She provides the outlines of a bioethics analysis of reprogenetic technologies that is sophisticated in its attention to the complex socio-political and ethical issues that shape the development and use of those technologies.

Chapter Four is a fine example of de Melo-Martin accurately presenting her opponent’s position and then skillfully exposing its errors and omissions. One of the arguments that she examines in this chapter contends that the use of reprogenetic technologies by individuals to have a child of a particular sex2 falls under the umbrella of procreative liberty and thus there should be a strong presumption against societal interference. de Melo-Martin makes the case that her opponent is not justified in making that claim because he has not provided evidence that the activity at issue is crucial for advancing the value that the right is meant to protect. Her larger point is that rights-based claims cannot be grounded merely on the intensity of the desire of individuals to affect a particular end, and that instead they must be based on the value relevant to the right invoked.

de Melo-Martin also finds wanting arguments that assert that parents have a moral obligation to have the (genetically) most perfect offspring possible. While such arguments are ostensibly addressed to parents, their target is primarily women of reproductive age. To state the obvious, those arguments in effect amount to a moral mandate of sorts to (a particular group of) women to lie back and think of the ‘higher good’ and permit their bodies to be subject to reprogenetic technologies. There is more than just sexism at work there. Given that in many nations, including the US, the use of reproductive technologies (coupled with genetic diagnosis) is available primarily to women of a certain class and given the racial disparity with respect to access to medical intervention, the exhortation to produce the (genetically) best possible children takes on a very morally troubling hue. It is also worrisome given the ethically reprehensible history and current practices of many nations with regards to the reproductive rights of persons with disabilities. de Melo-Martin points out that bioethicists err when they propose that all women should have access to those technologies as the solution to those problems. They overlook a host of larger complex moral and socio-political questions. One such issue is the ethical and political warrant (nationally and internationally) for the use of scarce medical and scientific resources to attempt to use genetic engineering to ‘create’ children with enhanced cognitive capacities. Availability of adequate nutrition, clean water, medical and preventative care, stable and safe home environments and communities, and education are some of the factors that play a crucial role in determining academic performance of children (as does the mother’s health and general well-being prior to and during pregnancy as well as postnatally). Of course, the use of reprogenetic technologies by socially privileged individuals to realize their desire to have children with whom they share genetic material must not be accepted unquestioningly either. While that desire is conceptualized as a purely biological urge, and thus, not considered a fruitful subject of discussion, it is a socially constructed and sanctioned desire. She rightly contends that societies must interrogate that desire and the socio-political contexts that produce it.

de Melo-Martin is warranted in castigating bioethicists who theorize about the ethics of reprogenetics without taking the trouble to educate themselves about, among other things, the mechanics of sexual reproduction (such as meiotic recombination, which IVF leaves untouched), the complicated relationship between genes and other cellular “machinery”, and the complex, entangled relationship between genes, environmental factors, and phenotypes. Moreover, such bioethicists fail their profession in an important regard when they present genetic engineering as the solution to alcoholism, antisocial personality disorder, memory, and intelligence enhancement, or substance addiction. There is no simple genetic fix for such problems because they are the product of complex, complicated mix of biological and social factors. The failure of (some) bioethicists to familiarize themselves with the basic science of human biology, including gene function, even though they write about them is confounding. Such off-target bioethics analyses recklessly veer into the realm of science fiction. de Melo-Martin contends those flawed bioethics analyses can have serious ethical and political consequences if they are used by institutions or nations to inform policy decisions or formulate regulations that govern research and use. If the uncertainties associated with the use of reprogenetic technologies are not acknowledged or if the attendant harms and risks are glossed over, they will not adequately protect women or the children they conceive using them.

By critiquing this flawed sub-strain of bioethics, de Melo-Martin, in effect, raises the larger question: how do such papers see publication daylight in mainstream bioethics journals? Clearly, at least some of the responsibility lies with the wider bioethics community involved in the review and editorial process. However, some of the blame must be placed at the door of researchers who permit the media to exaggerate the promise of their projects in the hopes of drumming up public support that translates into funding dollars.

Perhaps the most compelling feature of Rethinking Reprogenetics is that it is a demand for scientifically accurate and socio-politically engaged bioethics analyses about the use of reprogenetic technologies so that the public can engage in informed deliberations about funding such research and the use of the technologies and techniques they produce. Those normative decisions should not be left to scientists, bioethicists, or policy makers. While de Melo-Martin has argued that the public should be involved in making those decisions, she would be warranted in going further and arguing that in democracies the public discussions and decision-making should be particularly attentive and responsive to the concerns of the groups that would be disproportionately affected by the decisions and which have developed critical analyses of the dominant cultural narratives that assert that women are under a biological imperative to reproduce, there is a responsibility to have the (genetically) best possible children, and scarce medical and scientific resources should be devoted to the development and use of reprogenetic technologies.

Rethinking Reprogenetics will be of considerable interests to any academic audience concerned about the use of genetic technologies (or techniques) for the purposes of genetic diagnosis (or engineering) or the use of reproductive technologies. Moreover, it has relevance for policymakers, IRBs, researchers and the public in general. However, to reach the general public, a title that would easily convey to laypersons the subject of the volume would have been desirable.

All in all, given the many virtues of Rethinking Reprogenetics, the volume as a whole or at least chapters from it should be standard reading for undergraduate or graduate bioethics courses. Sections of it could also be used in ethics courses as an accessible and engaging model of careful ethics analysis.

Zahra Meghani

The University of Rhode Island

Kingston, Rhode Island

 

Endnotes

1 I.e., in-vitro fertilization (ivf) employed in conjunction with genetic tools that are focused on reproduction rather than research (p.19).
2 For considerations unrelated to sex-linked mutations.

Book Reviews

Kevin C. Elliott, Daniel Steel, eds. Current Controversies in Values and Science, Routledge, 2017

As a general claim, most philosophers of science accept that science is not value-free. The disagreements lie in the proverbial details. The essays in Current Controversies in Values and Science, edited by Kevin Elliott and Daniel Steel focus on such details. Like other volumes in the Routledge Current Controversies in Philosophy’s series, this one asks ten well-known philosophers of science to engage with various questions. Each question receives roughly positive and negative responses, though the authors’ nuanced answers make clear that the contrasting views also involve significant agreements.

The first question asks whether we can distinguish epistemic from non-epistemic values.  Hugh Lacey argues that such methodological distinction is not only possible but also desirable. For him, different attitudes are appropriate regarding scientific theories and attention to these different attitudes demonstrates the importance of the distinction. Epistemic –or rather cognitive—values are those that allow us to evaluate how well a scientific theory provides understanding of a particular phenomenon. Non-epistemic values, and in particular social values, on the other hand, allow us to evaluate social arrangements and social institutions and practices. Only cognitive values, Lacey contends, are relevant to deciding whether a theory is impartially held of a set of phenomena.  But scientific theories can be more than just impartially held. They can also be adopted, i.e., used as basis for further research, or endorsed, i.e., used to inform decision-making. According to Lacey, non-cognitive values are relevant to the justification of the attitudes of adopting and endorsing, even if they do not play a proper role in impartially holding a theory.

Phyllis Rooney agrees that a general methodological distinction between epistemic or cognitive values and non-epistemic ones is possible, but she questions the usefulness of a sharp distinction.  Her contention is that rather than a strict delineation, we find a “robust borderlands area” between epistemic and non-epistemic values. Rooney questions the sharpness of an epistemic/non-epistemic values distinction on various grounds. First, she argues, philosophers disagree even about what values count as epistemic or cognitive.  This is so, she points out, because science has a multiplicity of legitimate goals, and what one takes to be scientific inquiry’s primary goal(s) will affect what counts as an epistemic value. Second, non-epistemic values are hardly a uniform group, but more importantly, the use of some of those values, e.g., feminist values, has clearly contributed to the development of epistemically sound theories.  

Although at first sight it might appear that Lacey and Rooney defend opposing sides, the disagreements are more a question of emphasis. For Lacey, the distinction between epistemic/non-epistemic values is important because a failure to make such delineation effectively gives scientists more authority in policy decisions than they should have. Rooney is however concerned that drawing that distinction risks inappropriately delegitimizing the use of some non-epistemic values when conducting research while legitimizing the use of some epistemic values that depend on people’s judgments about what the primary goal of science might be. Both agree that non-epistemic values can and should play very significant roles in scientific inquiry.

The second question tackled in the collection concerns whether science must be committed to prioritizing epistemic over non-epistemic values.  Daniel Steel argues for a qualified priority of epistemic concerns in science. He offers two arguments for his position. First, science, he contends, has an immediate aim, which is to advance knowledge. Second, a rejection of the priority of epistemic values can lead to what he calls the “Ibsen predicament,” wherein attempts to promote a valued social aim can lead to corrupted science. Steel claims that only maintaining the priority of epistemic values can protect us against this outcome.

Matthew Brown presents the opposing view and argues that we should reject any strong version of the priority of epistemic values thesis. He presents three arguments to defend his claim. First, epistemic and non-epistemic considerations are too entangled in scientific inquiry to make talk of prioritization meaningful. Second, non-epistemic values can be defended with good reasons and epistemic values can lead to wishful thinking just as non-epistemic values can. Third, epistemic standards are context and historically dependent. They can be reevaluated in the course of inquiry. For Brown, rejecting the epistemic priority thesis has an added benefit. It forces scientists to consider the social consequences of their work because they have to consider trade-offs between epistemic and non-epistemic values.

In spite of the contrasting answers, it is not clear that Steel’s and Brown’s positions are significantly different. Perhaps as earlier, the differences are more a matter of emphasis. Clearly, neither Brown –as he explicitly says—nor anyone else Steel mentions in his essay think that epistemic considerations are unimportant or that scientists should accept scientific claims on the bases of non-epistemic values alone. It seems that Brown is more concerned with ensuring that scientists take their responsibilities regarding the social consequences of scientific inquiry seriously, and he worries that the fetishization of epistemic values can detract from this. Steel seems to fear that a failure to prioritize epistemic values can result in scientific theories driven by ideological interests. It is not clear, however, that his Ibsen predicament makes the case he wants to make. It does not seem that Dr. Stockman faces a conflict between epistemic and non-epistemic values, but one between various non-epistemic values: to protect the town’s livelihood or to risk some people’s health. There is no need to deny the results of the study. The conclusion of the study, i.e., that the baths are contaminated, do not mandate a particular policy action. To believe that it does, is to misunderstand the role of science in policymaking.

If the previous authors seem to disagree mostly on the details, Heather Douglas and Gregor Betz disagree on their answer to the question they are addressing: whether the argument from inductive risk justifies incorporating non-epistemic values in scientific reasoning. Indeed, Douglas and Betz agree on much of the details but differ on what follows from them. For Douglas, because most science is inescapably uncertain, scientists must make value judgments about the consequences of error. This is so, she argues, if science is to be useful for policymaking. Hence, scientists not only incorporate value judgments when making scientific claims, they have a duty to do so because of the authority that science has. In her view, the existence of inductive risks justify scientists using non-epistemic value judgments in scientific reasoning.

Betz, on the other hand, agrees that much socially relevant science is uncertain and that scientific evidence should inform public policy. He rejects the need for scientists to close the uncertainty gap by making non-epistemic value judgments. For him, scientists can deal with uncertainty by disclosing it to policy makers in various ways: spelling out the consequences of all the alternatives; altering the conceptual framework used for their research; quantifying the uncertainties in terms of probabilities; and by making the non-epistemic value judgments transparent.  Moreover, for Betz it is ethically inappropriate for scientists to incorporate non-epistemic value judgments. In democratic societies, that is the job of policy makers not of scientists.

Both authors believe their arguments have implications for the value-free ideal of science, i.e., the ideal that scientists ought to refrain from incorporating non-epistemic value judgments in scientific reasoning. For Douglas, the existence of inductive risks and the duty that scientists have to offer informative policy advice undermine the value-free ideal. For Betz, the fact that scientists can offer informative scientific claims without the need to incorporate non-epistemic value judgments vindicates the ideal. However, one can agree with Betz that the inductive risk argument is insufficient to undermine the value-free ideal and still reject such an ideal because non-epistemic values are incorporated in many other ways in scientific reasoning (de Melo-Martin and Intemann 2016).

The fourth question focuses on whether the social value management ideal espoused by Longino can incorporate all epistemically beneficial diversity while also excluding problematic moral and political points of views. Kristina Rolin argues that such is the case. Although she recognizes that Longino was particularly concerned with diversity of values because of its epistemic benefits, Rolin contends that the social management ideal could include other types of epistemically beneficial diversity, such as diversity of standpoints, theoretical approaches, or research strategies. She further argues that although the social management ideal requires that scientific communities share some standard of evaluation for transformative criticisms to arise, such requirement need not exclude a diversity of views. This is so because the share standard requirement should be interpreted in a thin way, allowing for the incorporation of diverse points of views. This does not mean that anything goes. For Rolin, the tempered equality and the uptake criteria espoused by the social value management model serve to exclude inappropriate values, such as sexist and racist ones, from consideration.

Kristen Intemann recognizes the important contributions of the social value management model towards advancing the aims of feminist philosophy of science but argues that it is insufficient. For her, the type of diversity that the model calls for, i.e., diversity of values and interests, and the role that values play in advancing objectivity are too limited. Because the context in which research happens makes certain points of view or certain values more likely to be represented or heard, the mechanisms used by the social value management model to exclude them will actually fail to do so. What we need, Intemann argues, is not value management but the explicit endorsement of social justice values. Endorsing such values will exclude sexist and racist values from consideration when making science.

Like in some of the previous chapters, the differences between viewpoints presented here are not substantive. The different answers are again more the result of attending to different aspects of the question. Rolin is concerned with defending the social value management ideal against claims that it does not allow for appropriate types of diversity and that it is too inclusive, thus allowing the incorporation of problematic values. Intemann is concerned with advancing the aims of feminist philosophy of science and in that respect she finds the social value management wanting because it fails to attend to social diversity and does not have mechanisms to exclude values that are inconsistent for feminist values.

The final question in the volume focuses on the type of research funding system that would best serve values of social justice and democracy. James Robert Brown and Julian Reiss agree that much is wrong with the status quo, but they arrive at different conclusions regarding this question. For Brown, the influence of commercial interests in science is problematic because of their corrupting effects and the skewing of the research agenda. He believes that the best way to address both problems is to socialize medical research, that is, to fund it primarily by taxes. A socialized research system would do away with IP rights, such as patents, and would result, he believes, in financially disinterested researchers who could impartially conduct research. More importantly, it would allow researchers to expand the range of options to consider when addressing medical problems.

For Reiss the problems with commercialized research are not so much the result of the influence of private funding but of not enough free market. He agrees with Brown about eliminating patents, but in his case is because patents involve a kind of market interventionism that stifles competition. Similarly, he rejects drug regulation by government bodies such as the FDA. From an epistemic point of view, Reiss argues, the lack of clear and judicially enforceable evidentiary standards gives the FDA reasons to set the bar too high, thus leading to the inappropriate exclusion of some drugs. Moreover, the FDA takes away individuals’ ability to decide how much risk they are willing to accept from certain medications. For Reiss, a true free market would give companies an incentive to produce the best products possible and would allow citizens to make decisions about how to trade off risks and benefits.

What research funding system can best promote research integrity and a socially responsive research agenda is ultimately an empirical question. Nonetheless, perhaps Brown has too much faith in the ability of public institutions to achieve these goals and underestimates the value of private funding. On the other hand, Reiss seems to have too much faith in the good workings of a free market for biomedical research and underestimates the many ways in which power differentials and unjust social conditions can make it difficult for citizens to be appropriately informed and easier for drug companies to try to game the system.

Many things speak in favor of Current Controversies in Values and Science. Although the questions addressed are not the only relevant issues in debates about values and science, they are significant ones. Moreover, the authors included are some of the main protagonists in these debates. The fact that the authors of contrasting positions engage each other makes the essays more appealing and relevant. Even when the disagreements between authors are minor, differences in emphasis and concerns are significant when approaching debates about the relationships between non-epistemic values and science. Anyone interested in such issues would gain greatly from reading this volume.

 

Inmaculada de Melo-Martín

Division of Medical Ethics

Weill Cornell Medicine—Cornell University

New York, NY

 

References

de Melo-Martín, I and Intemann, K. The Risk of Using Inductive Risk to Challenge the Value-Free Ideal, Philosophy of Science, 83 (2016): 500–520.

Book Reviews

Kate Manne, Down Girl: The Logic of Misogyny, Oxford University Press, 2017

Kate Manne’s Down Girl: The Logic of Misogyny is an accessible and timely exploration of a particular aspect of gendered oppression that has received surprisingly little scholarly treatment. There is a lot of feminist work on sexism, oppression, and patriarchy, but misogyny, as Manne defines it, is distinct from all of these. Her purpose in this book is to describe misogyny as a distinct force present in contemporary society, and to show how it shapes public life. The strength of Manne’s account is that it detaches misogyny from the intentions and attitudes of individual misogynists, showing instead how it is a feature of a patriarchal society.

Misogyny, according to Manne, is like the law enforcement arm of a patriarchal social order. Its function is not to justify women, or non-men, as having a lower place in social hierarchy, but is rather to enforce that lower social status. Misogyny is not a matter of individual attitudes or sexist hatred of women, and in fact it is entirely consistent to claim that misogynist acts can be committed by people who desired women, perhaps loved them in some way. This is important, since one of Manne’s primary motivating examples, the Isla Vista killings, was committed by a man who was deeply angry and resentful at the lack of sexual attention he received from women. His reaction was to lash out against what he saw as an unjust state of affairs—a violation of the patriarchal social order according to which he was owed the women he desired—and attempt to punish many of the women he saw as unjustly withholding attention from him by shooting people at a nearby sorority. The tool that Manne has provided us with for understanding this is a framework under which misogynist violence is a matter of maintaining subordination.

The introduction and first few chapters of Manne’s book introduce these basic ideas and other such motivating instances of misogynist hostility. She argues against such things in terms of what she calls the naive conception of misogyny, which sees misogyny as a matter of individual hatred or hostility towards women—individually or as a group. That gendered violence is more complex than simple hatred should not be surprising to anyone familiar with statistics of violence against women, since the majority of violence enacted against women is at the hands of people they know, often current or former intimate partners, and sometimes in the name of love or desire. It would seem more difficult to consider such violence as misogynist under the naive conception, since these crimes seem motivated by something other than hatred of the women who are victimized by it. And indeed, on Manne’s conception of misogyny, it is relatively independent of the individual feelings that the perpetrators of the violence have towards their victims. Rather, it is a matter of their enforcement of a certain social ranking that places women below men. Under Manne’s conception, misogyny punishes women who are not playing their patriarchally approved role. Unlike sexism, its role is not to justify what the role of women ought to be, but, given a system under which women are held to be subordinate, it enforces such subordination by means that are sometimes coercive or violent.

One feature of Manne’s definition of misogyny that makes it more friendly to feminist analysis than the naive conception, is that it centers the women who are punished by it, rather than the (typically male) enforcers of the patriarchal system. As such, we are better able to see what unreasonable demands patriarchy makes of women. This is the subject of Manne’s fourth chapter: considering how women are positioned as givers of characteristically moral goods such as affection and care. Now, on Manne’s distinction between sexism and misogyny, it is sexism that determines what women owe and to whom, but misogyny that enforces it, perhaps by punishing women who seem to be shirking their duties, or taking social goods that coded as masculine. Sometimes, this takes the form of anger and hostility towards successful women, rising, perhaps, above their station, or taking positions that men should rightfully be holding. Though when it comes to the goods that women are supposed to be providing, it is not always the case that there is a particular woman whose duty it is to provide them. In the case of the perpetrator of the Isla Vista killings, Elliot Rodger, his anger was directed at “hot women” in general, who were to be punished indiscriminately, since none of them were giving them the sexual or romantic attention he believed he merited. In calling himself an incel (involuntary celibate), he, and others who adopt the label, mark themselves as being among men who are unjustly deprived of feminine goods.

All this continues to speak against the naive conception of misogyny that views it as a more straightforward phenomenon of anger and hatred. Manne’s conception of misogyny allows us, for instance, to understand the narrowly circumscribed ways in which misogyny can allow women’s strength to be valued—when that strength is used to stand by or support some man or other. Also, it can explain why successful right-wing women are generally less targeted by misogyny; this framework allows us to understand this by noting that in such cases, women’s power is generally being used in support of patriarchal interests, such as “traditional family values.” Another advantage of moving away from the naive conception is that it lets us situate seemingly distinct types of misogynist violence within the same phenomenon of dissatisfaction with status. Family annihilators are typically successful men who, facing some kind of loss, such as bankruptcy or demotion, kill both their families and themselves. But like incel violence, this can also be seen as a misplaced reaction against low status (in the case of incels) or loss of status (in the case of many annihilators). So we can situate both types of violence on the same sort of continuum, which also demonstrates how a patriarchal system that associates men’s worth with their hetero-romantic and material success is ultimately going to fail people of several different genders.

The analysis of women as providers of feminine-coded goods is also used in Manne’s fifth chapter, to argue against a view that sees misogyny as an issue of dehumanization. More specifically, she argues against a view called humanism, which is a conjunction of several distinct but interrelated theses. This view takes dehumanization to be a key factor in many different forms of oppression, though particularly war crimes. Under such a view, the failure to treat or recognize others as fellow humans is the best explanation of why we treat each other in cruel, humiliating, and degrading ways. Applied to misogyny, the failure to recognize women as fully human, or the tendency to treat women as objects, is the best explanation for women’s mistreatment. And consequently, the best remedy for it would be to find strategies through which women could be portrayed as fully human, or in which common humanity could be showcased.

Manne’s primary argument against the humanist thesis relies on her insights from chapter four, namely that misogyny involves treating women as distinctively human and positions them as human givers. Given the nature of the moral goods that many perpetrators of misogynist violence see as being unjustly withheld, their stance on women seems incompatible with one of dehumanization. More specifically, incels like Rodger view women as being capable of love, affection, and deep emotional relationships; after all, these are the very things that they are demanding of the women they resent. But these capacities are distinctively human ones, and so dehumanization as an explanation of their cruelty towards women seems difficult to square with their stated attitudes. Further, the hostility displayed towards many successful women, such as Hillary Clinton or Julia Gillard, is explained on Manne’s framework as a result of their occupying traditionally male positions of power, or taking what, on a patriarchal scheme, they are not owed. But such a stance towards them positions them as human rivals or usurpers, which is incompatible with the humanist thesis as it has been characterized.

This chapter, though, reveals the primary weakness of Manne’s book, which is its focus on a single axis of oppression. Manne acknowledges other oppressions, such as racism and transphobia, and notes with regret in her introduction that she is unable to discuss them in much detail, and they are noted in several examples, say of misogynoir. It would be unfair to demand that one book do everything, but chapter five does mark at least some ways in which Manne’s analysis could have benefited from further consideration of issues such as racism. While I think she is right, in the examples she considers, such as hostility towards women such as Clinton and Gillard, that dehumanization plays no significant role, much of the literature on dehumanization focuses on ways in which it is applied to people of particular ethnic groups, rather than people of a particular gender identity. Accounts of dehumanization that she considers, like David Livingstone Smith’s, argue that dehumanization portrays a people as simultaneously human and inhuman. They are are seen as “uncanny,” like monsters or beasts wearing human faces, but such characterizations are often given along ethnic lines.

In pushing back against accounts like Smith’s, Manne points out the tension between it and atrocities such as sexual enslavement and wartime rape, arguing that, were dehumanization the mechanism that enabled the atrocities in such cases, we would find more aversion on the part of the perpetrators. We do not, after all, generally want to have sex with monsters, regardless of their outward appearance. Now, I grant to Manne that we do not typically want sexual relationships with the uncanny or monstrous—incels who desire sexual relationships with women might hate or resent women but still view them as human. But it is not clear that wartime rape (and other instances of rape) are sexual encounters, much less relationships. I think that we could view rape in such cases as a way of degrading a certain kind of good or loot, namely women. Soldiers in war might burn homes in a show of dominance over enemy civilians, just as they might steal valuables. They might just as well use rape as a way of destroying or defiling what is seen as essentially property.

What Manne gets right, though, is that we have no reason to think that misogynist violence generally occurs because women are dehumanized. But on an account of misogyny under which it is primarily a matter of putting women back in their place, it is likely not the source of all instances of women’s mistreatment. Factors such as ableism, racism, and transphobia may intersect with both misogyny and sexism in complex ways that are certainly worth further exploration. Women, as Manne argues, are positioned as providers of particular kinds of goods, particularly moral goods of care, service, and attention. But the form such giving is supposed to take might vary with the social identity of the woman in question, as well as the way in which she is to be punished for failing to provide it. I think this just shows us, though, how much more work on misogyny has yet to be done, and how Manne’s book provides us with an important starting point for further research.

In chapter six, now, Manne considers the stories we tell about the perpetrators of misogynist violence. Connecting misogyny to the issue of testimonial injustice, she considers how the latter can be seen as a mechanism through which hierarchies of subordination can be preserved. Situations of testimonial injustice are cases in which someone suffers a credibility deficit as a result of systemic identity prejudice. We can see many so-called “he said, she said” situations as instances of testimonial injustice, in which stereotypes about women’s capriciousness or irrationality can make their word less valuable than that of men. This is the flip side of misogyny as punishing women trying to rise above their supposed place; here we see misogyny as protecting more dominant men from falling from their place, namely by shielding them from accusations of wrongdoing. Testimonial injustice in the service of misogyny protects men who do wrong. Part of this protective function is what Manne calls himpathy, which is an excess of sympathy and understanding towards men, particularly male perpetrators of violence against women. We can see this in many media portrayals of those accused of sexual assault or harassment, which sometimes seek to demonstrate how men have their lives ruined by such accusations. What is missing here, of course, is the extent to which such narratives neglect the impact on the lives of victims of assault or harassment. But in a male-dominated social order, such omissions are sometimes what protects the status quo.

What, then, can victims do to be heard or believed? Chapter seven discusses the sometimes disparaged trope of women playing the victim, often dismissed as part of a culture of fragility and melodrama. This goes along with a further image of women making false accusations against powerful men in order to serve their own ends. But, as Manne points out in this chapter, what ends? Those who cast themselves in the role of victim, particularly when the perpetrator is a man with significant social power, do not often get a great deal of public sympathy—the latter, tending as it does, towards himpathy. Victims who deviate from an image of innocence and moral purity are often the subject of humiliating public scrutiny and speculations about hidden agendas which might lead them to have vendettas against those they accuse. Yet sometimes the benefits of exposing wrongdoing end up outweighing the personal costs. Without those willing take such risks and make public their experiences, many predators and misogynists might well continue unhindered.

The final chapter in Manne’s book deals with the case study of Hillary Clinton’s loss to Donald Trump in the 2016 US presidential election. While I have claimed that the book’s main shortcoming is its insufficient attention to modes of oppression beyond gender, it does provide an ideal way to analyze the treatment of high-status white women like Clinton, as well as the Australian politician Julia Gillard. Both women were notably criticized as being power-hungry liars, and marked by significant suspicion in the public eye, despite a lack of evidence of untrustworthiness. But of course, misogyny gives us a reason not to trust women such as this, who attempt to usurp positions that are traditionally occupied by men. Such transgressions lead to their being viewed with disgust and contempt, as so-called “nasty women.” Since attempting to run for high public office is already against the patriarchal rules, it is easy to see how women who do so are seen as rule-breakers or as unreliable generally. Misogyny, then, explains how a president like Trump, who has been caught in several lies and has admitted on tape to sexual assault (dismissed, of course, as “locker room talk”), is still seen by his supporters as trustworthy. He is, after all, doing what is expected of him.

So where does this leave us with respect to misogyny? Manne’s conclusion is pessimistic. Our society is one in which patriarchal social norms are deeply entrenched, sometimes with deadly consequences. Looking at daily events with her framework in mind reveals an unfortunate abundance of “down girl” moves, in which we see women face negative consequences for disrupting patriarchal strictures. The goal of the book, though, was not to provide prescriptions for ameliorating misogyny, but rather to help us understand the role it plays in our social life. So while Down Girl is not a hopeful read, it is an important one for the time in which we live.

As I said at the outset, the book is also quite accessible for audiences less familiar with feminist philosophy. The discussion of testimonial injustice may be somewhat difficult without the relevant background, as well as some portions of the discussion of dehumanization. But overall, even those parts of the book that engage with and make more technical philosophical points are grounded in concrete examples that make at least the overall shape of the argument clear. As such, the insights it provides make it a valuable addition to feminist philosophy, as well as an important read for anyone seeking to understand our contemporary political and social climate.

Audrey Yap

University of Victoria

Victoria, British Columbia, Canada

Editor's Pick

Editor’s Pick, June 2018: Tommy J. Curry and Ebony A. Utley

Our Editor’s Pick for our June 2018 issue is Tommy J. Curry and Ebony A. Utley’s paper, “She Touched Me: Five Snapshots of Adult Sexual Violations of Black Boys.” In this painful and nuanced paper, Curry and Utley argue compellingly that Black boys are especially vulnerable to sexual violation. Ironically, this special vulnerability is grounded in our cultural framing of Black masculinity in a way that makes Black boys seem impervious to sexual violation, almost as a matter of conceptual necessity. Through five case studies, Curry and Utley show that the boys themselves are not given the social tools to understand their own violation or how to protect themselves from it. They are also not provided with appropriate sexual education, in part because they are seen as already-sexual and not in need of training in self-protection. Curry and Utley’s paper is both heartbreaking and important.

Before reading this issue’s Editor’s Pick, readers should understand that it may be difficult to read for some, as it contains descriptions of sexual violation within relationships of gross power inequality, and under conditions of enormous vulnerability.

Download a PDF of Curry and Utley’s paper here.

Book Reviews

Sarah S. Richardson, Sex Itself: The Search for Male and Female in the Human Genome, University of Chicago Press, 2013

Following the tradition of feminist philosophers and scholars of science from the 1980s onward such as Evelyn Fox-Keller, Helen Longino, Anne Fausto-Sterling, and others who revealed how popular notions of masculinity and femininity infiltrated and shaped the content of scientific knowledge, Sarah S. Richardson’s book Sex Itself: The Search for Male and Female in the Human Genome (2013) deserves a place on the shelf with this canonical literature. It addresses one of the most celebrated symbols of biological sex binary: the X and Y chromosomes. The X and Y chromosomes, we learn, were not given the role of “sex chromosomes” upon their discovery in 1890 and 1905, respectively. Their transformation into the ultimate biological signifiers of male and female during the next five decades was neither inevitable nor free from significant theoretical and empirical challenges. Rather, the X and Y chromosomes, objects of scientific study, were gendered via the various stages of scientific inquiry and methodology. The implicit promise embedded in the human genome project to decode human differences and identify the genetic elements of maleness and femaleness make Richardson’s book a crucial contribution that outlines a much-welcomed reflection of this scientific endeavor.

Whereas during the late 19th century biologists understood “sex” as a “complicated, spectrum-like, and highly variable phenomenon” (24), the beginning of the 20th century saw biologists expressing a dimorphic vision of sex differences, with models that attempted to identify clear and distinguishing elements between males and females. The discovery and study of the X and Y chromosomes fit well within the emerging dimorphic vision of sex overall. Moreover, it led to the gradual replacement of metabolic and hormonal models of sex differences by a genetic model of sex, casting the X and Y chromosomes as the new symbols of biological dimorphic sex.

Richardson’s book addresses an issue that has become important to ethicists, jurists, and scientists in recent years: how to account for biological differences between humans in an ethical, productive manner. With respect to genetic differences between males and females, the book takes up the incredibly daunting challenge of how to conduct genetic research on sex differences that yields beneficial results but that also avoids the pitfalls of biological determinism that feed sexist agendas. Through the book’s historic narrative and analysis of the future trajectory of genetic research, Richardson argues that although gender conceptions have a history of distorting scientific research, they could potentially be used constructively. Beliefs about gender are part of the social backdrop in which scientific research operates and therefore cannot simply be identified and surgically removed. Instead, Richardson offers a theoretical approach she calls “gender modeling,” which aspires to understand, on a descriptive level, “what work does gender do in this case?” rather than focus on the possible prejudice that led to gender conceptions in (16). After reviewing the different chapters of the book, I will advance the speculation that the paradigm of “sex itself, the idea that scientific inquiry into the deep biological layers of the body could reveal the essence of sex, might be fading away.

Sex Itself proceeds in ten chapters. Chapter 1 introduces the bio-cultural concept of “sex itself” within the context of genetic research and feminist analysis of science, and the overall argument of the book. Chapters 2 through 4 provide a historical chronology of scientific research leading to the theory that the X and Y chromosomes are the biological markers of sex and gender: maleness and femaleness. When the X and Y were discovered, they were first called the “odd chromosomes.” The growing interest in fertilization and biological sexual dimorphism in early 20th century drove scientists to try to link the function of the odd chromosomes to existing theories about sex differentiation. Nettie Stevens and Edmund Wilson created a fundamental theory of the odd chromosomes as the biological element that determines sex, transforming them from “odd” into “sex” chromosomes (34). The theory of X and Y as sex chromosomes implied that femaleness and maleness are separate, distinct routes of development. Many decades of research using this framework did not produce any workable theory of genetic sex differences; nevertheless, the emerging molecular science of sex of the time gendered the X and Y chromosomes in effect by focusing on their empirically nonproven relationships to maleness and femaleness.

In 1959, it was discovered that the existence of a Y chromosome is critical for the development of testes (77). This discovery bolstered the notion that the Y chromosome is the biological “seat of maleness.” Chapters 5 and 6 provide two exemplary case studies on how gender conceptions attached to the X and Y chromosomes produced empirically invalid and methodologically shaky theories regarding their operation. One such hypothesis was the “XYY super-male” theory. After blood samples collected in a high-security psychiatric hospital indicated a high rate of males with extra Y chromosomes, it was theorized that an extra Y might be a cause for propensity to aggression. This theory provided an easy causal chain from chromosome (Y) to gonads (testes) to gender (maleness). Despite later studies demonstrating that XYY males had no greater propensity for aggression and that their offences were actually less aggressive and violent than those of XY males, the theory persisted for another decade and a half. After Chapter 6, which discusses a parallel process associating the X chromosome with femaleness, partly through theories that focused on the connection between the X chromosome to female autoimmunity, Chapters 7 and 8 take us to a new period in genetic research in which feminist criticism of science has taken root and began exposing gender biases in biological and medical research.

When the SRY gene was discovered on the Y chromosome in 1990, it was given the role of the “master gene,” which allegedly switched on and off masculine sex development. This theory did not last and, today, the SRY gene is known to be one among other possible genes that direct the genetic development of testes and ovaries. This realization is, at least partly, attributed to feminist critiques of science that applied a gender-conscious perspective to the model’s assumptions and revealed theoretical and empirical failings. Biologist Jennifer Graves, a leading scientist in the field of sex chromosomes, was among the first to expose the gap between existing evidence and envisioned expectations regarding the “switch” model for the SRY gene. In a 2000 paper, she located her criticism of the “switch” model within a feminist discourse about science and argued that masculine ideas about the dominance of the Y chromosome and “macho” conceptions of the SRY gene misled researchers to ignore contradictory evidence and sustain the weak theory (137). As Richardson further demonstrates, by the time Graves identified her criticism as “feminist,” gender criticism and critical perspectives in science had become a normalized practice that contributed to a constructive thinking on how gender ideologies infiltrate and shape scientific knowledge about biological sex differences.

In Chapter 8, we learn about Graves’s later feminist criticism of a different genetic theory addressing the deterioration of the Y chromosome. The revelation that special genes located on the Y chromosome have been slowly vanishing for the last 300 million years became conceptually interlinked with social anxieties about the disappearance of maleness. Were men doomed, or would the Y chromosome’s resourcefulness save them? Two leading scientists in the field took up this controversy. Based on the rate of gene deterioration, Jennifer Graves and another scientist, Ross Aitken, predicted the Y chromosome would become extinct in approximately ten million years. David Page a medically trained geneticist, took offence at the degeneration theory and thought the Y chromosome was a victim of negative male stereotypes promoted by feminists (158). He later suggested a counter theory—that the Y chromosome would acquire male fertility genes that would overcome the projected deterioration (162). Although public judgment of their explanations for the phenomenon was asymmetrical, as Graves alone was accused of being “gender biased,” Richardson suggests that recognizing the role that gender plays in these models is a blessing. The creation of highly developed scientific models and hypotheses that are conscious to their interaction with contemporary gender politics by Page and Graves cannot be explained as mere “gender bias”, but rather should be called “gender valence.” Unlike biases that operate invisibly and unreflectively, “gender valence” brings gender to the forefront and exposes it to critical observation—to be, we hope, applied symmetrically.

The last two chapters discuss the prospects of gender/sex genetic research in the genomic and post-genomic age. In Chapter 9, Richardson examines the claim news reports had made, interpreting the work of scientists L. Carrel and H. F. Willard, whereby males and females differ genetically by 2%—greater than the difference between chimpanzees and humans, stating that females and males are “different species.” Richardson seeks to debunk each part of this claim, on both empirical and conceptual grounds and offers an alternative, more perceptive way of explaining genetic sex differences: “sex as a dynamic dyadic kind” (197). Richardson suggests that we regard this case study as an example of how a powerful new language about the genome can be used to revive old frameworks of conveying differences between groups of humans that disturbingly echo a comparison to apes.

Chapter 10, which concludes the book, uses the lessons learned from research on the X and Y chromosomes to forge concrete analytical tools that could be applied in the field of genetic research on sex-based biology and medicine, which currently enjoys enormous political and institutional support by the US women’s health movement. Within the justified efforts to advance a better understanding of women’s particular health issues and to remedy systematic failures of scientific methodology that led to historic ignorance regarding women’s disparities, Richardson reminds us that research on sex differences within the sex-based biology movement can be a double-edged sword and that we should therefore elaborate to construct a gender-critical perspective about this new, robust strand of research as it moves forward.

One of the most central concepts the book expounds on within its chapters is “sex itself,” construed by Richardson as an object of scientific quest into the body. The fascination with finding the essence of sex within the inner, unknown layers of the body in the 20th century seemed both feasible and promising at the time. Ironically, the separation between sex and gender promoted by feminist advocates further cemented the notion that a biological element tattooed on the body’s infrastructure can represent the true essence of sex. Unlike sex, gender was located in the cultural and social worlds and understood to be flexible and not necessarily dichotomous. However, biotechnological advancements transformed some biological elements such as hormones, genitals, and tissues to also become flexible and easy to alter through medication or plastic surgery. These developments placed even greater weight on the order and clarity provided by genetic sex theory, as opposed to the “soft” easy-to-change biological sex elements, that sex chromosomes served as a stable, unchangeable, and irreducible biological truth. “While hormones and culture help to shape gender, genetics alone, it is thought, can reveal, “sex itself” (9).

Richardson is correct to recognize that the search after “sex itself” is, in many ways, a search for stability in times of changing bodies and social norms. The “natural body,” often conflated with the “biological body,” is often imagined as a site of consistency and order that yields a set of normative and practical implications. As legal scholar Liz Emens demonstrates, if a subject is treated as “natural,” a set of implications is likely to apply to that subject: first, that the subject is immutable as a descriptive matter (or at least, difficult to change), and second, that the subject should not be required to change as a normative matter. As Emens shows, these assumptions have some force in different legal doctrines pertaining to discrimination and accommodation and, therefore, different identity groups, including people with disabilities, sexual and racial minorities, women or the elderly, use this set of assumptions as a matter of legal strategy. This, for example, helps explain why some groups such as sexual minorities or trans people often promote a “natural” characterization of their differences through various biomedical theories and studies. The popular logic of ‘nature’ somewhat endorsed in the law suggests that if a condition is immutable it enjoys an inherent normative value and should not be forced or expected to change. Opponents to reforms led by such groups often argue that these differences are fictional, having no bearing on the body itself, and ought to be ignored or even eliminated.

In this context, Richardson’s identification of the sex chromosomes as a crucial site in which both natural and social orders are negotiated and justified is revealing. One of the most vivid examples for this concept can be found in recent public debate about the use of bathrooms by transgender students in educational institutions. Conservative voices usually bring the X and Y chromosomes to make the point that sex is fixed and immutable: “There are only two things that make me a man, and they are my X chromosome and my Y chromosome . . . . People have the right to feel that they should not be the gender that God gave them . . . . However, the fact that some people do not live in reality or that some wish reality were not true, does not entitle them to a special bathroom in a public university.” (Gershenson 2010) In this cultural and legal context, the sex chromosomes viewed as the locus of “sex itself” are not only biological carriers of genes and DNA but also normative carriers of social values and arrangements.

One of the most intriguing questions that arises is this: what does the future hold for the sex chromosomes in the age of gene editing? It seems that with biotechnological developments, even sex chromosomes—the hard core of “sex itself”—are becoming emendable. Studies from recent years examined the possibilities of ‘sex reversal’ on mice through modifying genes related to gonad determination. In 2009, a research group found that ablation of the FOXL2 gene in mice ovaries can reprogram their development into testosterone-producing testes (Uhlenhaut et al 2009). A 2011 study found a parallel process in testes, which were reprogrammed to produce estrogen after the DMRT1 gene was deleted (Matson et al). Just recently, a lab succeeded at using CRISPR technology to masculinize female cattle by adding the SRY gene to their X chromosomes (Rosenblum 2018). Not surprisingly, these developments are publicized in highly gendered “clickbait” language including: “From Minnie to Mickey (and all they did was turn off a gene),” (Connor 2009) and “Researchers Discover Sex-Change Gene.” (Anderson-Minshall 2011) Moreover, these articles speculate about the future implications for sex change in humans, to be used by the transgender community, or for DSD conditions (Disorders of Sex Development) (Geen 2009).The emerging capacity to edit, change, or add genes to living mammals seems to relocate “sex chromosomes” from the hard-core to the soft-changing elements of sex. Accordingly, we can expect that future biotechnological advancements and research will continue to hollow out “sex itself” from other purportedly stable and immutable biological elements.

If so, what then is the future of “sex itself” in the age of mutability? Would the increasing malleability of bodies boost scientific motivation to search for the essence of “sex itself” in other unexplored inner locations of the body or, alternatively, if biological sex in no longer understood to be a constant and stable element, would that somehow make the sex/gender distinction useless or the normative attachments to “nature” collapse altogether? Looking ahead to the growing sex-based medicine movement, it appears that scientific research on sex differences is prospected to grow. Nevertheless, it might be that research in the context of sex-based medicine will revert to the old contingent, spectrum-like concept of sex, or alternatively progress toward a model of individual differences or to an alternative related grouping basis, like the brain mosaic approach (Joel). Possibly, this grand research project would orient its hypotheses, working models, and studies to fulfill the purpose of improving health, rather than of finding the holy grail of sex differences.

Richardson’s book is highly recommended to anyone interested in a skilled and illustrative gender analysis of a scientific field and theory. Other than its monumental contribution to classic works on the intersection of science and gender, many of the book’s qualities make it especially educational for graduate and undergraduate students. Its language is clear and guides the reader through argument’s various stages. The book does an excellent job of translating complex genetic and chromosomal theories for the nonexpert reader, without over-simplifying them, along with preserving a richness of theory, evidence, and context. The book does a great service to the field of feminist analysis of science by illustrating how sensible skepticism to empiricism from a gender-conscious point of view can generate a constructive contribution to a field of knowledge.

Maayan Sudai

Harvard Law School

Cambridge, MA, USA

 

References:

Anderson-Minshall, Diane. 2011 “Researchers Discover Sex-Change Gene.” The Advocate, 21 July 2011.

Rosenblum, Andrew, “Meet the Woman Using CRISPR to Breed All-Male ‘Terminator Cattle,’” MIT Technology Review, accessed April 12, 2018, https://www.technologyreview.com/s/609699/meet-the-woman-using-crispr-to-breed-all-male-terminator-cattle/.

Clinton K. Matson et al., “DMRT1 Prevents Female Reprogramming in the Postnatal Mammalian Testis,” Nature 477, no. 7363 (September 2011): 238, https://doi.org/10.1038/nature10411

Connor, Steven. “From Minnie to Mickey (and All They Did Was Turn off a Gene).” The Independent, 11 Dec. 2009.

Daphna Joel et al., “Sex beyond the Genitalia: The Human Brain Mosaic,” Proceedings of the National Academy of Sciences 112, no. 50 (December 15, 2015): 15468–73, https://doi.org/10.1073/pnas.1509654112.

Geen, Jessica. “Gene Discovery Could Make Gender Reassignment Easier.” PinkNews, 11 Dec. 2009, www.pinknews.co.uk/2009/12/11/gene-discovery-could-make-gender-reassignment-easier/.

N. Henriette Uhlenhaut et al., “Somatic Sex Reprogramming of Adult Ovaries to Testes by FOXL2 Ablation,” Cell 139, no. 6 (December 11, 2009): 1130–42, https://doi.org/10.1016/j.cell.2009.11.021.

Olga Gershenson, The Restroom Revolution: Unisex Toilets and Campus Politics, in Toilet: Public Restrooms and the Politics of Sharing 200 (Harvey, Molotch, Laura & Noren eds., 2010).