Cognitive dysfunction after critical illness: measurement, rehabilitation, and disclosure

A growing consensus seems to be emerging that neurocognitive outcomes are poor for patients who have been critically ill with acute respiratory distress syndrome and multiple organ failure. However, intensive care unit delirium, post-traumatic stress disorder, and other outcomes must be considered as potentially confounding factors. Once the uncertainty around the causes of postmorbid cognitive functioning is acknowledged, there are practical implications for appropriate rehabilitative interventions and there are ethical implications for the kinds of appropriate disclosure to patients

Ramsey, Pragmatism, and the Vienna Circle

Frank Ramsey (1903-1930) is usually taken to be sympathetic to the Vienna Circle’s project. I will argue that this is not right. Ramsey was a pragmatist, and he put pragmatist objections to Wittgenstein’s Tractatus, objections which also had the Vienna Circle as their target. Ramsey thought the Circle’s position (like Wittgenstein’s) was mistaken in that, instead of starting with human inquiry, it tried to construct the world out of elementary particulars and logic, and resulted in an unacceptable solipsism. This paper traces the trajectory of Ramsey’s pragmatist thought, and its relationship to the early Wittgenstein and the Vienna Circle

Reply to Margolis, Madelrieux and Levine

Allow me to begin by thanking these three commentators for the time and energy they have put into thinking about the issues I raise in The American Pragmatists. There are some important common themes in their reading of the book and I am grateful for the opportunity to address them, and to clarify and expand on what I wrote. One thing that common to all three readers is that they see me as offering, in Stéphane Madelrieux’s words, a history of pragmatism that is both descriptive and normative..

Language and Experience for Pragmatism

It is sometimes said that contemporary pragmatists place too much emphasis on language and not enough on experience. This objection might hold for the pragmatism of Richard Rorty and his students, but it does not hold for the pragmatism of C. S. Peirce, William James, and John Dewey. I shall argue that we should return to the classical pragmatists and their truth-and-experience position. Indeed, an important insight at the very heart of pragmatism is that language and experience cannot be pulled apart

Nietzsche’s Pragmatic Genealogy of Justice

This paper analyses the connection between Nietzsche’s early employment of the genealogical method and contemporary neo-pragmatism. The paper has two goals. On the one hand, by viewing Nietzsche’s writings in the light of neo-pragmatist ideas and reconstructing his approach to justice as a pragmatic genealogy, it seeks to bring out an under-appreciated aspect of his genealogical method which illustrates how genealogy can be used to vindicate rather than to subvert and accounts for Nietzsche’s lack of historical references. On the other hand, by highlighting what Nietzsche has to offer neo-pragmatism, it seeks to contribute to neo-pragmatism’s conception of genealogy. The paper argues that Nietzsche and the neo-pragmatists share a naturalistic concern and a pragmatist strategy in responding to it. The paper then shows that Nietzsche avoids a reductive form of functionalism by introducing a temporal axis, but that this axis should be understood as a developmental model rather than as historical time. This explains Nietzsche’s failure to engage with history. The paper concludes that pragmatic genealogy can claim a genuinely Nietzschean pedigree

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

The Subterranean Influence of Pragmatism on the Vienna Circle: Peirce, Ramsey, Wittgenstein

An underappreciated fact in the history of analytic philosophy is that American pragmatism had an early and strong influence on the Vienna Circle. The path of that influence goes from Charles Peirce to Frank Ramsey to Ludwig Wittgenstein to Moritz Schlick. That path is traced in this paper, and along the way some standard understandings of Ramsey and Wittgenstein, especially, are radically altered