How Digital Therapeutics Are Urging the Need for a Paradigm Shift: From Evidence-Based Health Care to Evidence-Based Well-being.

A scientific paradigm consists of a set of shared rules, beliefs, values, methods, and instruments for addressing scientific problems. Currently, health care embraces the paradigm of evidence-based health care (EBH). This paradigm prompts health care institutions to base decisions on the best available evidence, which is commonly generated in large-scale randomized controlled trials. We illustrate the application of EBH via the evaluation of drugs. We show how EBH is challenged when it is applied to the evaluation of digital therapeutics, which refers to technology and data to prevent, manage, or treat a medical disorder or disease. We conclude that amid the growing application of digital therapeutics, the paradigm of EBH is challenged in four domains: population, intervention, comparison, outcome. In the second part of this viewpoint, we argue for a paradigm shift in health care so we can optimally evaluate and implement digital therapeutics, and we sketch out the contours of this novel paradigm. We address the need for considering design in health care and evaluation processes, studying user values so that health care can move from a focus on health to well-being, focusing on individual experiences rather than the average, addressing the need for evaluation in authentic use contexts, and stressing the need for continuous evaluation of the dynamic relations between users, context, and digital therapeutics. We conclude that the transition from EBH toward evidence-based well-being would improve the successful implementation of digital technologies in health care.

Living in the Flesh: Technologically Mediated Chiasmic Relationships (in Times of a Pandemic).

During the Corona pandemic, it became clear that people are vulnerable to potentially harmful nonhuman agents, as well as that our own biological existence potentially poses a threat to others, and vice versa. This suggests a certain reciprocity in our relations with both humans and nonhumans. In his The Visible and the Invisible, Merleau-Ponty introduces the notion of the flesh to capture this reciprocity. Building on this idea, he proposes to understand our relationships with other humans, as well as those with nonhuman beings as having a chiasmic structure: to sense, or perceive another entity in a particular way simultaneously implies to be sensed or perceived in a particular way by this other entity. In this paper, we show how a postphenomenological perspective expands on Merleau-Ponty: first, it more radically interprets Merleau-Ponty's notion of flesh by not only considering it to be a medium that is the condition of possibility for vision but as pointing to the constitution of an intercorporeal field in which entities-both human and nonhuman-mutually sense one another. Second, it augments Merleau-Ponty's thought by drawing attention to how technologies mediate chiasmic relations. This is clarified through the example of the facemask, which (1) reveals the chiasmic structure of our relation with nonhuman entities, and (2) shows that technologies co-constitute interpersonal relationships by making humans present to one another in a particular way. We suggest that these aspects are not unique to the facemask, but point to a general technologically mediated chiasmic structure of human-world relations.

Evaluating value mediation in patients with chronic low-back pain using virtual reality: contributions for empirical research in Value Sensitive Design.

Value Sensitive Design (VSD) is the most well-known method to consider values in design. It consists of three iterative phases of investigation: conceptual, empirical, and technical. Although the approach is promising, the role of empirical research remains unclear. We address two opportunities for extending the role of empirical research in VSD. First, we argue that empirical research enables us to identify values in context. Second, we explain that empirical research enables us to anticipate how technology mediates the values of users. We make our point by means of an empirical study in a real-life controlled experimental context into the value mediation of virtual reality (VR) in patients with chronic low-back pain. Using value-oriented semi-structured interviews with twenty patients, we first analyze what values these patients consider important, and how the values are experienced. The second set of interviews held after all patients used VR four weeks at home, aims to provide insight into value changes as mediated by VR. We end the article by a comparison of our empirical results with previous, often speculative, literature into values in VR. We show that empirical research benefits the VSD process by providing in-depth insight into the effects of context and technology on values and the ability to translate these insights into recommendations for more responsible design and implementation of the technology. Supplementary information: The online version contains supplementary material available at 10.1007/s12553-022-00671-w.

Understanding science-in-the-making by letting scientific instruments speak: From semiotics to postphenomenology.

Latour encourages us to use science-in-the-making as an entry point to understanding science, because it allows us to see how scientific knowledge is constituted and through which processes the 'absolute certainties' of ready-made science appear. He approaches science-in-the-making from the perspective of semiotics because it enables him (1) to attribute equal importance to humans and nonhumans, and (2) to let the actors in scientific practices speak for themselves. We argue that Latour's semiotic approach to science-in-the-making and his understanding of scientific instruments as inscription devices do not fulfill these desiderata. This, in turn, prevents him from understanding the crucial role that scientific instruments play in science-in-the-making. As an alternative to Latour's semiotic approach, we present a postphenomenological approach to studying science-in-the-making. Using the notion of technological mediation, we argue that scientific instruments actively mediate how reality becomes present to - and is treated by - scientists. Focusing on how intentional relations between scientists and the world are mediated by scientific instruments makes it possible to turn them into genuine actors that speak for themselves, thereby recognizing their constitutive role in the development of the interpretational frameworks of scientists. We then show how a postphenomenological approach can be understood as an ethnomethodology of human-technology relations that meets both of Latour's requirements when studying science-in-the-making.

The Struggle for Technology: Towards a Realistic Political Theory of Technology.

Pieter Lemmens' neo-Marxist approach to technology urges us to rethink how to do political philosophy of technology. First, Lemmens' high level of abstraction raises the question of how empirically informed a political theory of technology needs to be. Second, his dialectical focus on a "struggle" between humans and technologies reveals the limits of neo-Marxism. Political philosophy of technology needs to return "to the things themselves". The political significance of technologies cannot be reduced to its origins in systems of production or social organization, but requires study at the micro-level, where technologies help to shape engagement, interaction, power, and social awareness.

Ambient Intelligence and Persuasive Technology: The Blurring Boundaries Between Human and Technology.

The currently developing fields of Ambient Intelligence and Persuasive Technology bring about a convergence of information technology and cognitive science. Smart environments that are able to respond intelligently to what we do and that even aim to influence our behaviour challenge the basic frameworks we commonly use for understanding the relations and role divisions between human beings and technological artifacts. After discussing the promises and threats of these technologies, this article develops alternative conceptions of agency, freedom, and responsibility that make it possible to better understand and assess the social roles of Ambient Intelligence and Persuasive Technology. The central claim of the article is that these new technologies urge us to blur the boundaries between humans and technologies also at the level of our conceptual and moral frameworks.