North America’s overdose crisis is an urgent public health issue that hasresulted in thousands of deaths. As the crisis began to take holdacross Canada in 2016, bereaved parents, mainly mothers, emerged asvocal advocates for drug policy reform and harm reduction, using theirstories to challenge the stigma of drug-related death. In 2017, welaunched a qualitative research partnership with leading familyorganizations in Canada, conducting interviews with 43 mothers whosechildren had died from substance use, to understand their experiencesof drug policy advocacy. Our findings showed that participants’motivations for engaging in advocacy were rooted in their experiencesof grief, and that advocacy led to feelings of empowerment andconnection to others. Our research suggests that advocacy can becathartic and associated with healing from grief, but that “goingpublic” in sharing a family story of substance use death can also havea considerable personal cost. The overdose crisis has been described as one of the most urgent andchallenging public health issues of our time .In CanaAn emerging perspective that has been increasingly visible since 2016 in NorthAmerican drug policy discourse, but which has not been studied empirically,has been that of bereaved parents who have lost a child to substance use.Three volunteer advocacy organizations representing families who have beenimpacted by substance use in Canada are Moms Stop the Harm , Moms United and Mandated to Saving the Lives of Drug Users , and The Voice of the Family .MSTH and mumsDU use various methods to advocate for drug policy reform,including public speaking, organizing public protests, media engagement,meetings with policymakers and politicians, and working collaboratively withresearchers to advance evidence-based drug policy reform. Both grassrootsvolunteer organizations were initially created to advocate for familymembers who have lost a loved one to substance use, but have since expandedto provide peer support for individuals whose loved ones have died or arecurrently experiencing substance-related problems. The political advocacy ofboth groups is unique due to its outspoken support for harm reductionphilosophy and interventions, an approach that seeks to minimize the harmsassociated with substance use while supporting individuals who may not wantto abstain from drug use .While bereaved parents have emerged as significant actors in Canadian drugpolicy reform, a key element missing from discussions to date has been whatmotivates parents to undertake volunteer advocacy work and the personal tollit has for them. Studies of parents whose children live with disabilitiessuggest that motivational factors for parental advocacy may involve a senseof personal obligation , altruisWhen thinking of parent advocacy about substance use, Mothers Against DrunkDriving MADD;  is a likThe grief literature has provided few studies that report on the emotionalimpact to parents of being engaged in advocacy activities following thedeath of a child from substance-related causes. Family members haveindicated that advocacy contributes to personal growth , meaning-making , and an Research question 1 (RQ1): What are the motivationsbehind and the personal impacts experienced by bereaved motherswho advocate for drug policy reform?This article draws on data from a larger qualitative project, the purpose ofwhich was to systematically collect, analyze, and share the stories ofCanadian mothers who have experienced the death of a child to substanceuse–related causes and who have subsequently engaged in advocacy onsubstance use issues. For the purposes of this project, advocacy was definedbroadly to include a wide range of formal and informal activities to changeattitudes or promote policy change. We defined substance-related death as adeath related to a person’s use of substances . Participants were required to be 18 years ofage, live in Canada, and have first experienced a child’s death a minimum of6 months before the interview.n = 17), Alberta (n = 12),Saskatchewan/Manitoba (n = 4), and Ontario and the Maritimeprovinces (n = 10).1 Narrative interviewing techniques were used to support closeexamination of both the structure and content of mothers’ stories related toadvocacy , background questionnaire, andparticipant recruitment through distribution of an information letterthrough their social media and email networks. Upon receiving a letter ofinvitation and reaching out to the study principal investigator (PI)(R.H.-S.), participants were contacted by the PI or one of two regionalresearch assistants to arrange for an individual meeting in person or bytelephone. All interviews were audio-recorded, transcribed verbatim, andlasted between 26 and 135 min. Field notes were generated by the study teamfollowing each interview to record context and key insights. The majority ofinterviews (84%) took place in person, with the remainder being conductedover the phone. Participants provided their informed, written consent priorto the start of the interview and received a Can$50 gift card to recognizetheir time and contributions once the interview was complete.Our project protocol received approval from the research ethics boards at theUniversity of Calgary, University of Alberta, and the University of BritishColumbia. Between June and November 2017, we conducted a total of 43in-depth, semi-structured interviews with women from British Columbia code for the purposes of this article. As per And I think maybe, too, in the beginning, there was a littlebit of, “If I do good things, maybe she’ll come back.” Youknow? Like that sort of irrational grief sort of stuffthat comes into it. . . .Bereaved mothers’ motivations for engaging in advocacy were closely tiedto the emotions that arose from their experiences related to grief.While stories included tremendous disappointment and despair, manyparticipants spoke of their passion for advocacy being born out of thepain of losing a child. As one participant expressed,Like, so many people said, “Oh, you’re so courageous.” And Ithought, “That’s not courage. I was pissed.” I was angry.I’m angry. And I think anger is not a bad thing. It’swhere we get change.In addition to grief, nearly half of participants also spoke of atremendous sense of anger that motivated their advocacy—anger thattheir child died prematurely, anger at how the health care system orjustice system had failed their child, and anger at the stigma thatexists toward people who use drugs and their families. Some expressedanger toward themselves because they were not able to “save theirchild,” which could lead to a lack of self-confidence in theiradvocacy activities. These feelings of anger would often promptmothers to write a letter to a politician, reach out to other keystakeholders, or speak to the media. One participant recounted heranger upon hearing that there had been multiple deaths in a FirstNations community over a 2-week period and that “nobody was tellingtheir story,” while another participant expressed,And that’s part of why I tell the story I think, deep, deepdown, is I want to erase that shame for myself by tellingmy story and that shame for other people by telling mystory. “Well, if she [another bereaved mother/advocate]can say it, maybe I can say it . . . .”Other participants reflected on being motivated to engage in advocacyafter spending time with others with shared experience or throughsupport from family or community members. One such example came from aparticipant, who commented that “. . . it was really my daughter whopushed us into this.” Motivation from the community also came fromseeing positive changes or outcomes resulting from one’s advocacyactivities. One participant, for example, recounted that members ofher advocacy organization were encouraged after having gained accessto meetings with high-level officials, including the Canadian PrimeMinister, the Federal Minister of Health, and the Canadian Ambassadorto the United Nations. For others, the motivation to advocatefulfilled a personal need or responsibility to oneself or helped themcope with grief. A participant commented that following her son’sdeath, she had expressed to herself, “. . . at first, it was sort oflike, okay, [Son]’s gone. Now what? Now I need to do something. Right?And it was my way of avoiding. I think it was a total avoidance atfirst.” In addition, a few mothers spoke of being motivated by workingto erase the shame and stigma:. . . I think I have a responsibility to try and changethings so that this will not happen again to someone else.Because it’s not right, it’s very, very wrong, and I don’twant to be an accomplice to a tragedy.Participants regularly reflected on being motivated by a sense of hope.Although some spoke in more general terms of hoping for change ormaking the world a better place, others spoke more specifically oftheir hope for health care system reform or that the silence andstigma around substance use disorder would eventually be broken. Manyalso expressed that they were motivated by hope for fewer deaths orthat other parents would not have to experience the same loss thatthey had gone through. Such was the case with one woman, who stated,Quite a few of the women expressed this sense of social justice orresponsibility to others as a motivating factor, many of whom spoke ofwanting to help people and “do the right thing.” In one such example,a participant reached out to the media when her daughter was activelyusing drugs (before her subsequent death) after hearing about thetoxic drug supply on the streets. A sense of concern andresponsibility drove her to alert the public through the media toprevent future deaths. A different participant also alluded to thissense of responsibility when she stated, “. . . I’d rather not bedoing this. I’d rather be doing anything else. But your sense of dutyand your responsibility to serve others and yourself in some manner,kind of trumps that reluctance.” Another participant took thissentiment one step further in saying, “How would I ever look atanother mom down the road who just lost their child through somethinglike this if I didn’t do something?”And I always say I’m not doing it for [Daughter]. I’m doingit for somebody else’s child. That’s actually a lie. It’sa blatant lie. I am doing it for [Daughter]. I’m doing itbecause she was desperate. And as a mother, you never wantto see your child desperate for anything. So I couldn’tgive her the drugs in those situations. But I can give herresolve.Finally, one of the most significant motivators for advocating was takingthe opportunity to honor one’s child. Many spoke of how advocacy gavethem a “reason” for talking about their son or daughter, which cansometimes come to a premature end with friends or family members afterthe initial period of grieving. Being given the opportunity to saytheir child’s name through advocacy meant that their child was notremembered for how they died, but rather for how they lived. While oneparticipant who lost two children to substance use shared, “. . .everything I do, I do because of them,” a different participant spokeof how her motivation to advocate came partly from wanting to preserveher child’s memory, stating, “I’m so afraid of not remembering eventsor not remembering [Son], or forgetting what he looked like. . .” Onthe contrary, one woman spoke of a conversation she had with herdaughter about the severity of her cravings for the substances thatlater contributed to her death. She reflected on this when speaking ofwhat motivates her to advocate:The personal impacts of advocacy were both constructive and helpful, butalso, at times, harmful or damaging. Specifically, for participants inour study, the personal impacts of their advocacy centered on threeexperiences: Enhanced Sense of Empowerment, Solace in Connecting withOthers, and the Juxtaposition of Advocacy . . . if you want to talk about radicalization in apositive way, being part of our group radicalizes alot of people. People come in thinking that everydealer should be arrested, and then they feel themost important thing is that we decriminalize. . ..Advocacy brought with it an enhanced feeling of empowerment fornearly every participant. Over half of the women discussed asense of personal learning or growth that accompanied theiradvocacy activities. For example, participants learned aboutsubstance use and mental health (and resources for both),treatment, stigma, harm reduction, grief, and advocacy itself.In some instances, personal opinions began to change aboutcertain concepts or practices with advocacy activities. Oneparticipant stated, “before my son’s death. . . I thought, likeso many others, it was a choice, and I was so wrong,” whereas adifferent participant expressed,In addition to changing attitudes about particular issues, manyparticipants started to learn more about themselves over time.One woman exemplified this when she stated, “. . . I’m learninga lot about myself, what I’m capable of and where I’m strong andwhere I need to change and what I need to improve. So it’smeaningful in that way.”Many participants expressed that advocacy brought with it enhancedfeelings of strength, resilience, or confidence. This wassignificant as it was not unusual for mothers to feel a sense ofpowerlessness when their child was alive and active in theiraddiction. One participant stated that advocacy had allowed herto take an opportunity that “. . . has brought me to my mostpowerful self, to my most true self.” Similarly, another womanexpressed that advocacy contributed to making her both brave andstrong while reflecting on a conversation she had with awell-known politician and member of the cabinet who told her, “.. . don’t ever stop telling your story because telling yourstory will create change.” Feelings of resilience oftentranslated to a sense of pride and respect for oneself as it didfor a participant who stated, “. . . this almost feels like I’vefound my young, radical side again, and I like that side of me.”However, two of the participants spoke of feelings of guilt thataccompanied appreciating the positive attention that came withadvocacy activities, with one saying that her therapist helpedher resolve such emotions.Advocacy provided participants with a sense of meaning or purposeand a feeling that one is making a difference. One womanexpressed that it was because of this sense of purpose “. . .that I feel more alive than I did before when I was justfunctioning,” whereas another stated, “. . . this is my definingmoment. I don’t want it to be anyone in my family’s definingmoment, but it is mine.” Finally, participants became empoweredthrough the comfort or sense of freedom that came with beingopen and honest about their child’s substance use, which was notalways possible to do when their child was alive. Participantsalso felt empowered through a sense of hope generated throughtheir advocacy activities—hope that their efforts will bringabout changes that will ultimately improve others’ lives andhope that advocacy will help with their own grief process andpersonal journey. One participant exemplified such hope when shespoke about realizing that her son was no longer physicallypresent with her. “So that little piece of hope, that’s gone. .. you have to hang on to some hope for something else. So Ithink that’s part of what advocacy is . . . without that youcan’t keep going.”. . . I didn’t know for sure if going down that pathwith those women was going to resonate with meultimately. But every step forward with those womenproved to me that they absolutely knew what theywere talking about. . .Nearly all the participants expressed that advocacy brought with ita tremendous opportunity to connect with others, either withother bereaved mothers or with members of the community. Asindicated above, many of the participants spoke of the strongrelationships they had developed within their respectiveadvocacy organizations due to a shared sense of loss. One womanstated that, at the beginning,Another participant, like many of the participants we interviewed,spoke highly of the advocacy leaders, stating, “. . . they havebasically kept me going.” Others connected with bereaved motherswho were not necessarily involved in advocacy activities but whothey had met through community events or bereavement work.However, fostering a sense of connection could pose a challengefor those who lived more rurally, although online platformshelped with this.Participants also expressed that advocacy brought with it aconnection between themselves and other members of thecommunity, including friends, family, strangers, their child’speers, and health care providers. One woman spoke of sittingwith people who used drugs in her community to ensure theirsafety and being called to administer naloxone to someone whowas overdosing and reluctant to call the police. Anotherparticipant, on the contrary, recounted the time that a harmreduction manager tried explaining to her the vital contributionshe was making to the substance use policy context by stating,“You know, I can speak, and people hear. . . You speak, andpeople feel.” But such connections at times extended furtherafield to include police, news reporters, researchers, andelected officials. One woman spoke of a provincial Minister ofHealth being brought to tears during a meeting with bereavedmothers while another witnessed a high-ranking governmentofficial tearing up during an in-person meeting she attended.Seeing others express emotion through tears brought with it asense of comfort to bereaved mothers and a hope that theiradvocacy was impacting others in a meaningful way.And I think that advocacy work maintains yourcommitment to that relationship, and I think it’simportant . . . You’re publicly saying, “I’ve lostmy physical child, but I have not lost my commitmentto my child.” And I think that’s important formothers to say.Finally, nearly half of the participants spoke of advocacy,enhancing a feeling of closeness with their child who had passedaway. Several mothers indicated that their children would havebeen proud of the work that they were doing, or that they hadfelt their child’s presence during their advocacy activities.One woman confided, “And honestly, crazy as it sounds, I feelhim pushing me,” while another expressed, “. . . that the energythat was [Son] is now my energy. . .” A different participantagreed that her advocacy helped to maintain a connection withher child and that this was a primary driver of her work:While this sense of connection with their child was prominent forsome, others were unsure or did not feel that same relationshipbetween advocacy and the closeness they felt with their child.Some indicated that their children were very private and may nothave been happy with their mother’s decision to advocate andshare their story, whereas others felt that they connected withtheir child in other ways outside advocacy. One participantexpressed that she has always felt deeply connected to her childbut that her advocacy helped keep him connected with otherpeople in her community and extended family members.Sometimes I wonder how long I can do that [advocacy]. .. you sort of open up wounds a lot of the time withmedia work, with sharing stories, and with speakingto newly bereaved parents. That probably opens upthe most wounds. They tell their story . . . and itbrings back sort of this “waking up in the middle ofthe night in a panic” [feeling]. . .Participants expressed that advocacy brought with it both pain andhealing, which ultimately created a profound juxtaposition forsome. While several participants were motivated to engage inadvocacy to find healing, the perceived impact on theirwell-being was mixed. On one hand, advocacy work was emotionallydifficult or draining for nearly all participants. As such, ithad the potential to impact well-being and exacerbate feelingsof grief and loss negatively. Mutual support (in person oronline) was an essential component of many mothers’ advocacyactivities; however, it also had the potential to leaveparticipants feeling extremely upset and emotionally drainedafterward. One participant stated that advocacy kept her in a “.. . perpetual place of grief. If it’s not for your ownsituation, it’s for someone else’s.” Others spoke of advocacycontributing to strained relationships with family members,having to endure hurtful and stigmatizing comments from thepublic at times, and a “wave of grief” that can follow mediaengagement or large advocacy events:. . . we all have opinions on how things should bedone. . . there’s those that want to kill withniceness and get it done that way. There’s thosethat want to just yell and scream and hold theirsigns, and there’s those that believe in things thatothers don’t believe in . . . and sometimes thatmakes it quite difficult.Many participants spoke of the need to occasionally “step back”from advocacy activities to protect oneself emotionally tocounteract these and other advocacy stresses. Tensions couldalso arise with other advocates, contributing to stress andstrained relationships within the advocacy organization:I think that it’s kind of flip sides of the coin. . .on one hand, the advocacy can be cathartic andhealing. . . and then I think on the other side. . .it’s the right thing to do, but it just hurts.However, a contrast arose as the pain of advocacy intersected withits potential to contribute to healing. One participant stated,A different participant, alternatively, likened the experience to“. . . always pulling a Band-Aid off. But I would think after aperiod of time that your skin gets toughened up to that a littlebit.” Another participant added to these sentiments, stating,“And sometimes, some of the questions I’m asked really exposethe pain but in a good way. . . It hurts but it feels good.”Thus, although there is an emotional cost to advocacy work, nearlyall the participants spoke of advocacy as helping to heal, oftenacknowledging that grief would always be present. The mutualsupport that occurs between members of an advocacy group wasdescribed as one of its most important benefits. Participantsreflected on how such groups allow people to think about,discuss, and process their child’s substance use and subsequentdeath with others who have undergone a similar experience.Although some of the members may have only interacted online with others, the support theyreceived from fellow advocates was deemed significant. While oneparticipant spoke of “regaining strength by being with others,”another stated, “. . . I’ve told these women things that Ihaven’t even said to my husband . . . because they get it.” In asimilar vein, advocacy brought healing in the form of helpingothers, including friends, family members, their child’sfriends, or members of the community. To be able to do thiswhile channeling something negative into something positive,speaking their child’s name and keeping their memory alivebrought comfort to many, including one woman who stated, “. . .I think we all advocate because we want to honour our children.But at the same time, we also want to be able to help somebodyelse.”. . . by a process that brought meaning to the death in a way thathonored . . . [their child] . . . and through the discovery of apurpose that ensured a continued and heartfelt relationship with. . . [their child]. . . , p.112The findings of this study highlight that mothers’ motivations for advocacywere multifaceted and strongly rooted in their experience of grief. Themotivation for this advocacy work often came from a deeply personal placewhere, in many cases, participants experienced anger, intense grief, andimmense disappointment in how their child was treated within a system thatwas expected to care for them and keep them alive. As such, the participantswe spoke to worked tirelessly in their messaging to address the structuraland social determinants of substance use and the important role of the statein supporting the lives of all people who use drugs through anti-stigmaefforts, enhancing harm-reduction efforts and the creation of new laws andpolicies that support decriminalization and the legal regulation ofsubstances. Bereavement associated with the experience of a family member’sdeath due to substance use is unique and associated with feelings of anger,relief, guilt, shame, and stigma . It comeOur research aligns with the notion of relational empowerment put forth bythose who have described it as a process of acquiring power that is bothcollective and transformative, “. . . intended to alter structuralconditions and dynamics in social, political and community contexts” . WoodallIn undertaking this study, our intent was not to overshadow or undermine thelong history of advocacy that has been launched by people who use drugs andother people with lived experience but instead add to the voices of thosewho have been most directly impacted by substance use. Similar to theparticipants in our study, members of the Vancouver Area Network of DrugUsers (VANDU) have expressed that advocacy has brought with it a sense ofempowerment  and purpA key strength to this study is that, to our knowledge, our research addressingthe advocacy of bereaved mothers engaged in drug policy reform is the firstof its kind in Canada. We do, however, acknowledge several limitations toour research study. First, although we successfully included families fromacross various regions in Canada, both urban and rural, our sample wasprimarily women who would identify as “White” and “middle class.” Thus, adistinct limitation was our lack of representation of Indigenous familieswho we know are disproportionately affected by opioid-related deaths inCanada as a result of systemic racism, colonization, intergenerationaltrauma, and a lack of access to culturally safe care . In recrMany of the bereaved mothers in our study spoke of being motivated bytremendous anger and disappointment in the health care system that wassupposed to keep their child alive and healthy. Opportunities for people who use drugs and bereaved mothers to work together asallies in supporting one another in advocacy initiatives should be furtherexplored. Also, advocacy group members themselves need to continue tosupport one another in ensuring that new and continuing members fullyunderstand both the personal and collective benefits, as well as thechallenges in becoming involved in such activities. We anticipate that thisstudy’s findings will be of use to all organizations working to advance drugpolicy reform. It is hoped that, by examining and reflecting on themotivations and personal impact of bereaved mothers’ advocacy, all advocateswill be provided with the additional working knowledge necessary to continuetheir efforts to bring about sustainable system reform.Click here for additional data file.Supplemental material, sj-docx-1-qhr-10.1177_10497323211006383 for “It’sa Bit of a Double-Edged Sword”: Motivation and Personal Impact ofBereaved Mothers’ Advocacy for Drug Policy Reform by Heather Morris,Elaine Hyshka, Petra Schulz, Emily Jenkins and Rebecca J. Haines-Saahin Qualitative Health ResearchClick here for additional data file.Supplemental material, sj-docx-2-qhr-10.1177_10497323211006383 for “It’sa Bit of a Double-Edged Sword”: Motivation and Personal Impact ofBereaved Mothers’ Advocacy for Drug Policy Reform by Heather Morris,Elaine Hyshka, Petra Schulz, Emily Jenkins and Rebecca J. Haines-Saahin Qualitative Health Research


Throughout the history of biological/medicine sciences, there has been opposing strategies to find solutions to complex human disease problems. Both empirical and deductive approaches have led to major insights and concepts that have led to practical preventive and therapeutic benefits for the human population. The classic definitions of “science” (to know) has been paired with the classic definition of technology (to do). One knew more as the technology developed, and that development was often based on science. In other words, one could do more if science could improve the technology. In turn, this made possible to know more science with improved technology. However, with the development of new technologies of today in biology and medicine, major advances have been made, such as the information from the Human Genome Project, genetic engineering techniques and the use of bioinformatic uses of sophisticated computer analyses. This has led to the renewed idea that Precision Medicine, while raising some serious ethical concerns, also raises the expectation of improved potential of risk predictions for prevention and treatment of various genetically and environmentally influenced human diseases. This new field Artificial Intelligence, as a major handmaiden to Precision Medicine, is significantly altering the fundamental means of biological discovery. However, can today’s fundamental premise of “Artificial Intelligence”, based on identifying DNA, as the primary nexus of human health and disease, provide the practical solutions to complex human diseases that involve the interaction of those genes with the broad spectrum of “environmental factors”? Will it be “precise” enough to provide practical solutions for prevention and treatments of diseases? In this “Commentary”, with the example of human carcinogenesis, it will be challenged that, without the integration of mechanistic and hypothesis-driven approaches with the “unbiased” empirical analyses of large numbers of data, the Artificial Intelligence approach with fall short. Although surrounded by much hype, personalized medicine lacks the empirical and theoretical foundations necessary to render it a long-term perspective. In particular, the role of genetic data and the relationship between causal understanding, prediction, prevention and treatment of a disease need clarifying.”  “We reseRose in a dung heap”. This is seen with the US NIH starting an initiative on “Precision Medicine” [In an age where powerful technologies are available to biologists, as well as a shift in the approach to solve complex biological problems from a “biased, mechanistic hypothesis-driven approach” to an “unbiased” inductive examination of tons of data derived from these technologies, we are now incentivized to find a “edicine” .Even more disturbing to this author is that, in spite of early concepts that started the discipline of physiology by Claude Bernard and the discipline of artificial intelligence by Alan Turning , a very When Claude Bernard gave an explanation to whole animal responses by suggesting individual cells could send a molecular signal that could traverse the body to trigger a biochemical response to that molecular signal  could elicit in the specific cells receiving that signal, intracellular communication pathways that could determine the physiological fate of the receiving cell. What Dr. Claude Bernard did not know at the time was that there existed another system of communication, namely, cell–cell communication or intercellular communication, discovered by both electrophysiological techniques  and freeSo, it was with Alan Turning amazing computer algorithm to explain biological patterning, such as spots on leopards or stripes on zebras via his “diffusion-reaction” model. He apparently had no access to the later discovery of gap junctional intercellular communication (GJIC). In addition, he had no biological training, nor was he even aware of the physiological model of cells talking to each other. His algorithm basically accounted for the two early models of cell- cell communication, namely, extra- and intracellular communication. This model is still being used to make fairly accurate predictions of biological patterning, but it is obviously not perfect.Clearly, I am not saying that Artificial Intelligence or that the Turing model cannot be used to find “patterns” by using various algorithms on large data sets in an “unbiased” manner. The point I am trying to make is that these new patterns that are found give absolutely no insight to the underlying mechanism of the medical problem being studied. It is absolutely critical that mechanisms are understood, since, without this understanding, either no real practical outcome or even great human harm would be the result. In the case of human cancers, within the multi-stage, multi-mechanism process, it is experimentally clear that the initiation of that single normal stem cell is the result of a mutagenic event, either by an “error of DNA repair” or by an “error of DNA replication”. Knowing which type of mechanism causes that initiating event would be critical for basing any policy of intervention. In addition, the mechanism involved in the promotion process is clearly an epigenetic, non-mutagenic process. Knowing the detailed molecular, biochemical and cellular mechanisms is critical because these promoting properties can have quite diverse consequences, such as under certain conditions they can have antioxidant properties but under different conditions they can have pro-oxidant properties. The same chemical could be either a promoter or anti-promoter. The “progression” process is far more complex, involving either or both mutagenic or epigenetic.I have tried to restrict my analysis of “Artificial Intelligence” or Turing-Type models to the understanding of human carcinogenesis. Since all human diseases involve the disruption of the integrated extra-, intra- and gap junctional intercellular communication processes, to my knowledge, to date, these models have yet to predict, in a “Precision Medicine” or “Personized Medicine” manner, any known disease. I make this judgement based on the biology of all pathologies of metazoans involve the integration of all three forms of cell communication. This is true whether it is a birth defect, carcinogenesis, cardiovascular pathologies, immune disorders, reproductive- and neurological pathologies.Since I mentioned the immune process, which is highlighted in many current approaches to cancer therapies, I must bring a known fact of the relationship of the “initiated” cell and the surrounding normal cells that keep the “initiated” in a suppressed condition. It is obvious from classic initiation/promotion experimental studies that the immune system does not detect these single initiated cells. If it did, no one of us would ever get cancer. That is because the initiated single cells are being suppressed by the communicating surrounding normal cells. This phenomenon changes the “initiated” cell so that its phenotype appears “normal” to our immune system. This is a known fact, since an initiate cell can exist in this state until an epigenetic agent blocks that cell–cell suppressing effect, allowing that initiated cell to proliferate and not die by apoptosis. Most humans have many initiated cells in many of our organs, but they can reach death before any tumor is detected. Our skin has many sun-induced initiated cells. Skin cancer is the most predominate cancers. Yet, there are humans who live long lives without getting skin cancers. Yet, a non-artificial intelligent approach to study human carcinogenesis, based on hypothesis- testing of a “biased” potential series of mechanisms, has strong validated experimental support for initiated cells to remain in a quiescent state.One last issue also has to be built in any machine learning or Artificial Intelligent model. Classic pathologists have long noted that cancers seem to fall into two categories, very “embryonic-like” or the differentiated types. Most of the solid tumors have two types of cancers, carcinomas and sarcomas. Some examples include basal or squamous carcinomas of the skin; small cell lung cancers and non-small cell lung cancers; partially differentiated polyp-type colon cancers and very “embryonic-like “flat type” colon cancers. This might suggest that these types of cancers have two different “initiated” cells, one that exist in the stem cell state at the type of initiation, while the other might have just start to differentiate at the initiation state. Within each type there can be phenotypic classifications, such in the skin, where Merkel cell carcinomas, Kaposi sarcoma, cutaneous skin lymphoma, skin adnexal tumors can be found, which suggests that the micro-environment of the “initiated” cell can influence the phenotype of the resulting cancer. All of these biological facts have come out of a biased hypothesis testing of the potential mechanism of each state of the carcinogenetic process. These biological facts have to be taken into account in any Artificial Intelligent model.Current attempts by computer modelers are being made to improve the Turing algorithm, with only a few recognizing that this third form of cell–cell communication must be integrated into the Turning algorithm . Recent From the existence of the single cell organism during the early evolution of life on earth in a low oxygen environment to the eventual appearance of oxygen-producing microorganisms to the early multicellular organism, a large number of genes and physical/physiological structures and functions had to appear when the environment became rich with potentially toxic oxygen to signal cell organisms but important regulatory functions in multicellular organisms, such as the metazoans. Genes had to appear via evolution to protect genomic DNA from oxygen-derived metabolites that could interact with all biological macromolecules ; genes coding for nuclear membranes, specific regulation of patterns or sets of gene regulation; formation of a new cell type; i.e., stem cells; genes that code for intercellular direct communication or “gap junctions”; genes that control senescence; and genes that code for extracellular matrices and extracellular adherence molecules .To be sure, single cells can communicate with other single cells in an aqueous environment. Their survival as an individual cell or as a species did not necessitate their direct contact. Their means of survival in an ever-changing environment only depended on symmetrical cell division, where errors of DNA repair or DNA replication might produce a new mutation that gave that one cell in this population to survive.Stem Cell Niche [When the first multicellular metazoan appeared, that first cell would divide symmetrically until it reaches a small hollow ball shaped entity. At that moment, each cell had equal access to the outside world and to the inside world. However, at the next cell division, these new cells, by being forced inward from the surface, whereby, they no longer had equal access to the outside world. Their micro-environment had changed. This, then, forced new gene expression for its survival. This induced “differentiation”. In turn, this new series of cell division also had to adjust by being in its new micro-environment…and so on . At thisll Niche . It had ll Niche . For theThe key to understanding this complex homeostatic control of symmetric and asymmetric cell division of stem cells and their live-span limited progenitor cells seems to reside in a few critical genes. Oct4 is the so-called “Queen Bee” gene to maintain stemness. It is a redox sensitive gene . In otheOne of the early observations regarding GJIC was that “normal” cells had growth control or “contact inhibition”, and they could differentiation, apoptosis and senesce. On the other hand, cancer cells lost growth control or “contact-inhibition”, could not terminally differentiate or apoptosis normally, and had gained “immortality” and lost the ability to senesce. One key factor to help explain the difference between the “normal cell” and the cancer cell was either the presence or absence of GJIC .At the time of Loewenstein’s hypothesis that cancer cells lacked functional gap junctions, he was not aware of the concept or biological characteristics of stem cells. His concept of “normal” cells did not include “normal stem cells”, let alone “normal adult organ-specific stem cells”. Only after the isolation of human embryonic stem cells ,19, and Along with these observations, early in the study of gap junctions and cancer, a new insight was provided from the field of the mechanisms of carcinogenesis, namely the concept that carcinogenesis consisted of three vary distinct phases, the “initiation” step that involved the irreversible conversion of a normal cell to an “immortalized” but not tumorigenic cells; this was then followed by the “promotion” step, that involved the clonal expansion of that single “initiated” cell by agents that were not mutagenic but acted by “epigenetic” mechanisms. Finally, this clonally expanded “initiated” population has another series of either mutagenic or epigenetic processes or both, the “Progression” step ,27,28, tIn order to provide a visualization of this “initiation”/“promotion”/“progression” concept, which is based on validated experiment experiments, these three steps of carcinogenesis consist of very distinct mechanisms during the evolution of a normal cell  to become an invasive metastatic cancer stem cell. Promotion mechanisms were shown to be triggered by agents that could reversibly inhibit gap junctional intercellular communication, such as growth factors, hormones, cytokines and chemokines. Other epigenetic chemicals inhibited pollutants , etc.) . These eOne other factor must be kept in mind. The “initiation” step is inevitable. It can occur at any time in any organ-specific cell. The risk to the initiation stem can be prevented to some extent, but it can never be completely eliminated. Every time a normal cell proliferates, an “error of DNA replication” could occur. On the other hand, the promotion step is the rate limiting step. It must exceed threshold levels, be present for regular and long periods of time, and in the absence of anti-promoters. Other agents that can modulate gap junction gene expression or function has been shown to be by several oncogenes  or by several oncogenic viruses, such as hepatitis and human papilloma virus). Genetic engineering of these genes into normal cells can convert these cells to become “immortal”, but not tumorigenic in one step. On the other hand, transforming non-communicating cancer cells with tumor suppressor genes or normal gap junction genes, results it the restoration of contact inhibition and the loss of the tumorigenic phenotype ,41.In the quest to understand the cancer process by either “artificial Intelligence” approach or the mechanistic hypothesis approach, it is fair to point out that, by using any algorithm to find patterns in mountains of data generated by powerful technologies, one will indeed find patterns. The question is “What will those patterns signify?” One major criticism, especially trying to understand carcinogenesis for the purpose of either prevention or treatment in the context of “Precision Medicine”, is that, unless those algorithms are based on some solid biological understanding, those patterns with offer little benefit. Case in point. Today, we already know that carcinogenesis consists of three distinct steps, each encompassing distinct molecular mechanisms, e.g., mutation; cell death, and epigenetic alteration of gene expression, transcription and translation. In addition, we also know that there are individual genetic backgrounds, gender, development stage, nutrient/dietary components; length of time exposures, environmental factors, medication, time of day exposure factor; life style behavioral and other psychological, social and cultural components that can influence the carcinogenic process. It seems very clear, that, unless any such AI algorithm to be used to answer the question as to what is the mechanism causing cancer, it must involve the incorporation of the multi-stage, multi-mechanisms process of carcinogenesis, as well as understanding the role of adult organ specific stem cells and the different mechanisms of mutagenesis or “initiation” and the properties and mechanisms of cell–cell communication.What is the target normal cell such that, when initiated, ultimately gives rise to the cancer?” That raises the issue of the two major opposing hypotheses of the origin of cancer, more specially, the “cancer stem cell”, namely, The “Stem cell hypothesis” [De-differentiation” or “Re-programming” hypothesis [Equally important is the question: “othesis” ,43,44 anpothesis . These hAlthough intellectual arguments to support the Stem Cell hypothesis existed before the actual isolation and identification of human stem cells ,19, sevecancer stem cells”). Those florescent-containing cell were unable to sustain the long-term growth of the tumor. These were the “cancer non-stem cells” of the tumor or tumor cell line.Indirect supporting evidence of some of the characteristics of the “cancer stem cell” came from the many observations of cells isolated from either real human tumors or cell lines derived from those tumors. The technique of “side population” cells was use on these tumor derived cells, in which the fluorescent, Hoechst 33342 stain, was exposed to all cells, then separated by flow cytometry based on whether the cells contained the dye or not . It turnare the majority of human tumors in vivo sarcomas and carcinomas, are not teratomas?”Another, source of support comes from the use of antibodies to the Oct4 transcript factor protein. If those normal adult organ-specific stem cells had Oct4 expressed and maintained its expression during the initiation, promotion, progression process, including in the “cancer stem cells”, this provided evidence that the Oct4 gene was not turned on or “re-programmed” from a differentiated adult somatic cell. This argument has been made related to the Noble Prize winner Dr. S. Yamanaka’s discovery of “Induced pluri-potent” stem cells (“iPS”) . The argThe argument against his interpretation is that he & his team never took into account that any primary cell line has a few adult organ-specific stem cells in its population . These rThe original objective of this “Commentary” was to point out several weaknesses of current approaches to understand the mechanisms of pathogenesis of human diseases via either methods of Artificial Intelligence (AI) for Precision Medicine or Hypothesis -driven mechanistic approaches. Using our current understanding of human carcinogenesis as an example. I have noted that several concepts and experiment findings have been seriously ignored in these recent attempts. Several old hypotheses, such as the “Stem cell Hypothesis”, role of cell–cell communication; threshold exposures to epigenetic acting chemicals, and biological characteristics of adult organ-stem cells are among those that need to be integrated into either algorithms of the AI approach (improving the Alan Turing model), or a more realistic concept of cancer as a whole animal phenomenon.Starting from the beginning, the emergence of the family of the gap junction genes (connexins) ), among For the bio-informaticists and computer programmers, the simple task to integrate gap junctional intercellular communication into refining Alan Turnings algorithm will not be easy. This is because this system of communication, which makes possible homeostatic control in a whole organism is extremely dynamic . It incl


Dear Editor,Thank you for the opportunity to respond to the letter penned by Dr Blankstein Breman and colleagues, which highlighted issues regarding our scoping review on implementation science in maternity care. Similarly, we wish to thank Dr Blankstein Breman and colleagues for their interest in our contribution to Implementation Science.Our scoping review ‘appraise[d] the scientific study of methods to promote the systematic uptake of evidence-based interventions in maternity care by clarifying if and how implementation science theories, models, and frameworks are used’ . Akin toDr Blankstein Breman and colleagues expressed concern with our ‘study’s methodology’ . They inAlthough we appreciate this point and the suggested publications, our scoping review purposely focused on publications pertaining to ‘maternity’ care for four key reasons. First, this term is part of international vernacular, offering the capacity to detect publications conducted by midwives  as well as obstetric nurses . Second, and as justified in our article, a relatively more inclusive approach proved to unhelpfully dilute the relevance of the publications that were identified. Third, as a scoping (rather than a systematic) review, our aim was not to identify every relevant publication, but rather, to analyse a selection of publications—this limitation was duly noted in our article. As Dr Blankstein Breman and colleagues attested, ‘The breadth of maternity care settings, and diversity of implementation constraints between settings, makes it challenging to map this literature in one review paper’ —this comnot fault our findings. They agreed that ‘maternity care is in great need of implementation research to close… gaps’. Furthermore, they indicated that we ‘rightly note[d] the need to promote the consistent application of implementation science theories and frameworks’ (emphasis added). Given their familiarity with, and knowledge of the articles they helpfully suggested, the take-home-message appears to be the same. As Dr Blankstein Breman and colleagues noted, our study concluded that ‘there remains much work to be done to support implementation in maternity care’. We believe that, had we included the publications they kindly suggested, the key findings from our article would not have changed. As such, we argue that our study culminated with robust findings that withstand this critique.Despite their methodological concern, Dr Blankstein Breman and colleagues did Like all good research, our article was intended to promote discussion and debate on implementation science in maternity care. We thank Dr Blankstein Breman and colleagues for engaging in this discussion and their commitment to implementation science in maternity care. We encourage the Implementation Science community to similarly advance this discipline in the important field of maternity care, for the reasons cited in our article.Sincerely,A/Prof. Ann Dadich, Mrs Annika Piper, and Adjunct A/Prof. Dominiek Coates


The phenomenon of the quantified self, which is especially addressed by sociology and medical humanities, is still quite disregarded by philosophy. Yet, the philosophical issues it raises are various and meaningful, from the realm of epistemology to the realm of ethics. Moreover, it may be read as a key symptom to investigate the complex technological era in which we live, starting from the meaning of contemporary technology itself from a philosophical perspective. I shall focus on one of the epistemological issues raised by the phenomenon of the quantified self by arguing that it may be read in terms of epistemological anarchism, which also leads to other epistemological issues, such as a possibly detectable crisis of the notions of knowledge in general and science in particular as founded on the relationship between particularity and universality, as well as between reality and ideality. I shall select cases that are peculiarly representative of the founding epistemological stance I shall focus on. Yet, the reason why they deserve special attention is that they are also representative of an increasingly widespread attitude characterising not only the community of the quantified self but also, at least to some extent, anyone of us who may happen to use technologies (from apps to self-track symptoms to google to search symptoms) to try to self-diagnose. The phenomenon of the quantified self, which is especially addressed by sociology and medical humanities, is still quite disregarded by philosophy  and, second, testimonies of self-trackers published in its official websiteWolf and Kelly defined the quantified self as “self-knowledge through numbers”logos, according to which what can provide us with actual knowledge is a restricted form of rationality coinciding with “computation, reckoning”, i.e. the literal meaning of logosje ne sais quoi since the eighteenth century and other forms of rationality, starting from what we have been defining as wisdom from the ancient Greek metis to Nozick’s inspiring words : epistemological anarchism pairs with hypertrophisation of logos.According to Wolf, speaking of the quantified self means speaking of the move from uncertainty to certainty, i.e. what he defines as actual knowledge. Without self-tracking technologies, we “steer by guesswork. We go with our gut” Wolf . ConversIn the quantified self website, the section “Show & Tell”I select two presentations  as peculiarly representative of the founding epistemological stance I shall focus on .Where there’s data there’s hopeThe title of the first presentation is The story shows both a positive attitude  and a positive ending . But let us move from the reporter’s perspective to the philosopher’s perspective, according to which at least three epistemological issues deserve attention. I specify that the reason why they deserve attention is that they are representative of an increasingly widespread attitude that can be understood as founded on quite a precise epistemological stance characterising not only the community of self-trackers but also, at least to some extent, anyone of us who may happen to use technologies (from apps to self-track symptoms to google to search symptoms) to try to self-diagnose. The three epistemological issues are the following:logos;the move from feelings to numbers – which I shall try to read as hypertrophisation of the move from experts’ expertise to self-expertise – which I shall try to read as epistemological anarchism;the move from relationality, including recognition of counterparts and sense of community, to individualism, and even exceptionalism – which I shall try to read, again, as epistemological anarchism.As for the first epistemological issue, i.e. the move from feelings to numbers, we should address the following words: “don’t trust the diet book, actually measure”. More precisely, “this idea that you can feel what’s going on inside of you […] is just so epistemologically false; you just can’t do it. And so as you’ll see, there are things that are completely out of whack inside me and I would never know that by ‘feeling’, which is the first thing your doctor asks you when you come in the office. […] So what I’ve learned by this experience over 10 to 12 years is […] [that] when you go into the doctor’s office and he says how do you feel, this is next to useless. What you want to say is what are your numbers […]. And if that’s what the doctor looks at […] then you can have a useful conversation. So my endpoint where I’ve come to is where there’s data, where you can actually quantify your body and get a sense of knowledge […] there’s hope”. Two logical steps are noteworthy. The first logical step is the following: numbers can give us what feelings cannot give us, i.e. knowledge. The former, which can “measure”, can lead us to “a useful conversation” in which, if “there’s data”, i.e. quantif[ication], then there is not only “knowledge” from an epistemological perspective but also “hope” from an ethical perspective. Conversely, the latter cannot give us not only “knowledge” (“I would never know that by ‘feeling’”) but also, paradoxically enough, actual feelings . Needless to say, several philosophers advocate the opposite idea, according to which feelings play a key role from an epistemological perspective : the more we consider actual knowledge as something coinciding with a restricted form of rationality as “computation, reckoning”, the more we risk not considering at all what may fall outside of “computation, reckoning”. More precisely, we risk considering as actual knowledge what is not only reduced to simplism but also deprived of the kind of meaning that only the sense of the whole can provide us with .Thus, I may anticipate that hypertrophisation of logos and epistemological anarchism clearerThe second epistemological issue, i.e. the move from experts’ expertise to self-expertise, can make the correlation between hypertrophisation of Other testimonies stress an analogous attitude. As for the founders of the quantified self, they define it as “personal science”As for other self-trackers, two testimonies are especially instructive. In the first case, the self-tracker attacks the doctors by saying that “I didn’t see that [i.e. the scientific method] when I went to my doctors. They can’t help me, so I’ll try and find these methods of my own health condition”an) of something that “rules” (archo) – “anarchism” means radical “rulerlessness”. In the history of Western philosophy, epistemological anarchism, as an epistemological stance typically characterising contemporary culture, was claimed by Feyerabend, who described the epistemological anarchist as whoever “becomes capable of stepping outside the most fundamental categories and convictions, including those which allegedly make him human” , in what follows. According to the self-tracker, happiness, as well as unhappiness, is not something to feel (inside), but something to know (outside): “I was in a situation where I thought I was unhappy. So I thought I was in this situation where I thought I was unhappy […]. [But] I didn’t know if I was unhappy”. That is, feeling and thinking to be unhappy, on the one hand, and knowing to be unhappy, on the other hand, are considered as divergent. More precisely, unhappiness moves from being a non-quantifiable internal truth whose existence is proved by one’s feeling and thinking to being a quantifiable external truth whose existence is proved by self-tracking technology’s knowing. The move from something internal to something external, i.e. the epistemological externalisation of unhappiness, is explicit: “So I wanted to explore this whole space of unhappiness and how to improve it. So how do we do that? I wanted to measure my happiness and mood”, which means creating a quantifying self-tracking technology, i.e. “this android app called Happsee”. The epistemological externalisation of unhappiness exemplifies the way we seem to increasingly use technology: first, we increasingly think that computational knowledge is better than non-computational knowledge ; second, we increasingly think that technology’s computational knowledge is better than the human mind’s computational knowledge; third, we increasingly externalise knowledge from the human mind to technology – which means that, paradoxically enough, we increasingly stop exercising the capacity that, in Western culture, has been defining the core of human identity for millennia: the capacity to actually know, and to make decisions accordingly.We can find the first epistemological issue, i.e. the move from feelings to numbers , we can find it in what follows. The self-tracker says that he does not want to use apps designed by others. Conversely, he wants to use the app he designs as tailored to his individual needs: “So I looked at a lot of measurements tools. […] Most of them did not suit my needs. They were either too complex. They asked me to fill out a bunch of surveys and I think a few of them actually made me angry, because I was like [asking myself] why am I filling out all these questions and that completely defeats the purpose of understanding whether I’m happy. […] So in the spirit of software I made my own tool”. A kind of self-referentiality emerges from the self-tracker’s words, in that he escapes both from possible comparisons with others in general and from possible comparisons with others’ expertise in particular . And, if we address the kind of knowledge resulting from the self-tracker’s self-referentiality, we can find at least four noteworthy issues. First, he says that what he did to use his app was to “enter […] in some moods. I entered in how happy I was on a zero to ten scale”, and his app made graphs and maps also based on passive data such as geographical positions. We may note that what he did opposes what he says about the divergence between feeling and thinking, on the one hand, and knowing, on the other hand, since he actually “entered in” what he felt and thought (“how happy I was”) by simply translating it into numbers . Second, even if his knowledge is actually founded on what he felt and thought, a kind of placebo effect emerges, in that “uncertain is dropping. Stressed was in don’t know […] and my positive moods have […] been going up”. Thus, his questionable knowledge triggers his behaviours. Third, his knowledge is not only questionable but also obvious: “when I started to get less tired, I started to get a lot happier”. Yet, obviousness seems reassuring, and not suspicious at all. And he even wants to step forward: “to use machine learning to predict happiness”. Thus, his obvious knowledge also triggers his behaviours.  output is founded on happiness as the (suspicious) input, and to a kind of epistemological surrender, in that human alertness and critical thinking seem to decrease. More precisely, the reason why human alertness and critical thinking seem to decrease is that what is self-acquired is so individually satisfactory that actual obviousness is believed to be actual knowledge: what is self-acquired, whatever it is, increases a kind of individual satisfaction that, perfectly deprived of contradicting comparisons, easily falls into substituting not only less reassuring alertness and critical thinking with more reassuring self-confidence but also less reassuring knowledge as constitutively related to expert counterparts with more reassuring obviousness as constitutively self-related. Thus, expertise itself risks being radically devalued both when, in general, it has to do with exercising human alertness and critical thinking and when, in particular, it has to do with exercising human expertise . Moreover, and again, what founds expertise itself risks being radically sabotaged, i.e. the ideal model as the most powerful epistemological tool introduced by Western culture to know what is particular: knowing what is particular moves from referring it to what is universal to referring it to what is not only particular but also self-referentially idiosyncratic.on himself or herself, because here the researcher and the test subject are one and the same person” , we can find it both in what we have already seen and in what follows. The self-tracker specifies that to “suit my needs” especially means “to maximize information gathered while minimizing the information I actually had to type in because I’m lazy”. Again, being tailored to individual needs seems to mean being tailored to individual idiosyncrasies, no matter if they may interfere with the quality of knowledge. A kind of idiosyncratic self-referentiality seems to characterise not only the self-tracker’s knowledge of his self but also the self-tracker’s perception of his self. In the first case, as we have already seen, the knowledge of his self becomes self-referential through the removal of the comparison between particularity and universality, i.e. ideal models. In the second case, the perception of his self becomes self-referential through the removal of the comparison between him as a particular individual and others as other particular individuals . As a sociologist puts it, also “public presentations of self-tracking research at meetups or conferences make hardly any references to other self-trackers and their activities” Heyen : 133. Mon” Heyen : 131, thn” Heyen : 131. Fr28 years of tracking, but what have I learned?At times, self-trackers end up saying that their selves cannot be quantified, even after 28 years of self-tracking, which is a part of the title of the presentation archo) as a form of heteronomy, i.e. as doctors who can rule us as experts. Moreover, whenever, for instance, we make complex decisions by making algorithms process data and by doing exactly what they tell us to do, we may fall into epistemological anarchism by removing what “rules” (archo) as a form of autonomy, i.e. as our epistemological and ethical reasons that can rule us as what was identified by Kant as nothing less than the core of human identity (and dignity). Paradoxically enough, even if we, as Western humans, come from a cultural tradition according to which the notion of human identity (and dignity) has been founded on the notion of autonomy, we seem to increasingly use technology to shift autonomy from ourselves to technology, as several technologies’ definitions show, such as autonomous vehicles, autonomous systems, autonomous software, autonomous devices, autonomous applications, autonomous silicon, autonomous machines, autonomous equipment, autonomous drones, autonomous weapons, autonomous robots, autonomous agents, autonomous workloads and so forth. More precisely, we seem to increasingly trade (human) autonomy for  automation – and trading (human) autonomy for  automation is one of the most anarchic moves we may make.Whenever, for instance, we self-diagnose by googling our symptoms, we may fall into epistemological anarchism by removing what “rules”  of “laws”, i.e. something that “rules” (archo), but also with the presence of the kind of “random[ness]” that being “automated” means: whatever algorithms tell us to do, their reasons are, at least to some extent, inscrutable to us not only because of technical reasons but also because of their constitutive separateness from the kind of individual responsibility that makes what is “self-given” even more “self-given”, as it were. When we make the wrong decision through (human) autonomy, we are likely to bear its burden forever . Conversely, when we make the wrong decision through  automation, we are likely to bear its burden for hours, if any. If it is true that (human) autonomy and  automation can promisingly work together, it is also true that we seem to increasingly substitute the former’s action with the latter’s action .From an etymological perspective, whenever we trade, for instance, our autonomous decisions funded on our epistemological and ethical reasons for algorithms’ automated decisions, we trade something that, being “autonomous”, is a “self-given law” with something that, being “automated”, is not a “law” at all – and radically removing the “law” means taking the first step toward anarchism. More precisely, being “automated” means what the ancient Greek verb tout court – and, again, the reason is that the quantified self takes to extremes a founding epistemological stance that goes exceedingly far beyond it, and which may be read as epistemological anarchism.From a philosophical perspective, the quantified self can help us understand a phenomenon that seems to characterise our technological era First, as we have already seen, we can find epistemological anarchism in the crisis of expertise. Moving from the quantified self to more general phenomena, we can find the crisis of expertise whenever we self-diagnose by googling our symptoms, not only because we substitute doctors’ expertise with our non-expert self-expertise but also because we substitute the realm of “laws”, where the experts’ identities are clearly exposed and responsible for what they say, with the realm of “random[ness]”, where the experts’ identities are not clearly exposed and responsible for what they say. And we can find the crisis of expertise whenever we make complex decisions by making algorithms process data and by doing exactly what they tell us to do, not only because we increasingly lose our expertise in making complex decisions by increasingly externalising it from ourselves to technology (which means by increasingly atrophying it) but also because we substitute human capacities that can work on non-computable data with technological capacities that can work on nothing but computable data. Finally, and more generally, we can find the crisis of expertise whenever we haunt social media with millions of non-expert judgements on whatever, ending up being even the worst kind of epistemological anarchist, i.e. the epistemological apathetic.tout court, starting from personalised medicine .Second, as we have already seen, we can find epistemological anarchism in the crisis of knowledge in general, as well as of science in particular, as founded on the relationship between particularity and universality, as well as between reality and ideality. Moving from the quantified self to more general phenomena, we can find the crisis of the relationship between real particularity and ideal universality, i.e. the ideal model, whenever we self-diagnose by googling our symptoms, in that we rely on the relationship between a first idiosyncratic particular (our symptoms) and a second idiosyncratic particular . And we can find the crisis of the ideal model whenever we make complex decisions by making algorithms process data and by doing exactly what they tell us to do, in that we rely on a kind of abstraction that, being technological, may happen not to cover at all what the human mind’s abstraction can cover, even if on a subconscious level . Finally, and more generally, we can find the crisis of the ideal model whenever we consider ourselves as the exception to the rule – and the rule, exception after exception, ends up dissolving in rulerlessness, i.e. epistemological anarchism. The quantified self takes to extremes a founding epistemological stance that risks increasingly characterising, for instance, our notion of health The New York Times says, “he engaged in self-tracking because he believed that ‘[y]ou want to be your best self’” ;individuals strive for making ideal models real. Yet, as Plato already taught us, making something ideal real is epistemologically and ontologically impossible  reduces complexity to simplism by (outwardly) quantifying even something ideal?Yet, both Western humans and their ideal models do not seem reducible to “an engineering problem”.an) of what rules (archo) not only knowledge itself  but also ourselves  – and we become perfectly ruleless.But we keep trying to use technology to reduce complexity to a kind of reassuring simplism that sometimes, as we have already seen, seems to increase our self-confidence even through obviousness. Yet, and again, obviousness is nothing less than a further emergence of epistemological anarchism: whenever we substitute complexity with obviousness we deprive (an) ourselves not only of a ruling (archo) epistemology we are irreducibly responsible for but also of a ruling (archo) ontology we are irreducibly responsible for?The founders of the quantified self also add that it introduces a novel notion of self: the self becomes an exoself through the increasing number of wearable technologies we use  but also to make it obtain divine prerogatives and burdens. If we ask ourselves in what realm we increasingly happen to use typically theological notions such as omnipresence, omniscience, omnipotence and inscrutability, then we should answer that we increasingly happen to use them to define technology – a kind of technology that, from when we use it to google our symptoms to when we use it to make algorithms make decisions for us, becomes more and more omnipresent, omniscient, omnipotent and inscrutable. Yet, it is not transcendent at all. Conversely, technology is totally immanent, being a totally immanent human creation – and substituting a transcendent divine with a totally immanent divine may be thought of as the most anarchic move we may make in our history.