Type 2 Diabetes, Evidence-Based Medicine, and Real Human Welfare (Difficulty Level: Intermediate)

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Warning: Persons with diabetes should not ever make ANY significant lifestyle changes without first reviewing such changes with their professional healthcare specialist. Coma and death are entirely possible via uncritical lifestyle change in diabetics. As always, the following is not to be interpreted as medical advice. Instead, it is merely an invitation regarding considerations which may prove useful for some individuals, some of the time.

Note: In the essay below, the term "diabetes" will refer to Type 2 Diabetes (unless otherwise specified).

The prevalence of Type 2 Diabetes has been growing exponentially for more than 80 years (1). It should be noted immediately that this sharp rise in prevalence debunks, at the outset, any and all theories on the etiology of diabetes which happen to place a heavy emphasis on "genetic" or other "un-modifiable" factors. Indeed, the only plausible explanations for sharp rises in the prevalence a human disease are those centered around modifiable factors - as they are the only things that can cause sharp rises.

That diabetes is indeed on the rise - and has been so for over 80 years - is evidenced by a recent article that reprints an historical quote (1) from its original source: a 1921 article in the Journal of the American Medical Association:

"There are entirely too many diabetic patients in the country. Statistics for the last thirty years show so great an increase in the number that, unless this were in part explained by a better recognition of the disease, the outlook for the future would be startling." -Elliot P. Joslin

The authors, who have quoted Joslin's words above for the 80-year perspective it provides, offer no comfort with their own synopsis of how this early concern has played out: " ... Joslin's vision of the future has become a reality." Instead, they offer such bleak snapshots and staggering conclusions as the following:

-more than 18 million Americans have diabetes

-the annual cost of the disease is estimated to be at least $132 Billion (more than 10% of US expenditures on health care services)

-in the next 50 years, the number of diagnosed diabetes cases is predicted to increase by 165% in the US

-for the cohort of Americans born in 2000, the estimated lifetime risk of diabetes is more than 1 in 3

Well, obviously, something is wrong with this picture - some error must be (and must always have been) in the making, for us to be so pitifully losing a health battle of this magnitude. An error which may - in the future - be recalled as the biggest blunder of modern medicine. But what is this fatal error of human thinking in the field of medicine? It is the lack of mental integration of available information (a "philosophical" error). Failing to properly integrate evidence leads to piecemeal analysis, and an unprincipled allocation of time and money aimed at poorly-defined (or elusive) targets for intervention. A failure of integration leads researchers down many blind-alleys as they only get a "snapshot" picture requiring much otherwise-preventable assumption (due to failed integration of previous facts) when viewing the evidence surrounding a given disease.

One strategy for integrating available evidence is to examine societies around the world to see if a problem - which is prevalent in one area of the world - is absent, or even much less prevalent, in another. If such a method is undertaken, then the next step (assuming you've found a stark contrast in the prevalence for a given disease) is to provide an explanation for the stark contrast found and, in doing so, to understand the mechanics behind the particular disease in question. Indeed, a few leads have already surfaced from this process - as applied to diabetes: relative muscularity, cell membrane composition (which is modifiable by diet) and dietary elements, like chromium and magnesium, have surfaced as biochemical explanations of the discovered differences in insulin-resistance and diabetes found round the world.

But, on a more somber note, this type of analysis is amazingly absent from the majority of professional articles on such an onerous disease as diabetes. To add insult to injury, the articles which do note geographical differences in diabetes prevalence, almost invariably make the mistaken assumption that genetics is the primary factor for the differences found. But, as I've proven in the first paragraph of this essay, sharp increases in prevalence disqualify "genetics" as a primary factor (additional weight to this line of argument - though not necessary for its finality - is added by the noted increased prevalance in those otherwise "genetically-protected" individuals after adopting the lifestyle of the "genetically-susceptible" individuals).

The grossest of errors lies not in failing to integrate evidence however, but in feigning to do so under the guise of a new paradigm: Evidence-Based Medicine (EBM). EBM is a new paradigm in medicine that supposedly enshrines evidential reasoning as the arbiter of truth and action in medicine. In other words, all medical decisions are to be weighed against all alternative decisions and the vast scientific literature is to be critically examined to place decisions in a hierarchy for proper medical practice.

I have to admit that I was, at first, taken in by the goals of EBM, which seemed to bring hope for a new level of objectivity in medicine. But this initial hope was clearly a premature evaluation and has been turned upside-down by the dominant professional application of EBM, which breaks down to merely finding the best evidence for things within a paradigm (see above) without questioning the paradigm itself. What EBM has done is to make decision-makers demand the most internally valid research (Randomized, Placebo-Controlled Trials) that has, by happenstance, been done.

What it HAS NOT DONE is to demand that research takes more valid directions, such as the integrative approach outlined above. So what we end up with is decision-making based on the "best-available evidence", but without any wisdom in research DIRECTION, we have substandard "evidence" to base decisions on. An analogy illustrating this inherent weakness of EBM is a dragster with 1000 horsepower, but no wheels to transfer the power into winning actual drag races (no amount of horsepower is useful unless the "rubber hits the road"). In short, if the only good evidence for an existing intervention happens to be a dangerous drug, then that drug will be used to the exclusion of alternatives which have "promise" but have not yet been through the rigorous type of investigation that the dangerous drug has gone through.

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Now that I have "trashed" EBM as the final solution to medical decision-making, I have to say that there is something to salvage in its aspirations. Recent attention was given to intervention alternatives for diabetes in an EBM review on the matter (2). This review reads like a literal "who's who" as far as promising, popular alternative interventions go (though little merit is awarded to these "alternatives" in this "evidence-based" review): "Attention is focused on dietary fiber, glycemic index, dietary protein, omega-3 fatty acids, chromium, magnesium, and vitamin E."

As stated above, this list of alternatives captures much of the promise available with complementary approaches to either 1) reverse diabetes, or 2) lessen its complications. The changes that I'd make to this list of alternatives (to make it more promisingly health-promoting) are:

1 - change "dietary fiber" to "soluble fiber" (insoluble fiber has relatively little effect on glycemic control)

2 - change "glycemic index" to "glycemic load" (higher glycemic index foods can often be used, if only judiciously, though the total load of such foods in a diet can "make or break" a lifestyle program aimed at glycemic control)

3 - change "dietary protein" to "% dietary protein" (to reveal the fact that low-protein diets - by increasing the total load of carbohydrates and fats to which we are exposed; 2 known triggers of diabetes in experiments - are inherently diabetogenic)

4 - change "omega-3 fatty acids" to "long-chain omega-3 fatty acids" (such as those found in fish)

5 - change "chromium" to "supplemental chromium" (to reflect the fact that the experimental doses of this nutrient that HAVE PROVEN USEFUL are in excess of that expected from even well-selected diets)

6 - change "vitamin E" to "supplemental vitamin E" for the same reason as above (in contrast, health-promoting doses of magnesium are easily attained with well-selected diets)

7 - add 150 minutes per week of moderate-to-high intensity exercise (to take advantage of this proven diabetes "intervention")

8 - include a restriction on alcohol consumption to 1-2 drinks per day

9 - include a special warning against most packaged foods (which often contain 2 of the most highly-suspected "diabetes-promoting" ingestibles available to humans: high-fructose corn syrup and trans fatty acids)

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Again, this essay is not meant as medical advice (or as any kind of substitute for medical advice). My only "advice" (if anything here is appealing to you) is to share these considerations with your professional healthcare specialist and discuss them rationally. Here is a utility-inspired outline of basic food choices for consideration:

Approximate Weekly Grocery List


A) Lean protein sources (per ounce: 7 grams protein; 0-3 grams fat)

2-3 pounds of boneless, skinless chicken or turkey breast
2-3 cans or foil-packs of tuna, salmon, or sardines (water packed)
2-3 dozen eggs (for veggie omelettes or hard-boiled eggs)
2-3 pounds of lean beef


B) Unrefined carbohydrate sources (cooked: 30-45 grams carbohydrate per cup)

1-2 boxes of brown rice
1-2 cans of Whole Oats
One 3-lb bag of sweet potatoes or yams


C) Fibrous, low-carb vegetable sources (5-15 grams carbohydrate per cup)

1-2 bags frozen mixed veggies (ones containing veggies of at least 3 different colors - green, red, yellow, orange, etc)
1-2 bags of fresh pre-mixed salad greens (ones containing veggies of at least 3 different colors - green, red, yellow, orange, etc)

*other prominent, single-veggie choices include: red & green pepper, onion, tomato, mushroom, asparagus, spinach, broccoli, romaine lettuce, red cabbage, parsley


D) Low glycemic-index Fruits (10-20 grams carbohydrate per cup)

melons
berries
citrus fruits


E) Miscellaneous:

1 container of saccharin, Sucralose, or Sunnette (sweeteners)
1 shaker of cinnamon
1 small bottle of extra-virgin olive oil
1 small bottle of balsamic vinegar
1 shaker of either Butter Buds or Molly McButter
1 aerosol can of Pam Butter spray
1 squeeze-bottle of lemon or lime juice (or 2 whole lemons or limes – to squeeze juice from)
1 bottle Mrs. Dash Salt-Free Seasoning (the "Table Blend" is suggested)
2-3 gallons of spring water (or distilled "drinking water" - with the added minerals)

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Very Rough Outline of Daily Meal Plan:

-more than 2 meals per day
-less than 500 total kcal per meal
-more than 25 grams of protein per meal (more than 100 kcal)
-less than 50 grams of carbohydrates per meal (less than 200 kcal)
-less than 20 grams of fat per meal (less than 180 kcal)
-green veggies with at least 2 of the daily meals
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Sample Day:

Meal #1:
4-egg (2 whole eggs + 2 egg whites) veggie omelette (w/green pepper, onion, tomato, mushroom) & 1/3 - 1/2 cup of oatmeal (w/cinnamon, sweetener, berries)

Meal #2:
"Colorful" Chef salad (w/chicken, beef, turkey, or tuna) & 1 medium sweet potato or 1/2 yam

Meal #3:
Meat/egg and broccoli stir-fry on 1/3 - 1/2 cup brown rice

Meal #4:
Steamed chicken breast AND steamed mixed veggies (seasoned to taste)
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References:

1. Williamson DF, et al. Primary prevention of type 2 diabetes by lifestyle intervention: implications for health policy. Ann Intern Med, 2004; 140(11):951-7
2. Neff LM. Evidence-based dietary recommendations for patients with type 2 diabetes mellitus. Nutr Clin Care, 2003; 6(2):51-61

A healthful way to GAIN weight (Difficulty Level: Basic/Introductory)

A healthful way to GAIN weight (Difficulty Level: Basic/Introductory)

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Unplanned, uncritical weight gain can be unhealthy. Some evidence suggests that obesity plays a deciding factor in about 300,000 premature deaths each year. A person's body weight can often (but not always) give us an indirect view into what types of food they've been consuming. In the population at large (pun intended), this often means unhealthy food choices, which are recently in the process of being redefined with qualifying terms such as "glycemic load" (the type and total carbohydrate we now eat) and "good fats vs. bad fats" (the type and total fat we now eat).

Technology is wonderful and should never be shunned, but one aspect and consequence of food technology is to be able to make foods with broad characteristics that are outside of the range found in any unadulterated food in nature (what you'd get by hunting & gathering). For the first time in history, humans have access to foods with high levels of trans fatty acids (a "bad" fat). Something even our great-grandparents did not have to deal with.

We have also, in general, dramatically increased the glycemic load of the "usual" diet, which can be evidenced by the fact that our current daily blood glucose and insulin readings are often twice the average value found in low-technology indigenous societies. Readings so high that they would be not even be found in 1% of indigenous peoples around the globe, are often found in most (>50%) of a given group of those tested in Western societies.

Though obesity is increasing globally and, along with it's physiological cousin: diabetes, will be the biggest dual-issue (in human health) of the 21st Century, some folks are working to gain a few pounds (athletes, frail elderly, etc). Below is a guideline for them to consider.

To my knowledge, there is not much information on how to gain weight in a healthy way, and this guide serves to break new ground (or break old ground "better" than others have done). As usual, it is meant as a suggestion which folks are invited to consider, rather than as a type or kind of medical advice, such as that which one would receive from their health care professional.

Approximate Weekly Grocery List:


A) Protein sources:

2-3 pounds of boneless, skinless chicken or turkey breast
2-3 cans or foil-packs of tuna or salmon (water packed)
2-3 dozen eggs (for veggie omelettes or hard-boiled eggs)
2-3 pounds of lean beef
 

B) Whole-food carbohydrate sources:

2-3 boxes of brown rice (Minute Rice is best for weight gain, but slightly less healthy)
2-3 cans of Quaker Oats (Quick Oats are best for weight gain, but slightly less healthy)
One (3 lb - 5 lb) bag of white potatoes (but sweet potatoes or yams are healthier)
 

C) Low-carb vegetable sources:

1-2 bags frozen mixed veggies (ones containing veggies of at least 3 different colors - green, red, yellow, orange, etc)

1-2 bags of fresh pre-mixed salad greens (ones containing veggies of at least 3 different colors - green, red, yellow, orange, etc)

*other prominent, single-veggie choices include: red & green pepper, onion, tomato, mushroom, asparagus, spinach, broccoli

 

D) Fruits:

economy-size box of raisins

1-2 dozen bananas

1-2 lbs of grapes

 

E) Miscellaneous:

1 container of brown sugar

1 shaker of cinnamon

1 small bottle of extra-virgin olive oil

1 shaker of either Butter Buds or Molly McButter

1 aerosol can of Pam Butter spray

1 squeeze-bottle of lemon or lime juice (or 2 whole lemons or limes –  to squeeze juice from)

1 bottle Mrs. Dash Salt-Free Seasoning (the "Table Blend" is suggested)

2-3 gallons of spring water (or distilled "drinking water" - with the added minerals)

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Very Rough Outline of Daily Meal Plan:

 
-more than 2 meals per day

-more than 500 total kcal per meal

-more than 25 grams of protein per meal (more than 100 kcal)

-more than 50 grams of carbohydrates per meal (more than 200 kcal)

-more than 10 grams of fat per meal (more than 90 kcal)

-green veggies with at least 1 of the daily meals

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Sample Day:

 
Meal #1:
4-egg (2 whole eggs + 2 egg whites) veggie omelette (w/green pepper, onion, tomato, mushroom) & 1 cup of oatmeal (w/cinnamon, brown sugar, raisins, and sliced banana)

Meal #2:
Chef salad (w/chicken, beef, turkey, or tuna) & 1-2 large baked potatoes (or 2-4 small ones)

Meal #3:
Meat/egg on 1-2 cups brown rice

Meal #4:
Steamed chicken breast AND steamed mixed veggies AND potatoes

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"Nutrition Advice" and "Good Will": commonly separated things. (Difficulty Level: Intermediate)

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The title of this essay makes a claim (to which I provide a key example) - a claim that something other than good will is behind much of the nutrition advice that people on the whole are receiving from various "experts" and "institutions" (whether from government or the private sector). How is this possible? How could a recurrent underlying theme of unchecked bias run through the publications of scientific experts? Answer: money.

Now I am not a Marxist. In fact, I think that Marxists, when taken on the whole, are self-perpetuated ignorant fools (they persistently ignore some key facts). Instead, I am for a free market economy (as Church and State are separated for good reasons; so - ie. for the same reasons - should Economy and State be separated). How then can I criticize money for corrupting nutrition advice if I'm such a free market advocate? Answer: power.

Where is power found in the world today? Answer: institutions. How do institutions acquire the power they have? Answer: statist collectivism (the Big Brother effect of Orwell's 1984).

In the novel 1984 by George Orwell, the citizens are given information by the media, which is controlled by the state-industrial complex of his novel. They are persistently told contradictory things to keep their minds numb to facts, and this allows them to be manipulated by a central power. But how can nutritional advice today compare to Big Brother indoctrinations? Here is an example (regarding advice on the growing epidemic of obesity):

People are told that "a-calorie-is-a-calorie." And they are told that, if you want to lose weight, then you must exercise more often and eat less - as dictated by the Energy Balance Equation (a mathematical equation which states that ENERGY IN (CALORIES EATEN) minus the ENERGY OUT (CALORIES EXPENDED) equals the ENERGY BALANCE (CALORIES STORED AS FAT).

Notice that if the calories expended in a day are more than the calories eaten (in that day), then the "calories stored as fat" will be a negative number; which really just means that you will lose fat that day.

On the surface, this seems quite reasonable as a means to advise the public on weight control. However, upon a close, comprehensive inspection, this equation becomes identified as something that is overly-simplisitic and, therefore, it has less utility, or usefulness, than is commonly recognized by the experts touting it (ie. it's not as "good for you to blindly follow" as the experts would have you believe).

Well, what am I really saying here? Answer: That all calories are not "created" equal - that there are unique effects from unique ways of taking in calories; and unique ways of burning them off.

Well, if what I'm really saying here is true, then where is my evidence? Note: Reasonable persons should always request evidence for any advice which they receive; especially advice on WHAT TO SPEND MONEY ON DAILY - such as advice on what to eat.

Here's a great question for experts (who wish to retain that title) to be forced to answer and explain: Have there been any controlled studies where a group of people ingested more calories (in relation to their body weight and activity level) than another group did - but were still found (in spite of ingesting more relative calories!) to lose more fat? Answer: Yes! (1)

A scientific review (1) which looks at the question of how there can EVER be LESS weight loss with MORE calorie deprivation (as predicted by the simple Energy Balance Equation), fails to find an adequate EXPLANATION of this unexpected finding. But the fact the Energy Balance Equation failed MUST BE ACCOUNTED FOR WHEN GIVING NUTRITION ADVICE.

Notice how this discovery blows the Energy Balance Equation out of the water as far as a means or method of advice for us to blindly follow. If people can EVER lose more fat following the OPPOSITE of what the Energy Balance Equation simplistically predicts, then this equation should NOT be uncritically advocated.

In this review, a very important point is made evident. This point is where my "key example" of ill-willed experts offering us unjustifiable advice stems from. It is "important" if you have good will and care about empowering people with a greater means for weight control. So what's this point that many experts don't account for?

The point is that, whenever calories from fat or carbohydrates are replaced with calories from protein (as in high-protein diets), people lose more weight relative to the total amount of calories they've eaten. In other words, excess carbohydrates and fat are what make you fat, and protein - when eaten as a greater percentage of total calories - helps you lose fat.

If there is one thing you can tell someone in order to make them more fat, then tell them to eat less protein and more carbohydrates and fat (they will be able to gain some fat - even if they don't increase their total calories!).

But who wouldn't want us to know about the scientifically measured, fat-reducing effect of high-protein/low-carb/medium-fat diets? Answer: AgriBusiness (the largest food companies).

The largest food companies won't make as much profit (as they do now) from selling "high-protein" foods - in fact, they are sitting on a grain-based gold mine. Add to this the fact that they have millions (perhaps billions!) invested in the process of "lower-protein" grain production (white flours, which are cheapest to mass produce, are lowest in protein - among other nutrients). Telling folks how to best lose fat would hurt their profit-margins.

My reply to them is that "those are the breaks" in a free market: EITHER produce something actually valued (so that you can sell it to folks) OR take a profit loss.

But, instead of producing something of more value to folks (such as higher protein food that helps them control weight), they ignore the promising results of controlled studies that point to higher protein (but less profitable for them) foods helping people control their body weight.

Protein is consistently down-played (without good evidential support) by experts, while carbohydrates (higher-profit items) are consistently esteemed (again, without good evidential support that they are better sources of calories for us). You will even hear proclamations that we already eat too much protein (that we should eat even less) and that eating more is "unhealthy."

The $64,000-question: Is there any good evidence for this claim that more protein is "unhealthy"?

Here's a great string of questions for experts to be forced to answer and explain: Have there been any controlled studies where a group of people ingested more protein (than the RDA) and were more healthy for it? Have there been any controlled studies where a group of people ingested less protein (down to the RDA from a previous level that was above it) and were less healthy because of it? Are there healthy human societies (Greenland Eskimo, Australian Aborigine, African Masai, etc) that eat more than twice the protein that we do?

While it is true that there is always a dose that is "more than was needed" or that is "more than is healthy" (which are really just restatements of the maxim that "the dose makes the poison"); you will search in vain - as I have - for dozens and dozens of hours (at your local university biomedical library) for any good evidence of harm from "accidentally" eating too much protein.

So what risk DOES have evidential support in controlled studies? Answer: Only folks with pre-existing liver or kidney conditions have been harmed by "being too liberal" with the amount of protein they eat. And if you have a medical condition, then it is ALWAYS advisable to seek the advice of your professional health care specialist (rather than blindly following a statement made by me - or one made by anyone else).

To recap, NO CONTROLLED STUDIES show otherwise healthy folks DEVELOPING DISEASE from eating more protein.

A special note should be added here: people should be eating at least 7 servings of fruits and veggies per day (to capitalize on health benefits that have shown to be evident, measureable, and reproducible; over and over - in several studies)! If you are doing this "eating your 7," then you will be setting the stage for problem-free increases in protein intake.

IF YOU DON'T EAT fruits and veggies often or at all (note: don't count French Fries and ketchup as veggies!), then you may be at an unknown risk if you begin to eat lots of protein. In other words, by starting from such an unbalanced diet in the first place, you may be able to hurt yourself by unbalancing it even further. "Steak and salad" go together, and each one makes the other (by balancing nutrients) more healthy for us.

Extra note: It's also good to eat fish a couple times a week, as this balances out special nutrients called Essential Fatty Acids, which are not quite found in the proper balance in the meats that we commonly consume. Again, notice how the COMBINATION makes each individual food more healthy (individual foods should not be viewed in isolation).

Suggestions that you are invited to personally consider - based on my competence and good will (and not someone's profit margins):
-eating at least 49 servings of fruits & veggies a week (7 a day)
-eating fish twice a week
-for weight loss or control: eating a higher protein diet (25-35% of calories)

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Reference:
1. Buchholz AC and Schoeller DA. Is a calorie a calorie? Am J Clin Nutr 2004;79(suppl):899S-906S

The Ed_ucator ("Ed") 

How to understand every position taken (including Rand's) in the Realism-Nominalism debate (Difficulty Level: Advanced)

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This essay serves 3 purposes:

1) Identification of the distinct positions taken in the Realism-Nominalism debate
2) Identification of Rand's (implicit) position in this debate
3) Final resolution of the "Problem of Universals" (by creating an understanding so clear and sufficient that the problem is decisively transcended)
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Background

"Universals are features (e.g., redness or tallness) shared by many individuals, each of which is said to instantiate or exemplify the universal. Although it began with dispute over the status of Platonic Forms, the problem of universals became a central concern during the middle ages. The metaphysical issue is whether or not these features exist independently of the particular things that have them: realists hold that they do; nominalists hold that they do not; conceptualists hold that they do so only mentally."1


Background Summary

Human thought requires regarding universals as "shared features." Questions or disputes regarding the fact of their existence, taken along with those regarding the nature of any affirmed existence, will altogether exhaust the available positions. There are 4 options regarding the precise genesis of universals. They may be taken to have no instantiation (nominalism); instantiation in entities (realism); instantiation in a particular mind (classic conceptualism); instantiation that is inherent in the MODE of interaction between reality and ANY human mind (intentional conceptualism). The possible positions are summarized below:

A. No existence of shared features (no universals): "nominalism"
B. Shared features in the ontological sense (extra-mental; entity-instantiated): "realism"
C. Shared features in the subjective (objects in the mind) sense: "classical conceptualism"
D. Shared features in the intentional (objective) sense: "intentional conceptualism"

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Who's who (in this debate)?

*4 questions (utilizing 4 modes: non-existence + 3 existences) that, when taken together, sufficiently delineate all available positions.

1. Do universals exist?

**If yes, proceed to question 2;

**if no, you're a cursed nominalist - you may have "trouble" communicating with others as your words have no objective "meaning" - seek psychiatric help if the situation warrants


2. Are universals extra-mental (an existence independent of thought)?

**If yes, you're a cursed ontological realist - probably one of those Scholastic types - go read some more Plato and give away any books by Aristotle, and especially those of Rand;

**if no, proceed to question 3


3. Are universals located in the mind (as the "content" of cognition)?

**If yes, you're a cursed, classical conceptualist - probably one with an arbitrarily invented "criterion of classification" - one who thinks that "units exist qua units" and not solely as "things viewed by a consciousness in certain existing relationships"2 - you probably don't believe that "[t]he conceptual classification of newly discovered existents depends on the nature and extent of their differences from and similarities to the previously known existents."3 ;

**if no, proceed to question 4


4. Are universals merely the form in which humans conceptualize (as the "mode" of cognition)?

**If yes, congratulations! You're an "intentional conceptualist" - the type of thinker Rand was, though she never explicitly stated it in such sufficiently illustrative terms - you realize that "units are things viewed by a consciousness in certain existing relationshps" and that "units do not exist qua units" either in your mind OR outside of it - you realize that units have existence by way of THE INTERACTION of a mind with reality (they're not in the mind or out in reality; they are in the relation of mind to reality;

**if no, you're probably a shifty, post-modern relativist, taking pains to avoid the explicit identification of anything important to humans, probably because of the frightening personal "responsibility to think" that these identifications entail - go rent all of Michael Moore's films and have a movie marathon with a popcorn-bowl full of litely-salted Prozac pills and some diet-soda with double aspartame

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Final note on this new term for an "old" (Randian) type of conceptualism: "intentional" (In order to clarify exactly what "intentional" means in this context).

"Intentional existence is not independent of the human mind, but it is also not dependent on the existence of any one individual mind, as subjective existence is.

Objects that exist for two or more minds, objects that they can discuss with each other, have intentional existence. If there were no minds on earth, there would be no objects that had intentional existence. To summarize this middle ground between real existence and mental existence. It consists in (1) not being dependent on the acts of any particular human mind, and in this respect it differs from subjective existence. And (2) not being independent of the human mind in general, and in this respect it differs from real existence. It is a mode of existence that depends on there being some individual minds at work."4


Conclusion

The quote above (regarding intentional existences) decisively captures Rand's stance, albeit in terms she didn't explicitly use (this clearly categorizes her thought under the newly differentiated position in the ordinal scale: intentional conceptualism). What is remarkably evident is that the intentional existence of concepts is what makes communication possible (acknowledging this position in the scale is necessary to explain, without the contradictions of the other positions, how it is that we can communicate about reality). This occurs because of the "public" nature deriving from the inherent objectivity of proper concept formation (what is subjective is private; what is objective is the same for all). Reality is continuous, but human minds must delineate (due to cognitive limitations, we cannot treat each of the trillions of entities on an individual basis).

In sum, universals don't exist independently, but (human) thinking makes it so. This solves the "Problem" and illuminates Rand's position, putting it in a explicit perspective with regard to the other possible positions.

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Reference:
1. [online] Philosophy Pages (link to dictionary). Accessed 30 Jun 2004.
Available:< http://www.philosophypages.com/dy/index.htm>
2. Rand, Ayn. Introduction to Objectivist Epistemology. page 7
3. ibid. page 73
4. [online] Adler On - Topical Index to the Works of Mortimer J. Adler (link to "Being"). Accessed 30 Jun 2004. Available:< http://www.thegreatideas.org/apd-bein.html>

The 3 Views of Truth (Difficulty Level: Basic/Introductory)

One criterion for education to take place is to first have something to teach. But all "teachings" - whether each is taken in specific parts, or as a general whole - are either true or false.

This immediately brings up the concern over how it is that humans can know whether something is true or false - as well as the concern over whether or not those things which are "known" to be true are indeed true for everybody, always and everywhere; or whether they are merely true for some people, some of the time.

As it happens, there are 3 ways to approach this concern. Each of these 3 ways leads to its own potential solution to the "problem" of understanding exactly what it is that we are talking about - when we find ourselves talking about human "knowledge."

The 3 Views of Truth
There are 3 main views on "truth" or how you might "come into possession of truth" that exist in human thought. Your own idea of what "truth" is will depend on which of the 3 views that you are currently accepting. The 3 views are:

1) the Skepticist view
2) the Intrinsicist view
3) the Objectivist view

1) The Skepticist view is a "subjective" view that advocates the idea that there is no such thing as any "external" truth - truth that is outside of our own internal impression of things (although this view admits that we can be in touch with or, we can REALLY KNOW, our own feelings about things).

2) The Intrincist view is an "ultimate reality" view that advocates the idea that, while there is ultimate truth about things, we cannot get to this truth using traditional human "intelligence."

In other words, it is assumed that we cannot find the truth of the matter about things by "merely" applying logical reasoning to the evidence to which we are exposed (although this view admits that we can "pick up the truth signal" intuitively, and experience a revelation that puts us directly in touch with the ultimate reality of things).

3) The Objectivist view is the traditional "scientific" view that advocates the idea that we can learn the truth about things - although sometimes only very slowly - by systematic observation, by recording what we find, and applying logical reasoning to the evidence that we discover.