Bottom Up Ethics - Neuroenhancement in Education and Employment

Philosophy

ORIGINAL PAPER Bottom Up Ethics Neuroenhancement in Education and Employment Imre Bard & George Gaskell & Agnes Allansdottir & Rui Vieira da Cunha & Peter Eduard & Juergen Hampel & Elisabeth Hildt & Christian Hofmaier & Nicole Kronberger & Sheena Laursen & Anna Meijknecht & Salvör Nordal & Alexandre Quintanilha & Gema Revuelta & Núria Saladié & Judit Sándor & Júlio Borlido Santos & Simone Seyringer & Ilina Singh & Han Somsen & Winnie Toonders & Helge Torgersen & Vincent Torre & Márton Varju & Hub Zwart Received: 8 February 2018 /Accepted: 18 April 2018 # The Author(s) 2018 Abstract Neuroenhancement involves the use of neurotechnologies to improve cognitive, affective or behavioural functioning, where these are not judged to be clinically impaired. Questions about enhancement have become one of the key topics of neuroethics over the past decade. The current study draws on in-depth public engagement activities in ten European countries giving a bottom-up perspective on the ethics and desirability of enhancement. This informed the design of an online contrastive vignette experiment that was Neuroethics https://doi.org/10.1007/s12152-018-9366-7 Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12152-018-9366-7) contains supplementary material, which is available to authorized users. I. Bard (*) :G. Gaskell Department of Methodology, London School of Economics, London, UK e-mail: firstname.lastname@example.com A. Allansdottir Toscana Life Sciences Foundation, Siena, Italy R. V. da Cunha :A. Quintanilha : J. B. Santos Institute of Molecular and Cellulaor Biology, Porto, Portugal P. Eduard : S. Laursen Experimentarium, Science Communication Centre, Copenhagen, Denmark J. Hampel : C. Hofmaier Center for Interdisciplinary Risk and Innovation Studies, Stuttgart University, Stuttgart, Germany E. Hildt Center for the Study of Ethics in the Professions, Illinois Institute of Technology, Chicago, IL, USA N. Kronberger : S. Seyringer Department of Social and Economic Psychology, Johannes Kepler University, Linz, Austria A. Meijknecht :H. Somsen Tilburg Institute for Law, Technology, and Society, Tilburg University, Tilburg, The Netherlands S. Nordal Centre for Ethics University of Iceland, Reykjavik, Iceland G. Revuelta :N. Saladié Centre on Science, Communication and Society Universitat Pompeu Fabra, Barcelona, Spain J. Sándor :M. Varju The Center for Ethics and Law in Biomedicine Central European University, Budapest, Hungary I. Singh Department of Psychiatry and Oxford Uehiro Centre University of Oxford, Oxford, UK administered to representative samples of 1000 respondents in the ten countries and the United States. The experiment investigated how the gender of the protagonist, his or her level of performance, the efficacy of the enhancer and the mode of enhancement affected support for neuroenhancement in both educational and employment contexts. Of these, higher efficacy and lower performance were found to increase willingness to support enhancement. A series of commonly articulated claims about the individual and societal dimensions of neuroenhancement were derived from the public engagement activities. Underlying these claims, multivariate analysis identified two social values. The Societal/ Protective highlights counter normative consequences and opposes the use enhancers. The Individual/ Proactionary highlights opportunities and supports use. For most respondents these values are not mutually exclusive. This suggests that for many neuroenhancement is viewed simultaneously as a source of both promise and concern. Keywords Neuroenhancement . Social values . Empirical ethics Introduction Neuroenhancement is a controversial area of science and technology that has the potential to influence fundamental aspects of our mental and behavioural functioning. It involves the use of neurotechnologies to improve cognitive, affective or behavioural functioning, where these are not judged to be clinically impaired [1]. There are a range of technologies that might result in neuroenhancing effects, such as pharmaceuticals, braincomputer interfaces, gene editing and brain stimulation. To date, much of the neuroethics literature has focused on the off-label use of pharmaceuticals intended for the treatment of medical conditions, such as attention deficit hyperactivity disorder (ADHD) or narcolepsy [2], and more recently, on transcranial electrical brain stimulation [3–5]. While surveys suggest that some students, academics and medical professionals use prescription substances to enhance their cognitive performance [2, 6–8, 9], the precise extent of this practice is difficult to ascertain. For example, estimates of student use range from 5%–35% depending on the definition of enhancement and the method of assessment [10]. Questions around enhancement have become one of the key challenges for neuroethics and over the past decade the topic has received considerable attention in both academia and in popular culture [11, 12]. A number of national and international reports have addressed the social, legal and ethical aspects of neuroenhancement. The reports call for more research into the effects and side effects of available methods and express varying degrees of scepticism about the prospect of meaningfully improving upon normal capacities ([13]; BMA [14, 15]; Comitato Nazionale per le Bioetica [16]; NCOB [17]; PCOB [18]). Several researchers have highlighted the importance of unders tanding publ ic a t t i tudes towards neuroenhancement and of involving a wide range of stakeholders in deliberations about the governance of the field [19, 20]. An influential report on human enhancement by the European Parliament's Science and Technology Options Assessment agency was among the first to call for the establishment of public fora, where citizens could engage in dialogue about the opportunities and challenges of enhancement, in order to work towards a normative framework for the governance of enhancement technologies [15]. In recent years a body of empirical studies about public views in relation to enhancement has emerged. In 2004 the European Social Survey asked respondents if they approved of 'the use of medicines to improve the memory of healthy people'. Of the ten countries featured later in this paper, on average 53% of the respondents in national samples approved or strongly approved, while 23% disapproved [49]. A Eurobarometer in 2010 found that 58% thought that 'brain and cognitive enhancement' would have a 'positive effect' on 'our way of life over the next 20 years' with 12% saying that it would have a 'negative effect' [21]. Overall, the surveys show considerable interest in enhancement and at most one in five respondents expressing scepticism. I. Bard et al. W. Toonders :H. Zwart Institute for Science, Innovation and Society, Radboud University Nijmegen, Nijmegen, The Netherlands H. Torgersen Institute of Technology Assessment Austrian Academy of Sciences, Vienna, Austria V. Torre Centre for Neurobiology, International School for Advanced Studies, Trieste, Italy Findings from smaller scale and in-depth studies about the ethics of enhancement reveal greater scepticism and show that the public's views are broadly similar to those discussed in the academic literature, namely, concerns about the safety of enhancers and their potential for coercion and inequity are paramount [22]. Drawing on experimental methods to study university students' willingness to use cognitive enhancing drugs, Sattler and his team found evidence of a pragmatic approach to decision-making [23], where perceptions of acceptability were influenced by a variety of situational factors including peer pressure, the user's performance level in the relevant domain, the safety and efficacy of the enhancer and the person's characteristics, such as their moral evaluation of enhancement, prior use, and study habits and motivation [24, 25]. Substances with severe side effects elicited lower willingness to use than those with moderate or slight sideeffects, and willingness was significantly higher when the hypothetical student depicted in the experiment was a low performer, compared to average or high performers [24]. It is notable that two out of three respondents in Sattler et al.'s sample said they would not use cognition enhancing drugs under any circumstances. While Sattler's factorial surveys focused on the university context to investigate the determinants of willingness to use enhancers, a series of contrastive vignette experiments by Fitz et al. [26] studied public attitudes to the most commonly discussed ethical issues around neuroenhancement; safety, pressure to use, fairness and authenticity. They found that respondents were significantly more likely to approve of neuroenhancement and accept its risks if the aim was restorative rather than enhancing, irrespective of whether the method was pharmacological or neuro-stimulation. They found evidence for the hypothesis that attitudes towards the risks and benefits of enhancement differ according to the perceived prosocial nature of the subject's occupation who engages in the enhancement practice. The study also showed that an enhancer that supports greater effort is preferred to an enhancer that replaces effort. Irrespective of the technology in question, respondents reported a high likelihood of using enhancers in the workplace. Furthermore, in terms of fairness the study showed that the public embraces meritocratic views and cherishes hard work [26]. A subsequent study investigated public attitudes to restorative and enhancing uses of pharmaceuticals. Across twelve cognitive, affective and social domains it found that respondents were significantly more comfortable with interventions towards the norm (restoration) than with interventions above the norm (enhancement) [27]. At the same time, stakeholder studies reveal a great deal of ambivalence and the presence of conflicting ethical principles when individuals consider the acceptability of enhancement [28]. Situated within experimental neuroethics the present study was designed to provide further empirical input into discussions about the contours of a normative framework for neuroenhancement. In line with the Forlini and Hall [28] call that research should assess the morally significant values that motivate public attitudes, the study includes a focus on values and the ways in which these influence the pragmatic approach to decision-making identified in earlier studies. To our knowledge, this is the largest investigation of public attitudes to neuroenhancement to date. Methods The study reported here was part of a 39-month European project called Neuroenhancement – Responsible Research and Innovation (NERRI), conducted in ten EU Member States. The project was designed to facilitate public dialogue about the ethics and desirability of neuroenhancement (referred to hereafter as NE). The project ran more than sixty public engagement events in the form of focus groups, workshops, debates, exhibitions, a hackathon and science cafes on the subject of NE. The events involved scientists, ethicists, teachers, students, military officers, medical professionals, entrepreneurs and members of the public. The events ranged from 8-person focus groups to 500 or more attending exhibitions or other live events, and from hour-long group discussions to workshops and activities spanning several days. The outcome of these events was a qualitative appreciation of issues of interest and concern about NE [29]. These insights served as the basis for developing an online survey, in which the aim was to gain a more robust understanding of the public's views about neuroenhancement in the participating EU countries. The United States of America was included in the survey when a project participant moved there. The survey comprised two main sections: 1) two experiments focused on the public's views about neuroenhancement in an educational and employment context; Bottom Up Ethics Neuroenhancement in Education and Employment 2) a series of broader attitude questions related to neuroenhancement; The experiments employed the contrastive vignette technique [30], which is emerging as a powerful method for experimental neuroethics research [26], combining the causal analysis of experimentation with the large sample sizes typical of survey research. Broadly speaking, a vignette is a short account of a situation in which a protagonist with certain characteristics faces a dilemma and choses one of two available courses of action. In its simplest form the contrastive techniques involve presenting minimally different versions of a single vignette to respondents and asking all participants the same set of questions. The minimal contrasts allow experimenters to investigate how a single factor influences people's responses. An advantage of using vignettes for our study is that only a minority of people in our public consultation events had heard about NE. As such, asking respondents for a judgement on NE without providing them with some information about the topic would not have yielded meaningful results. With vignettes, it is possible to give an accessible and non-technical account of NE, embedding the technology in contexts familiar to respondents. Experiment 1 & 2 – Education and Employment It has been established in the literature that therapeutic interventions on the brain are generally not seen as problematic by the public. However, use by nonclinical groups in certain life world situations, such as education or work, appears more contested. Such use has been among the foci of the neuroethics literature [31, 32], and was often raised by members of the public during our engagement activities, leading to lengthy discussions of the possible personal and societal benefits and risks of NE. Following Cohen's [33] typology of enhancement technologies, the situations depicted in the education and employment experiments broadly fall into the same category. They describe reversible, nongenetic, biological enhancements that individuals choose for themselves. The enhancement targets the upper bounds of abilities that people already possess. It is somewhat debatable whether the enhancements described in the life world contexts of education and employment should be considered positional (relative to others) or absolute (of intrinsic value) goods [34]. Respondents were presented with two vignettes, one featuring NE in education, the other NE in employment. The order of presentation of the two contexts was randomised. The experiments were designed to assess whether the type of enhancing technology, its efficacy, the gender of the user, and the user's current level of performance shape attitudes to NE. Efficacy has been shown to be an important factor modulating attitudes towards enhancement [24]. It was also a key question in the qualitative consultation exercises, where a recurrent issue raised by the participants was how well NE actually works. This suggests that both pragmatic and moral assessments may be predicated on such basic facts about the interventions.We hypothesized that a smaller (10%) improvement compared to a larger (50%) improvement would elicit different responses, with higher efficacy making NE more acceptable, because more significant benefits might outweigh perceived risks and other considerations. In relation to the performance of the protagonist earlier studies established that lower performance correlates with higher levels of support [24]. We hypothesise that, with the prospect of a serious loss as a result of failing an examination or losing one's job, there would be greater propensity to accept the possible risks of enhancement [35]. Furthermore, a scenario where a protagonist is acting to avert such a loss might be perceived as a quasitherapeutic intervention [27], and thus seen as more permissible. In our public consultations, discussions often revolved around 'pills' and 'electrical brain stimulation' as two of the currently available methods of NE. The public can draw on a great degree of life-world experience in relation to pills, and a significant proportion of the neuroethics discussion has also focused on this type of NE. Electrical brain stimulation devices are more recent but their neuroenhancing effects [4], commercial availability, and uptake in the DIY community [36] have sparked debates and proposals about the regulation of such cognition enhancing devices [37]. We sought to investigate whether contrasting these two technologies, the more familiar, pharmacological intervention with the less familiar, technological one, would influence attitudes. We also investigate whether the gender of the person engaging in NE would affect responses. The analysis of experimental effects is subsequently complemented by the inclusion of sociodemographic characteristics to assess whether these correlate with certain attitudes. Each factor had two levels; gender (male/female); type of enhancer (pill/device); enhancer efficacy (10% or 50% improvement), and current performance I. Bard et al. (good/failing). The 16 vignettes each present a short story in which the protagonist confronts a problem, which leads to a decision to use NE. Having read the vignette, respondents answer the same set of questions, capturing the outcome variables of interest. Respondents were not aware of the other conditions. The hypotheses relating to the four factors are tested with different versions of the vignette. As respondents see only one vignette this acts against the 'good respondent' effect, the desire to conform to mainstream expectations on moral issues [38]. Communicating possible risks as well as benefits was deemed important to make the scenarios more realistic and life-like. For employment, the risk was described as 'occasional insomnia', similar to Fitz et al.'s (2013), and Sattler's studies [24]. For education, the risk was described as 'some people get a headache after the effect wears off'. Box 1 shows the different versions of the education and employment vignettes. Box 1 Education and Employment Vignettes – English language versions; first names were adapted to local equivalents Employment: (GENDER Paul/Jack/Emily/Sarah) is in his/her mid-30s and works full-time at a big company. Recently, his boss told him that last year his work successfully (PERFORMANCE met / failed) to meet the company's expectations. Paul is determined to get a promotion. This raised Paul's fears that he could lose his job. He recently came across the idea of using (TYPE OF ENHANCER a pill / device) that promises to somewhat / substantially increase a healthy person's concentration and memory, by about (ENHANCER EFFICACY 10% / 50%). (for device only: It delivers tiny electrical currents to stimulate certain areas of the brain using small sticky pads attached to the outside of the head for about 15 min.) In some people, the pill / device can cause occasional insomnia, but there are no known long-term side effects. He decides to give it a try. Education: (GENDER Emily/Jack/Sarah/Paul) is in his/her early twenties and studying full-time at university. His/Her results so far have been (PERFORMANCE good / below average). S/he is currently preparing for his/her examinations. While s/he feels overwhelmedwith howmuchwork s/he has to do, she is aiming for the top grade. / She feels overwhelmedwith howmuchwork she has to do and fears that she may fail the exam. Recently s/he heard about a (TYPE OF ENHANCER pill / device), which promises a (ENHANCER EFFICACY small / significant improvement in the speed of learning in healthy people, but still about 10% / by about 50%). (for device only: It delivers tiny electrical currents to stimulate certain areas of the brain using small sticky pads attached to the outside of the head for about 15 min.) Some people get a headache after the effect wears off, but there are no known long-term side effects. She decides to give it a try. Respondents were randomly allocated a vignette from both contexts and were asked a number of questions after each presentation. Here we report on one key outcome measure: & In (name of protagonist)'s shoes, would you make the same choice? We will refer to the outcome of this question as the respondent's 'willingness to use NE'. The full set of questions and results are available upon request. Responses were recorded on an 11-point scale, ranging from −5 to +5. We assumed that respondents could imagine themselves in the same predicament and to be able to decide whether they would support the protagonist's choice or not. We also assumed that this question, inviting a participant script [39], would induce a more active involvement in the situation than a question asking about the extent to which they approve or support the choice or approve/disapprove of NE in general – a non-participant script. Claims about Neuroenhancement After experiments 1 & 2 respondents were asked to read the following definition of neuroenhancement, which was intended to provide a neutral account of NE introducing some key ideas without influencing respondents to lean either way in their assessment. Scientists are learning more about how our brains work – how we remember, how we think, how we feel and how we perceive the world. This research is driven by the desire to understand the brain and to find treatments for conditions like Alzheimer's, Parkinson's, stroke, and depression. It is hoped that this work will result in new ways of intervening in brain functions to improve the mental abilities and sensory capacities of patients. At the same time, such research might also bring about ways of enhancing the capacities of Bhealthy^ people as well (for example: improve concentration or increase memory). This is called neuroenhancement. The stories you read on the previous pages are just two examples of many possible situations. Some are optimistic about neuroenhancement and think that we will be able to improve our abilities. Others are doubtful because Bottom Up Ethics Neuroenhancement in Education and Employment the brain is very complex and so little is known about how it functions. In the course of the public engagement activities conducted throughout Europe (the United States was not involved in this part of the project), researchers met regularly to discuss their experiences, insights and the issues raised by the participants. A number of recurring themes included the personal and social consequences of NE, therapy and the duty of care, the use of technology to aid human achievement, the future of humanity, potential misuse and regulation. From these themes, the research group identified fourteen commonly mentioned claims about neuroenhancement and the use of technological interventions in human achievement. These claims may be seen as the results of a bottom-up approach to identifying moral and other considerations thought to be of relevance by the public. Box 2 Claims about neuroenhancement In the survey, the following instructions were presented. BHere are some views that people have expressed about neuroenhancement of healthy individuals, and its wider implications for society. Please read the statements below and show how much you agree or disagree with them, using the scale provided (−5 to +5). 1. People should be content with their talents and abilities and not use artificial means to improve their performance 2. It is an expression of human nature to try to overcome the limitations of our body and mind 3. People's achievements should come from their own effort and not from pills and devices 4. I can imagine neuro-enhancement opening up fascinating new opportunities 5. Some people will use neuro-enhancers to cope with increasing demands in life 6. As life gets more pressured, neuro-enhancement may be the only way out 7. It is essential that public authorities oversee and control neuro-enhancement 8. Only people with a medical problem should have access to neuro-enhancement 9. People need to be protected from pressures to use neuro-enhancers 10. If a neuro-enhancer is safe, it should be available as a consumer product 11. Neuro-enhancement should never be used on children 12. Neuro-enhancement should be available to all those whomight want it 13. Neuro-enhancement will increase competition between people 14. Neuro-enhancement will threaten social cohesion Responses were recorded on an 11-point scale, from Strongly disagree (−5) to Strongly agree (+5). Design and Respondents The survey was developed using the Qualtrics web platform. The vignettes and the accompanying questionnaire were designed by the NERRI research group. Translation from English into the national languages was undertaken by members of the research group. Assiduous attention was paid to ensuring comparability of meaning of words and phrases. The vignettes underwent qualitative piloting in focus groups conducted by the Austrian team. Subsequently, the draft survey was piloted on 200 respondents in the UK. Field work was conducted between January and February 2016 in Austria, Denmark, Germany, Hungary, Italy, the Netherlands, Portugal, Spain, UK and the USA by the commercial company Respondi, which coordinates double opt-in access panels of respondents for online surveys. In Iceland, the fieldwork was carried out by Gallup, using the same quotas. In each country quota samples of persons 18 years and above, approximating the national profile of age groups, gender and level of education (tertiary or not) were selected, N = 11,716. The questionnaire included two trap questions to automatically disqualify respondents speeding through the survey; some 400 per country on average. Demographic information was collected at the beginning. In the survey, the experimental vignettes were the first block of questions, followed by respondents' level of agreement with claims about NE. The rationale for this ordering was to ensure that the effects of the experimental treatments (gender, technology, efficacy and performance) would not be influenced by the substantive content of the claims about NE. In other words, the claims might introduce respondents to arguments about NE that they had not previously encountered and these arguments might set the context for responding to the vignettes. Were this to have occurred it would not be possible to claim that changes in responses to the vignettes could be confidently attributed solely to the experimental treatments. However, with this ordering of the questions, it is possible that the experimental treatments created a context effect for responses to the claims, a possibility that we investigate. In reporting the results of the survey, we reverse the order as the claims about NE provide informative descriptive information on respondents' assessment of arguments for and against NE. I. Bard et al. Results and Discussion Claims about Neuroenhancement As described above, this section of the survey included 14 claims derived from a series of public engagement activities. We report descriptive analyses of the level of agreement to these claims and then turn to multivariate methods to explore, whether there are any latent variables underlying the responses. Table 1 shows that there is strong agreement among respondents that neuroenhancement should not be used on children. There is also strong agreement that NE should be controlled by public authorities, that people's achievement should come from their own efforts instead of technological aids, and that people need to be protected from pressures to use enhancers. This suggests that NE is viewed as a technology with significant potential for causing harm and leading to undesirable outcomes, so strong red lines need to be drawn and mechanisms of control put in place. However, there are also indications that the desire to overcome our limitations is an integral part of being human, hinting at a view of human nature as malleable and open to improvement. While this position is strongly held by around 50% of respondents, the same proportion indicated that people should be content with their talents and abilities and not use artificial means to improve performance. Together with the statement about the importance of people's achievement coming from effort, this may be interpreted in multiple ways. Perhaps the public is sensitive to distinctions between different ways of pushing the boundaries of what humans can accomplish. While overall it may appear desirable to surpass our mental and physical limitations, certain means of doing so, such as pills and devices, are still unacceptable. It seems that the value of effort is paramount, and a large proportion of respondents hold the view that the 'natural' distribution and level of talents and abilities should not be tampered with technologically. The boundaries of where and how the human pursuit of improvement becomes undesirable warrants further investigation. Recent evidence suggests that interventions requiring the activity and agency of the subject are seen more favourably than those that involve a pharmaceutical quick fix [40]. Half of the respondents strongly agree that some people will use enhancers to cope with increasing demands and that NE is likely to increase competition among people. On average, responses are slightly above the mid-point of the scale on whether NE will threaten social cohesion, whether NE will open fascinating new opportunities and on questions concerning the group of people who should have access to NE. The average response to whether NE should be available to all is just below the mid-point. Finally, average responses are just below the mid-point, with only 20.5% of respondents agreeing that NE might be the only solution to increasing pressures in life. Table 1 Mean, standard deviation and percentage in agreement with claims Claim Mean (SD) % Agree* Neuro-enhancement should never be used on children 8.0 (2.81) 76 It is essential that public authorities oversee and control neuro-enhancement 7.7 (2.52) 74 People's achievements should come from their own effort and not from pills and devices 7.5 (2.57) 69 People need to be protected from pressures to use neuro-enhancers 7.3 (2.51) 66 It is an expression of human nature to try to overcome the limitations of our body and mind 7.2 (2.18) 68 Some people will use neuro-enhancers to cope with increasing demands in life 7.2 (2.11) 71 People should be content with their talents and abilities and not use artificial means to improve their performance 6.7 (2.85) 57 Neuro-enhancement will increase competition between people 6.6 (2.64) 58 Neuro-enhancement will threaten social cohesion 6.0 (2.76) 45 I can imagine neuro-enhancement opening up fascinating new opportunities 5.9 (2.64) 46 Only people with a medical problem should have access to neuro-enhancement 5.7 (2.97) 45 If a neuro-enhancer is safe, it should be available as a consumer product 5.6 (3.00) 43 Neuro-enhancement should be available to all those who might want it 4.8 (3.22) 34 As life gets more pressured, neuro-enhancement may be the only way out 3.8 (2.83) 21 *0, 1, 2, 3: disagree; 4, 5, 6: neutral; 7, 8, 9, 10: agree Bottom Up Ethics Neuroenhancement in Education and Employment Next, the claims are investigated with multivariate methods. Using principal components analysis, two components with eigenvalues larger than 1 were extracted, which accounted for 43.5% of the variance in the data. The components were found to be uncorrelated (component correlation −0.077) hence it was appropriate to use a Varimax rotation, treating the components as orthogonal. The rotated component loadings are shown in Table 2. A reliability analysis on the items belonging to the two components indicated that the 14 questions may be seen as 2 separate scales measuring distinct concepts, with 7 questions in each scale. Given that the 14 claims about NE were not designed to measure specific latent constructs the interpretation of the two scales is not entirely straightforward. However, it seems justifiable to observe that scale 1 contains items that are prescriptive and formulate views on how NE should be dealt with. These items pertain more to the potential harmful societal consequences of NE and involve protective measures. On the other hand, scale 2 contains items that are more proactionary and individualistic in nature. Hence, we label them 'Societal/Protective (SP for short) and 'Individual/Proactionary' (IP for short) respectively. For the 'Societal/Protective' scale Cronbach's alpha = 0.74; while for the 'Individual/ Proactionary' scale Cronbach's alpha = 0.73. Here, the term proactionary is appropriated from Fuller's work [41] and is understood as an approach that is open to taking individual and societal risks in order to achieve a positive transformation of the human condition. As described in the methods section, these 14 claims were presented to respondents in a randomised order following the two contrastive vignette experiments. Did the vignettes create a context effect in the responses to the 14 claims? To investigate this possibility regression models were fitted using the experimental manipulations as explanatory variables to predict scores on the two scales separately. We found that a few of the sixteen experimental conditions influenced the SP and IP scales. Controlling for other variables, respondents who were randomly allocated to an employment vignette with a high performing protagonist scored on average 0.082 points higher on SP than respondents who were allocated to a low-performing protagonist (p < 0.01). For the education context two experimental factors impacted significantly on the responses to the claims. Respondents allocated to a vignette with a male protagonist instead of a female one scored on average 0.074 points Table 2 Claims loading on societal protective and individual proactionary components Rotated Component Matrixa Claim Component Societal / Protective Individual / Proactionary People should be content with their talents and abilities and not use artificial means to improve their performance .708 People's achievements should come from their own effort and not from pills and devices .722 It is essential that public authorities oversee and control neuro-enhancement .486 Only people with a medical problem should have access to neuro-enhancement .591 People need to be protected from pressures to use neuro-enhancers .571 Neuro-enhancement should never be used on children .449 Neuro-enhancement will threaten social cohesion .673 If a neuro-enhancer is safe, it should be available as a consumer product −.469 .567 Neuro-enhancement should be available to all those who might want it −.553 .509 It is an expression of human nature to try to overcome the limitations of our body and mind .578 I can imagine neuro-enhancement opening up fascinating new opportunities .678 Some people will use neuro-enhancers to cope with increasing demands in life .653 As life gets more pressured, neuro-enhancement may be the only way out .501 Neuro-enhancement will increase competition between people .564 aVarimax with Kaiser normalization, Coefficients below 0.4 suppressed I. Bard et al. higher on SP (p < 0.05) and those assigned to a vignette describing a high performing protagonist vs those with a low performing one scored on average 0.112 points higher (p < 0.001). For IP, a somewhat different pattern emerged. In the employment experiments, a high efficacy enhancer was associated with 0.097 points higher scores on IP compared to a low efficacy intervention (p < 0.01). The same was true for the education context, where a high efficacy NE increased average responses by 0.060 points compared to a low efficacy NE (p < 0.05). While the effects are statistically significant, the regression coefficients are marginal from a substantive point of view and the explained variation is equally small (maximum R2 = 0.002, that is 0.2%). There is a moderate negative correlation between the two scales (Pearson's r = −0.351, p < 0.001), showing, it might be thought, that the two scales capture opposing values. The idea of pairs of values in opposition is a basic feature of a contemporary theory of values, Schwartz places ten universal and core values in a circular structure depending on whether they are in opposition or complimentary. BOne oppositional pair is openness to change versus conservatism. On this dimension, self-direction and stimulation values oppose security, conformity and tradition values^ ([42]: 269). Hence we would expect those subscribing to individual proaction to be opposed to societal protection. To test this idea we recoded the original continuous variables into 3-point categorical variables using a tertile split. Table 3 shows that some people express agreement with both values simultaneously. It is notable that the proportion of those scoring low on SP or IP is very low, suggesting that themajority of respondents can identify, to some extent, with the two value orientations. 40.7% of respondents scored high on SP while having moderate scores on IP. 15% have high scores on both scales. In total, 60.8% of respondents have high SP scores, while 33.9% have high IP scores. This could be a sign of genuine ambivalence expressed as the parallel desire to protect societal values, while also pursuing individual enhancement. Now we turn to the discussion of the contrastive vignette experiments. In a subsequent section, we will analyse how the different value orientations captured by the two scales are related to opinions expressed in the experiment. Contrastive Vignette Experiments Neuroenhancement in Education and Employment We used ordinary least squares regression with the four experimental manipulations (gender of protagonist; pill or device; high or low performance and high or low efficacy) included in the models as dichotomous dummy variables. We first consider the employment context and the effects of the experimental manipulations, looking at the entire dataset of 11 countries (N = 11,716). Table 4, model 1 shows the regression coefficients of the experimental manipulations. The protagonist's gender and the method of NE intervention were not significant predictors of respondents' judgments on whether they would use an enhancer. However, respondents were more likely to believe they would make the same decision to use the enhancer if the protagonist's performance was low (β = −0.355; p < 0.001), and if the enhancer's efficacy was high (β = 0.307, p < 0.001). In substantive terms, the effect of the experimental manipulations was low, yielding a change of around 0.3 units on the 11-point scale. The amount of variation explained by the model is 0.5%. In model 2, sociodemographic indicators are added. The effect of the experimental manipulations is only marginally affected, with the pattern of significant vs. nonsignificant predictors remaining unchanged. On average, female respondents gave lower scores than males on the response variable, by close to half a unit on the 11-point scale. Compared to the 18–24-year-old age group, those aged 45–54 and 55 or above gave increasingly lower scores on the response variable, while possession of a university degree had no effect on the dependent variable. Finally, model 3 includes the scales, SP and IP, derived from the 14 claims about neuroenhancement described in the previous section. The most striking difference between models 2 and 3 is in the amount of variation explained by the regressions. Including the two scales increases the explanatory power of the model Table 3 Cross tabulation of support for societal protective and individual proactionary values Individual/Proactionary value scale Societal/Protective Value Scale 0–3.33 3.34–6.66 6.67–10 Total 0–3.33 0.2% 0.3% 1.8% 2.3% 3.34–6.66 0.8% 19% 17% 36.8% 6.67–10 5.1% 40.7% 15% 60.8% Total 6.1% 60% 33.9% 100% Bottom Up Ethics Neuroenhancement in Education and Employment 17-fold, with the pattern of significant and nonsignificant variables staying the same. Controlling for the other variables in the model, each unit increase on the SP scale is associated with a 0.4-unit drop on the response variable, while each 1-unit increase on the IP scale corresponds to a 0.76-point increase on the dependent variable. This suggests that respondents who expressed concerns about the societal impacts of neuroenhancement and favoured a cautious, protective approach were less likely to endorse neuroenhancement in an employment context. On the other hand, respondents who showed agreement with the IP scale were more likely to be in favour of enhancement. Turning to the education context, Table 5, model 1 shows the regression coefficients of the experimental manipulations on the key response variable. The variation explained by the models is similarly small 0.6% but as in the case of the employment context, some experimental manipulations exerted a significant effect on responses. The protagonist's gender was insignificant. A pill versus a brain stimulation device led to lower average scores of around 0.3 units (p < 0.001). The protagonist's high performance compared to low performance created lower willingness to use an enhancer (β = −0.274, p < 0.001), while higher efficacy NE interventions led to higher willingness to use (β = 0.336, p < 0.001) NE. Model 2 shows that female respondents expressed lower willingness to use a neuroenhancer than males (p < 0.001). With reference to the 18–24-year-old age group, those aged 35 or above gave lower scores on the response variable, with the 55+ age group being most different to the youngest (β = −0.803, p < 0.001). Having completed tertiary education made no difference to the responses. As in the employment context, the amount of variation explained bymodel 3 is 15 times higher than that ofmodel 2 (R2 = 0.27). Controlling for the other variables, each unit increase on the SP scale is associatedwith a 0.45-unit drop on the response variable, while each 1-unit increase on the IP scale corresponds to a 0.76-point increase. It is important to note that the two contexts, education and employment are not directly comparable, because the depicted side effects (headache vs occasional insomnia), benefits (speed of learning vs memory and concentration) and the stakes involved in the two scenarios (exam performance vs job performance) were very different. Notwithstanding these crucial differences, we find that the protagonist's level of performance and the enhancer's efficacy were significant considerations in both contexts, which is in line with the pragmatic approach to NE Table 4 Employment context regression coefficients Employment Context Model 1 Model 2 Model 3 R-squared 0.005 0.016 0.278 Constant term 3.191 (0.067) 3.705 (0.113) 2.193 (0.198) Protagonist's gender (Reference category Female) 0.044 (0.060) 0.052 (0.060) 0.017 (0.051) Protagonist's performance Good (reference category Failing) −0.355*** (0.060) −0.347*** (0.060) −0.284*** (0.051) NE-technology Pill (reference category: Device) 0.070 (0.060) 0.068 (0.060) 0.024 (0.051) NE-efficacy High (reference category: Low) 0.307*** (0.060) 0.317*** (0.060) 0.233*** (0.051) Respondent is female (reference category: Male) −0.491*** (0.060) −0.306*** (0.052) Respondent age 25–34 (reference category 18–24) 0.041 (0.116) 0.016 (0.100) Respondent age 35–44 (reference category 18–24) −0.202 (0.113) −0.172 (0.097) Respondent age 45–54 (reference category 18–24) −0.275* (0.113) −0.204* (0.097) Respondent age 55+ (reference category 18–24) −0.552*** (0.104) −0.283*** (0.089) Respondent has a university degree (reference category: no degree) −0.004 (0.068) −0.101 (0.058) Societal/Protective scale (11-point scale) −0.444*** (0.016) Individual/Proactionary scale (11-point scale) 0.759*** (0.017) Standard errors in parentheses * p < 0.05; ** p < 0.01; *** p < 0.001 Model 1 includes the 4 experimental manipulations represented as dummy variables Model 2 includes Model 1 plus sociodemographic indicators Model 3 includes Model 2 and SP and IP scales I. Bard et al. identified by previous studies. Furthermore, in the education context pills were associated with lower willingness to use than brain stimulation. This finding is somewhat surprising, given that pharmaceuticals are much more familiar and we may reasonably assume that most respondents have had experiences with them, while electrical brain stimulation is a new and unfamiliar intervention. However, the negative effect of pills in the education context may be – at least partially – explained by long standing concerns and discussions about the use psychostimulant medications to address conditions such as attention deficit hyperactivity disorder [43]. A breakdown by country of Table 5 showing the regression coefficients (see Supplementary Material) shows that, with the exception of the two value scales, there are no consistent effects or remarkable differences between countries. We doubt whether the interpretation of the significant effects would justified. Conclusion Large scale survey research assessing the public's support for neuroenhancement in general showed that many people are in favour of the technology to improve the abilities of healthy people. By contrast, the experimental neuroethics literature indicates that people are sceptical about non-medical applications of neurotechnologies, identifying concerns about the safety of non-medical interventions, risks associated with coercion, inequity and authenticity. While therapeutic applications are generally acceptable, the enhancement of healthy people is not [22, 26, 27]. The current study draws on extensive public engagement activities to provide a bottom-up perspective on the ethics of enhancement and to combine this with the experimental and survey methodologies to investigate the public's views about NE. In contrastive vignette experiments we assessed how the gender of the protagonist, his or her level of performance, the efficacy of the enhancer and the mode of enhancement affects support for the use of NE in educational and employment contexts. Respondents were also asked the extent to which they agreed or disagreed with claims about NE that were frequently voiced in a series of public engagement exercises. The results of the experiments show that, as Sattler [24] had found, a pragmatic approach to decision taking is in evidence. We find that Table 5 Education context regression coefficients Education Model 1 Model 2 Model 3 R-squared 0.006 0.018 0.270 Constant term 3.580 (0.069) 4.301 (0.117) 2.668 (0.205) Protagonist's gender (Reference category Female) −0.039 (0.062) −0.039 (0.062) 0.038 (0.053) Protagonist's performance Good (reference category Failing) −0.274*** (0.053) −0.286*** (0.062) −0.206*** (0.053) NE-technology Pill (reference category: Device) −0.293*** (0.053) −0.286*** (0.062) −0.246*** (0.053) NE-efficacy High (reference category: Low) 0.336*** (0.053) 0.341*** (0.062) 0.298*** (0.053) Respondent is female (reference category: Male) −0.489*** (0.062) −0.301*** (0.053) Respondent age 25–34 (reference category 18–24) −0.199 (0.119) −0.226* (0.103) Respondent age 35–44 (reference category 18–24) −0.478*** (0.117) −0.446*** (0.100) Respondent age 45–54 (reference category 18–24) −0.433*** (0.116) −0.363*** (0.100) Respondent age 55+ (reference category 18–24) −0.802*** (0.107) −0.531*** (0.092) Respondent has a university degree (reference category: no degree) 0.042 (0.070) −0.054 (0.060) Societal/Protective scale (11-point scale) −0.450*** (0.017) Individual/Proactionary scale (11-point scale) 0.764*** (0.017) Standard errors in parentheses * p < 0.05; ** p < 0.01; *** p < 0.001 Model 1 includes the 4 experimental manipulations represented as dummy variables Model 2 includes Model 1 plus sociodemographic indicators Model 3 includes Model 2 and SP and IP scales Bottom Up Ethics Neuroenhancement in Education and Employment caution prevails when it comes to applications beyond medical use and the extent to which agreement to use NEs can be modified by such factors is small. Looking at the aggregate data across eleven countries we find that there is no evidence that the use of NE by men and women is viewed differently. In the education context, there is more support for neuroenhancing electrical brain stimulation rather than pills. This finding may be related to a number of factors, including unfavourable representations of drug taking and illegal substances, or to widespread concerns and the high media visibility of debates about psychostimulant ADHD medications, as well as to the low levels of public trust in the pharmaceutical industry [44]. In both the education and employment contexts, when performance is already good respondents see little need for further enhancement. By contrast, NE is more acceptable when performance is low and an extra boost is needed to avoid failure. In both contexts, higher efficacy of NE is associated with greater willingness to use. There is a clear generational divide in willingness to support; the 18–24-year-old respondents show consistently higher agreement to use and as age increases so does agreement to use decline. When deciding whether to support NE or not respondents focus more on the anticipated benefits (efficacy) rather than the technology (pills or device). The claims about NE show that over 70% agree that NE should never be used on children and that it needs oversight from public authorities. Yet, almost 70% agree that overcoming the limitations of mind and body is in human nature and more than 40% say that, if shown to be safe, NEs should be available as consumer products. Looking at the responses to these claims with multivariate methods we find two distinct value orientations the societal protective and the individual proactionary stances. These are strongly correlated with people's views about the use of enhancement in employment and education. The pursuit of the good life is an inextricable part of human nature, which is essentially underpinned by values. In social psychology, the concept of social values not only captures preferences and desires, but also expresses what should, and what should not, be deemed desirable. People feel committed to values, not because they have to, but because theywant to [45].We have seen the role of values very clearly in previous debates about science and technology, such as the public controversy over research on human embryonic stem cells. That debate was characterised by the competing demands of the values of 'duty of care' and the 'sanctity of life' [46]. In passing, with respect to enhancement it seems likely that the value of the 'duty of care' lies behind the almost universal support for therapeutic interventions. Traditionally, social values have been seen as stable, enduring and applying across all walks of life. On this perspective the two value orientations might be argued to reflect different attitudes towards the current and familiar state of affairs and to the risks associated with change. The societal protective outlook views the status quo positively and as the right and proper state of affairs. People are rightly rewarded for hard work; they should be satisfied with their talents and abilities, medicines are only for people who are ill and people need to be protected from pressure to use NE. In contrast, the proactionary sees change and personal growth as a natural part of human motivation; human enhancement is a means to open up new opportunities for individual and social development and, if safe, enhancers should be consumer products. These value orientations result in different evaluations of the effects of NE on society. The proactionary view accepts that NE will increase competition between people and that it will be used to cope with increasing demands in life; the protective outlook fears that enhancement will threaten social cohesion. The values of collectivism and individualism, once taken to be mutually exclusive, are now recognised as co-existing constructs both within cultures and individuals [47]. For many of our respondents NE is viewed through the two perspectives and simultaneously evokes ideas of concern and promise. Parens makes a similar point in a discussion of ethical frameworks that shape people's responses to issues like enhancement technologies. He identifies a gratitude framework (be thankful for what we have) and a creativity framework (an obligation to transform ourselves). But crucially, he argues that Bnone of us who is thoughtful inhabits on only one of these frameworks^ ([48]:38). This ambivalence suggests that there is a need for broad societal engagement with the questions raised by the prospect of enhancement in various spheres of life. Funding This research was funded by the European Commission as part of the study BNeuroenhancement, responsible research and innovation^ Grant Agreement No: 321464. The field work was conducted by Respondi. This study complied with the ethical regulations of the Research Ethics Committee of the London School of Economics. Data created during this research are openly available online at https://zenodo.org/record/166066. I. Bard et al. 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Philosophy

Are	Conspiracy	Theories	a	Force	for	the	Good? Daniel	Cohnitz	is	professor	of	theoretical	philosophy	at	Utrecht	University	and president	of	the	European	Society	for	Analytic	Philosophy. The	NSA	spies	on	you.	Before	Edward	Snowden	leaked	classified	information	in 2013,	which	confirmed	this	claim,	many	would	probably	have	shrugged	it	off	as	a "mere"	conspiracy	theory.	What	about	now?	Is	the	theory	that	the	NSA	spies	on you	still	a	conspiracy	theory,	now	that	it	is	a	widely	held	(and	apparently	wellevidenced)	belief? It	seems	common	to	think	that	it's	not.	That	Caesar	was	murdered	by	a conspiracy	of	Roman	senators,	or	that	9/11	was	the	outcome	of	a	conspiracy among	members	of	al-Quaeda	does	not	make	these	historical	accounts conspiracy	theories.	For	many,	the	latter	requires	that	there	is	an	element	of speculation,	perhaps	paranoia	in	the	belief	of	such	theory. Interestingly,	most	philosophers	who	work	on	conspiracy	theories	disagree	with that	common	understanding	of	the	term.	They	find	it	hard	to	identify	features that	make	conspiracy	theories	an	intrinsically	bad	explanation	type,	in	part because	some	initially	suspicious	conspiracy	theories	(like,	perhaps,	the	theory that	the	NSA	is	spying	on	you)	later	turned	out	to	be	true.	Instead,	these philosophers	argue	that	"conspiracy	theory"	should	be	defined	widely:	a conspiracy	theory	is	the	explanation	of	an	event	that	cites	conspiring	agents	as	a salient	cause.	Consequently,	we	are	all	conspiracy	theorists.	Everyone	who believes	that	some	historical	event	came	about	thanks	to	the	successful	secret collaboration	of	several	individuals	believes	in	a	conspiracy	theory	and	thus	is	a conspiracy	theorist,	and	surely	everyone	believes	this	of	some	event. Since	some	of	these	accounts	are	true	and	known	to	be	true	(e.g.	that	the assassination	of	Caesar	was	due	to	a	conspiracy),	believing	in	a	conspiracy theory	as	such	can't	be	irrational	or	misguided.	In	principle	then	there	is	nothing wrong	with	conspiracy	theories	or	belief	in	such	theories.	Of	course,	sometimes conspiracy	theories	are	mistaken	and	sometimes	they	are	believed	on	the	basis of	insufficient	evidence,	but	that	is	the	possible	fate	of	every	theory.	There	is nothing	that	makes	conspiracy	theories	particularly	irrational,	doubtful	or	fishy, just	because	they	are	conspiracy	theories. Accordingly,	attempts	by	psychologists	and	sociologists	to	investigate	the psychological	and	social	profile	of	conspiracy	believers	might	be	seen	as	nothing but	a	witch-hunt.	In	a	recent	public	statement,	a	group	of	social	epistemologists and	sociologists	(Matthew	R.	X.	Dentith,	Lee	Basham,	David	Coady,	Ginna	Husting, Martin	Orr,	Kurtis	Hagen,	Marius	Raab),	even	argue	that	such	witch-hunt endangers	our	(development	towards	an)	open	society.	In	their	paper,	Social Science's	Conspiracy-Theory	Panic:	Now	They	Want	to	Cure	Everyone,	which	was published	last	year	by	the	Social	Epistemology	Review	&	Reply	Collective,	they	say: "[W]e	believe	that	it	is	not	conspiracy	theorizing	that	is	the	danger,	but rather	the	pathologizing	response	to	conspiracy	theories. The	antidote	to	whatever	problems	conspiracy	theories	present	is vigilance,	not	some	faux	intellectual	sophistication	which	dismisses conspiracy	theories	out	of	hand.	It's	really	quite	simple	when	you	think about	it:	conspiracy	theorising	is	essential	to	the	functioning	of	any democracy,	or	indeed	any	ethically	responsible	society." The	argument	behind	it	is	that	conspiracy	theorising	keeps	the	public	in	critical control	of	the	people	in	power	and	might	prevent	the	latter	from	doing	serious harm.	Such	critically	minded	citizens	should	be	interested	in	developing	an	even more	open	society	with	institutions	that	exercise	mutual	control,	one	might	add, because	that's	what	makes	conspiring	much	harder.	So,	is	conspiracy	theorising not	actually	a	danger	to	our	current	political	system,	but	rather	a	force	for	the good? I	believe	that	these	philosophers	and	sociologists	are	right	in	thinking	that	the problem	with	(certain)	conspiracy	theories	is	not	their	explanation	type,	and	that the	fault	of	conspiracy	theories	needs	to	be	identified	on	a	case	by	case	basis	in the	many	ways	in	which	people	make	mistakes	when	theorising.	But	from	that	it doesn't	follow	that	conspiracy	theorising	in	a	society	is	largely	a	force	for	the good	or	that	we	should	welcome	it	in	the	interest	of	an	open	society. On	the	contrary,	conspiracy	theorising	is	a	danger	to	the	institutions	of	the	open society,	and	this	can	be	shown	on	the	basis	of	social	epistemological considerations	alone. In	any	case,	it	can	already	be	made	plausible	on	the	basis	of	empirical	evidence. Have	a	look	around	at	countries	that	were	on	a	path	to	open,	democratic societies	with	separation	of	power,	freedom	of	speech,	etc.	and	in	which conspiracy	theories	have	played	a	significant	role	in	political	campaigns	that	led to	political	change.	The	examples	I	have	in	mind	are	Turkey,	Hungary,	Poland, and	the	USA.	In	all	these	cases,	the	political	change	induced	was	then	not	at	all towards	a	general	strengthening	of	the	institutions	of	open	societies	so	that these	could	better	exercise	mutual	control.	On	the	contrary,	the	change	was towards	a	mutilation	of	these	institutions	and	a	development	away	from	an	open society	towards	a	closed	society	that	displays	elements	of	an	autocracy. Now,	obviously,	in	all	these	cases	there	is	a	variety	of	factors	that	came	together and	led	to	the	particular	political	development.	I	don't	want	to	argue	that	it	is only	due	to	conspiracy	theorising	that	these	countries	got	off	the	path	to	an	open society.	But	I	do	want	to	argue	that	conspiracy	theorising	has	been	a	causal factor	in	this	process.	There	is	an	epistemological	explanation	for	the	turn	these societies	took. To	see	this,	reflect	for	a	minute	on	the	things	you	know	and	why	you	know	them. Most	of	that	knowledge	stems	from	testimony.	A	lot	of	it	stems	from	the testimony	of	people	that	you	do	not	know	personally	but	that	you	have	trusted anyway	because	you	realized	that	they	have	the	relevant	expertise	on	the	matter. You	get	knowledge	from	reading	the	news,	watching	TV,	reading	books, attending	classes	in	college	or	school,	talking	to	a	physician	or	a	lawyer.	The	fact that	you	attain	knowledge	on	the	basis	of	what	you	read,	see,	and	hear	there	is due	to	the	fact	that	the	people	that	certain	institutions	(like	the	media,	the universities,	colleges,	and	schools)	present	as	experts	actually	are	experts. Now,	unless	we	have	intimate	insight	into	these	institutions	ourselves	and	know how	journalists,	scientists,	lawyers,	physicians,	etc.	work;	how	they	are	trained and	selected	and	what	track	record	they	have	of	getting	things	right,	we	are typically	not	in	a	position	to	evaluate	ourselves	whether	trust	in	these	experts	is justified.	But	then	how	do	we	realize	their	expertise?	Well,	typically	we	do	that on	testimony	as	well.	You	picked	it	up	from	people	that	you	already	trusted	on	a personal	level	like	your	parents	and	others	in	your	close	vicinity	–	who	told	you that	you	can	also	trust	these	institutions	and	their	experts.	Your	parents,	or	those others	in	your	close	vicinity	had	themselves	then	either	direct	personal	reasons to	trust	specific	experts	(perhaps	based	on	personal	acquaintance)	or	also indirect	reasons	for	such	trust,	based	on	the	testimony	of	yet	others. For	such	networks	of	trust	to	lead	to	knowledge,	this	must	somewhere	bottom out	in	(collective)	direct	knowledge	of	the	reliability	of	the	procedures	used	to generate	the	knowledge	in	the	first	place.	But,	typically,	most	people	do	not	have that	direct	knowledge. You	learn	from	your	physician	that	you	should	vaccinate	your	children	because the	benefits	far	outweigh	the	possible	health	risks	this	might	pose	for	your children.	You	don't	know	what	the	evidence	for	that	claim	is,	you	don't	typically check	the	data	that	your	physician	bases	her	recommendations	on.	And	that makes	sense:	if	presented	with	the	empirical	data	and	their	statistical	analysis, most	people	would	be	unable	to	see	whether	the	data	seems	uncorrupted	and whether	the	conclusions	drawn	from	it	are	justified.	They	are	better	off	believing their	physician,	because	she	is	the	expert. In	her	judgment,	to	be	sure,	your	physician	will	be	relying	on	other	expert testimony	herself.	The	statistical	methods	she	is	using	were	developed	and checked	by	statisticians	who	themselves	used	mathematical	methods	that	they did	not	verify,	etc.	This	division	of	cognitive	labour	in	our	complex	societies	is not	just	a	matter	of	saving	us	valuable	time.	It	is	a	matter	of	necessity.	We	cannot check	all	the	interdependent	knowledge	claims	in	our	society	because	it	would be	impossible	to	acquire	all	the	expertise	that	we'd	need	for	doing	this. So,	on	the	one	hand,	our	society	with	its	division	of	cognitive	labour	and	its institutions	that	train	and	systematically	educate	highly	specialized	and knowledgeable	experts,	and	that	provide	incentive	structures	and	selection processes	which	lead	to	reliable	and	trustworthy	performance	of	these	experts, generates	a	lot	of	knowledge.	However,	on	the	other	hand,	this	does	not	by	itself guarantee	that	everyone	can	automatically	benefit	from	the	generated knowledge.	One	needs	to	happen	to	stand	in	a	number	of	stable	enough	personal trust	relations	of	the	right	kind	in	order	to	be	able	to	get	oneself	to	trust	in	the output	of	these	knowledge	generating	institutions. After	all,	for	all	that	most	people	directly	know	about	academia,	the	media	and the	schools,	and	for	all	knowledge	of	facts	they	observed	themselves	and	that they	can	use	in	order	to	verify	claims	made	by	members	of	these	institutions,	this "generated	knowledge"	could	all	just	be	a	major	scam.	Which	brings	us	back	to our	conspiracy	theorists. In	many	of	the	contemporary	problematic	conspiracy	theories,	the	relevant conspirators	are	many,	if	not	all	of	the	institutions	that,	in	open	societies,	are supposed	to	exercise	mutual	control.	Big	pharma	lobbies	politicians	and	pays scientists	and	the	media	to	convince	everyone	else	that	vaccinations	are beneficial	and	pretty	harmless	to	the	recipient	in	order	to	make	profit. If	you	think	you	have	reason	to	believe	such	a	conspiracy	theory,	this	has repercussions	for	your	epistemic	situation.	Let	us	assume	that	you	falsely	believe that	vaccination	is	harmful	for	the	recipient	but	that	this	is	covered	up	in	the	way and	for	the	reasons	described	above. The	heuristic	rules	that	the	relevant	institutions	provide	for	the	identification	of expertise	(e.g.	having	a	scientific	degree,	being	employed	at	such	an	institution, etc.)	will	then	become	useless	to	you	(unless,	of	course,	you'd	see	that	the institutions	react	appropriately	to	the	alleged	fraud	by	firing	corrupt	scientists	or journalists,	which,	of	course,	they	don't,	since	your	theory	is	false).	It	will	also impact	the	way	you	view	the	rest	of	the	trust	network.	Those	members	of	your family	or	your	immediate	vicinity	who	initially	provided	a	pathway	to	benefit from	the	knowledge	produced	by	the	institutions	of	your	society	are	now unreliable.	You	don't	need	to	think	that	they	tried	to	mislead	you,	it	is	sufficient to	think	that	they	too	have	been	misled.	And	indeed,	if	pressed	on	details	of	your new	vaccination	conspiracy	theory	they	don't	have	direct	evidence	that	they	can provide	against	it,	right?	So,	they	naively	believed	on	hearsay,	and	you	can	now "enlighten"	them. As	a	result,	however,	you	are	cut	off	the	knowledge	generated	in	your	society. Presumably	you	have	a	residual	core	of	personal	trust	relations	left.	At	least those	relations	with	your	fellow	"truthers",	the	people	who	put	you	initially	in the	know	about	the	purported	large-scale	conspiracy	that	is	going	on	in	your society.	Your	interest	will	be	that	none	of	the	institutions	that	have	failed	you will	get	in	between	you	and	those	you	personally	trust.	It	will	be	rational	for	you to	prefer	an	information	flow	architecture	that	gives	you	unfiltered	and immediate	access	to	information,	coming	from	persons	to	which	you	(believe	to) stand	in	a	direct	trust	relation. This	is	rational	for	someone	who	believes	a	false	conspiracy	theory,	because	for her	it	seems	that	the	institutions	that	are	meant	to	filter,	mediate,	or	cross-check information,	are	all	corrupt	or	broken.	Note	that	even	though	personal	trust	is necessary	to	participate	in	the	knowledge	generated	in	your	society,	your	trust	in its	institutions	is	not	completely	based	on	testimony.	For	one	thing,	you	may	have direct	evidence	that	the	experts	in	your	society	can't	be	completely	incompetent. Technology	typically	works	and	makes	progress,	occasionally	things	turn	out	the way	that	politicians	promised	such	that	you	experience	the	consequences	of	that improvement	yourself.	But	normally	you	also	observe	that	when	things	go	wrong, there	are	correcting	mechanisms:	journalists	report,	say,	that	scientists	falsified their	data,	and	politics	and	academia	react	properly.	Studies	are	retracted, perhaps	laws	are	changed	in	order	to	ensure	higher	standards,	policies	that	were based	on	the	misinformation	are	changed,	the	scientists	get	punished	or	fired. Thus,	in	order	to	have	trust	in	the	institutions	of	your	society,	you	don't	need	to believe	that	everything	is	always	going	well.	But	you	need	to	believe	that	when things	go	wrong,	the	mutual	control	mechanisms	of	these	institutions	will	detect and	correct	the	mistakes,	and	you	have	occasionally	evidence	that	this	indeed happens. Now,	as	we	already	noted	before,	in	case	that	you	believe	a	false	conspiracy theory,	none	of	this	happens.	The	vaccination	program	doesn't	stop,	scientists just	deny	the	allegations,	politicians	even	discuss	to	introduce	a	formal	duty	to vaccinate	in	order	to	force	vaccination	sceptics	like	you	to	comply.	You	can directly	observe	that	the	system	is	broken.	Why	should	you	want	corrupt institutions	to	become	even	stronger? If	you	get	someone	who	you	personally	trust	into	power	–	perhaps	even	into presidency	-,	you	will	not	be	interested	in	having	that	person's	actions	controlled by	corrupt	institutions.	The	influence	of	these	institutions	would	need	to	be reduced,	their	political	power	limited,	the	swamp	must	be	drained.	It	will	be rational	to	prefer	the	destruction	of	(what	actually	are)	institutions	of	the	open society.	That	is	precisely	what	we	can	empirically	observe	when	open	societies take	an	autocratic	turn	based	on	false	conspiracy	theories. We	started	with	the	observation	that	conspiracies	sometimes	happen	and	that, therefore,	belief	in	a	conspiracy	theory	can't	be	irrational	just	because	you believe	that	certain	events	are	orchestrated	by	a	conspiracy.	Indeed,	uncovering actual	conspiracies	in	our	society	is	important.	Conspiracy	theorising	might occasionally	be	onto	something,	and	when	it	is	we	need	to	know.	So,	shouldn't one	conclude	that	conspiracy	theorising	is	an	important	force	for	the	good	in	our society?	Shouldn't	we	tolerate	the	growth	of	false	conspiracy	theories	as	a harmless	(and	sometimes	even	somewhat	entertaining)	side-effect	of	an important	control	mechanism? I	have	argued	that	this	would	be	naïve.	False	conspiracy	theories	are	dangerous for	the	institutions	of	open	societies.	They	undermine	and	eventually	destroy	the trust	network	that	is	necessary	for	these	institutions	to	perform	their	primary functions.	As	a	consequence,	their	very	existence	may	be	put	in	question.	It	is thus	necessary	that	we	understand	why	(some)	people	are	prone	to	believe	false conspiracy	theories	even	though	the	evidential	situations	for	these	theories seems	objectively	bad.	This	will	require	epistemological,	sociological	and psychological	research	on	conspiracy	theories	and	their	believers.	This	is	not	a witch	hunt.