Philosophy of Medicine
https://philmed.pitt.edu/philmed
<p><em>Philosophy of Medicine</em> publishes original philosophical research and perspectives, as well as content for health professionals, health scientists and the general public.</p>University of Pittsburgh, University Library Systemen-USPhilosophy of Medicine2692-3963<p>Authors who publish with this journal agree to the following terms:</p> <ol> <li class="show">The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.</li> <li class="show">Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.</li> <li class="show">The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a <a title="CC-BY" href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution 4.0 International License</a> or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions: <ol type="a"> <li class="show">Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site;</li> </ol> with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.</li> <li class="show">The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgement of its initial publication in this journal.</li> <li class="show">Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.</li> <li class="show">Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.</li> <li class="show">The Author represents and warrants that: <ol type="a"> <li class="show">the Work is the Author’s original work;</li> <li class="show">the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;</li> <li class="show">the Work is not pending review or under consideration by another publisher;</li> <li class="show">the Work has not previously been published;</li> <li class="show">the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and</li> <li class="show">the Work contains no libel, invasion of privacy, or other unlawful matter.</li> </ol> </li> <li class="show">The Author agrees to indemnify and hold Publisher harmless from Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.</li> <li class="show">The Author agrees to digitally sign the Publisher’s final formatted PDF version of the Work.</li> </ol>Equal Access to Parenthood and the Imperfect Duty to Benefit
https://philmed.pitt.edu/philmed/article/view/151
<p>Should involuntarily childless people have the same opportunities to access parenthood as those who are not involuntarily childless? In the context of assisted reproductive technologies, affirmative answers to this question are often cashed out in terms of positive rights, including rights to third-party reproduction. In this paper, we critically explore the scope and extent to which any such right would hold up morally. Ultimately, we argue for a departure away from positive parental rights. Instead, we argue that the state has an imperfect duty to benefit involuntarily childless people in relation to their parental aspirations.</p>J.Y. LeeEzio Di Nucci
Copyright (c) 2023 J.Y. Lee, Ezio Di Nucci
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2023-08-032023-08-034110.5195/pom.2023.151When, How, and Why Did “Pain” Become Subjective?
https://philmed.pitt.edu/philmed/article/view/146
<div><span lang="EN-US">The pain-assessment literature often claims that pain is subjective. However, the meaning and implications of this claim are left to the reader’s imagination. This paper attempts to make sense of the claim and its problems from the history and philosophy of science perspective. It examines the work of Henry Beecher, the first person to operationalize “pain” in terms of subjective measurements. First, I reconstruct Beecher’s operationalization of “pain.” Next, I argue this operationalization fails. Third, I salvage Beecher’s insights by repositioning them in an intersubjective account. Finally, I connect these insights to current pain-assessment approaches, showing that they enrich each other.</span></div>Charles Djordjevic
Copyright (c) 2023 Charles Djordjevic
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2023-06-022023-06-024110.5195/pom.2023.146What We Argue about when We Argue about Disease
https://philmed.pitt.edu/philmed/article/view/172
<p>The disease debate in philosophy of medicine has traditionally been billed as a debate over the correct conceptual analysis of the term “disease.” This paper argues that although the debate’s participants overwhelmingly claim to be in the business of conceptual analysis, they do not tend to argue as if this is the case. In particular, they often show a puzzling disregard for key parameters such as precise terminology, linguistic community, and actual usage. This prima facie strange feature of the debate points to an interesting and potentially instructive hypothesis: the disease debate makes little sense within the paradigm of conceptual analysis but makes good sense on the assumption that pathology is a real kind.</p>Harriet Fagerberg
Copyright (c) 2023 Harriet Fagerberg
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2023-12-212023-12-214110.5195/pom.2023.172From Evidence-Based Corona Medicine to Organismic Systems Corona Medicine
https://philmed.pitt.edu/philmed/article/view/138
<div class="page" title="Page 1"> <div class="layoutArea"> <div class="column"> <p>The Covid-19 pandemic has challenged both medicine and governments as they have strived to confront the pandemic and its consequences. One major challenge is that evidence-based medicine has struggled to provide timely and necessary evidence to guide medical practice and public policy formulation. We propose an extension of evidence-based corona medicine to an organismic systems corona medicine as a multilevel conceptual framework to develop a robust concept-oriented medical system. The proposed organismic systems corona medicine could help to prevent or mitigate future pandemics by transitioning to a bifocal medicine that extends an empirical evidence-based medicine to a theory-oriented organismic systems medicine.</p> </div> </div> </div>James A. MarcumFelix Tretter
Copyright (c) 2023 James A. Marcum, Felix Tretter
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2023-05-112023-05-114110.5195/pom.2023.138“Tortured Phrases” in Covid-19 Literature
https://philmed.pitt.edu/philmed/article/view/164
<p><span lang="EN-US">Medical practitioners and healthcare workers rely on information accuracy in academic journals. Some Covid-19 papers contain “tortured phrases”, nonstandard English expressions, or imprecise or erroneous terms, that give the impression of jargon but are not. Most post-publication attention paid to Covid-19 literature has focused on the accuracy of biomedical aspects, the validity of claims, or the robustness of data, but little has been published on linguistic specificity. This paper highlights the existence of “tortured phrases” in select Covid-19 literature, arguing that they could serve as a class of epistemic marker when evaluating the integrity of the scientific and biomedical literature.</span></p> <p> </p>Jaime A. Teixeira da Silva
Copyright (c) 2023 Jaime A. Teixeira da Silva
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2023-08-032023-08-034110.5195/pom.2023.164The Allure of Simplicity
https://philmed.pitt.edu/philmed/article/view/139
<p>This paper develops an account of the opacity problem in medical machine learning (ML). Guided by pragmatist assumptions, I argue that opacity in ML models is problematic insofar as it potentially undermines the achievement of two key purposes: ensuring <em style="font-size: 0.875rem;">generalizability </em>and <em>optimizing clinician–machine decision-making. </em>Three opacity amelioration strategies are examined, with <em>explainable artificial intelligence </em>(XAI) as the predominant approach, challenged by two revisionary strategies in the form of <em>reliabilism </em>and the <em>interpretability by design. </em>Comparing the three strategies, I argue that interpretability by design is most promising to overcome opacity in medical ML. Looking beyond the individual opacity amelioration strategies, the paper also contributes to a deeper understanding of the problem space and the solution space regarding opacity in medical ML.</p> <p> </p>Thomas Grote
Copyright (c) 2023 Thomas Grote
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2023-09-272023-09-274110.5195/pom.2023.139Does Schizophrenia Exist?
https://philmed.pitt.edu/philmed/article/view/15
<p>This paper develops and defends a deflationary analysis of existence claims involving psychiatric disorders. According to this analysis, a given psychiatric disorder exists if, and only if, there are people who have the disorder. The implications of this analysis are spelled out for our views of nosological decision making, and for the relationship between claims about the existence of psychiatric disorders and claims about their reality. A pragmatic view of psychiatric nosology is defended and it is argued that worries about the “reality” of any given disorder have to be distinguished clearly from questions about its existence.</p>Georg Repnikov
Copyright (c) 2023 Georg Repnikov
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2023-05-112023-05-114110.5195/pom.2023.15On the Relationship between Asymptomatic Infections and Diseases
https://philmed.pitt.edu/philmed/article/view/171
<p>Many microbes responsible for infectious diseases are known to run an asymptomatic course in a significant portion of the population. By highlighting the conceptual complexities of host-microbe interactions, this paper elucidates the fact that while many infections remain asymptomatic, this does not necessarily mean that such infections are of no concern for health. The paper builds on the so-called damage-response framework and considers several developments required to gain a more comprehensive perspective on infections and their relationship to diseases. Irrespective of their (short-term) clinical manifestation, infections leave an imprint with consequences for health. Finally, these considerations regarding host-microbe interactions must be incorporated into policy decisions and public understanding of health if we hope to handle future pandemics such as Covid-19 better.</p>Martin Zach
Copyright (c) 2023 Martin Zach
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2023-10-022023-10-024110.5195/pom.2023.171Epistemic Injustice Should Matter to Psychiatrists
https://philmed.pitt.edu/philmed/article/view/159
Ian James KiddLucienne SpencerEleanor Harris
Copyright (c) 2023 Ian James Kidd, Lucienne Spencer, Eleanor Harris
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2023-05-112023-05-114110.5195/pom.2023.159Philosophers of Medicine Should Write More Letters for Medical Journals
https://philmed.pitt.edu/philmed/article/view/161
Timothy Daly
Copyright (c) 2023 Timothy Daly
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2023-05-112023-05-114110.5195/pom.2023.161The DSM and Its Sociomedical Discontents
https://philmed.pitt.edu/philmed/article/view/174
Simone RaudinoFrancesco Raudino
Copyright (c) 2023 Simone Raudino, Francesco Raudino
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2023-12-082023-12-084110.5195/pom.2023.174Review of Jonathan Y. Tsou’s Philosophy of Psychiatry
https://philmed.pitt.edu/philmed/article/view/152
Hane Htut Maung
Copyright (c) 2023 Hane Htut Maung
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2023-05-112023-05-114110.5195/pom.2023.152Medical Disorder Is Not a Black Box Essentialist Concept
https://philmed.pitt.edu/philmed/article/view/165
Harriet Fagerberg
Copyright (c) 2023 Harriet Fagerberg
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2023-07-312023-07-314110.5195/pom.2023.165Why It (Also) Matters What Infectious Disease Epidemiologists Call “Disease”
https://philmed.pitt.edu/philmed/article/view/149
<div> <div> <p class="AbstractParagraphs"><span lang="EN-US">Infectious diseases figure prominently as (counter)examples in debates on how to conceptualize “disease.” But crucial epidemiological distinctions are often not heeded in the debate, and pathological and clinical perspectives focusing on individual patients are favored at the expense of perspectives from epidemiology focusing on populations. In clarifying epidemiological concepts, this paper highlights the distinct contributions infectious disease epidemiology can make to the conception of “disease,” and the fact that this is at least tacitly recognized by medical personnel and philosophers. Crucially, infectious disease epidemiology can help elucidate how carrying and transmitting infectious, communicable entities is a disease, even if the carriers themselves are not directly affected by symptoms detrimental to them.</span></p> <p class="AbstractParagraphs"> </p> </div> </div>David Stoellger
Copyright (c) 2023 David Stoellger
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2023-12-132023-12-134110.5195/pom.2023.149Methods of Inference and Shaken Baby Syndrome
https://philmed.pitt.edu/philmed/article/view/41
<div class="page" title="Page 1"> <div class="layoutArea"> <div class="column"> <p>Exploring the early development of an area of medical literature can inform contemporary medical debates. Different methods of inference include deduction, induction, abduction, and inference to the best explanation. I argue that early shaken baby research is best understood as using abduction to tentatively suggest that infants with unexplained intracranial and ocular bleeding have been assaulted. However, this tentative conclusion was quickly interpreted, by some at least, as a general rule that infants with these pathological signs were certainly cases of abuse. Rather than focusing on inductive arguments, researchers today may be better off focusing on making a compelling inference to the best explanation.</p> </div> </div> </div>Nicholas Binney
Copyright (c) 2023 Nicholas Binney
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2023-05-112023-05-114110.5195/pom.2023.41Polygene Risk Scores
https://philmed.pitt.edu/philmed/article/view/156
<p style="font-weight: 400;">This paper explores the interpretation and use of polygenic risk scores (PRSs). We argue that PRSs generally do not directly embody causal information. Nonetheless, they can assist us in tracking other causal relationships concerning genetic effects. Although their purely predictive/correlational use is important, it is this tracking feature that contributes to their potential usefulness in other applications, such as genetic dissection, and their use as controls, which allow us, indirectly, to "see" more clearly the role of environmental variables.</p>James WoodwardKenneth Kendler
Copyright (c) 2023 James Woodward, Kenneth Kendler
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2023-07-052023-07-054110.5195/pom.2023.156