Philosophy of Medicine

Polygene Risk Scores

James Woodward, Kenneth Kendler — Wed, 05 Jul 2023 00:00:00 -0400

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.

Equal Access to Parenthood and the Imperfect Duty to Benefit

J.Y. Lee, Ezio Di Nucci — Thu, 03 Aug 2023 00:00:00 -0400

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.

When, How, and Why Did “Pain” Become Subjective?

Charles Djordjevic — Fri, 02 Jun 2023 00:00:00 -0400

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.

What We Argue about when We Argue about Disease

Harriet Fagerberg — Thu, 21 Dec 2023 00:00:00 -0500

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.

From Evidence-Based Corona Medicine to Organismic Systems Corona Medicine

James A. Marcum, Felix Tretter — Thu, 11 May 2023 00:00:00 -0400

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.

“Tortured Phrases” in Covid-19 Literature

Jaime A. Teixeira da Silva — Thu, 03 Aug 2023 00:00:00 -0400

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.

The Allure of Simplicity

Thomas Grote — Wed, 27 Sep 2023 00:00:00 -0400

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 generalizability and optimizing clinician–machine decision-making. Three opacity amelioration strategies are examined, with explainable artificial intelligence (XAI) as the predominant approach, challenged by two revisionary strategies in the form of reliabilism and the interpretability by design. 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.

Does Schizophrenia Exist?

Georg Repnikov — Thu, 11 May 2023 00:00:00 -0400

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.

On the Relationship between Asymptomatic Infections and Diseases

Martin Zach — Mon, 02 Oct 2023 00:00:00 -0400

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.

Epistemic Injustice Should Matter to Psychiatrists

Ian James Kidd, Lucienne Spencer, Eleanor Harris — Thu, 11 May 2023 00:00:00 -0400

Philosophers of Medicine Should Write More Letters for Medical Journals

Timothy Daly — Thu, 11 May 2023 00:00:00 -0400

The DSM and Its Sociomedical Discontents

Simone Raudino, Francesco Raudino — Fri, 08 Dec 2023 00:00:00 -0500

Review of Jonathan Y. Tsou’s Philosophy of Psychiatry

Hane Htut Maung — Thu, 11 May 2023 00:00:00 -0400

Medical Disorder Is Not a Black Box Essentialist Concept

Harriet Fagerberg — Mon, 31 Jul 2023 00:00:00 -0400

Why It (Also) Matters What Infectious Disease Epidemiologists Call “Disease”

David Stoellger — Wed, 13 Dec 2023 00:00:00 -0500

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.

Methods of Inference and Shaken Baby Syndrome

Nicholas Binney — Thu, 11 May 2023 00:00:00 -0400

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.