It is a matter of some irony that psychiatry's most trenchant critic for over four decades is himself a psychiatrist. I refer to Thomas S. Szasz. Szasz's core thesis may be succinctly rendered: mental illness is a “myth”, a “metaphor” which serves only to obscure the social and ethical “problems in living” we face as human beings. This paper reconsiders the conceptual bases of Szasz's assault on psychiatry and assesses recent counter-arguments of his critical interlocutors. It presents a defence of (...) the Szaszian conception and emphasises the continuing relevance of his earliest work. Additionally, the paper discusses Szasz's thesis in light of the work of the influential French philosopher of medicine, Georges Canguilhem. (shrink)

Background Biomedicine, i.e. the application of basic sciences to medicine, has become the cornerstone for the study of etiopathogenesis and treatment of diseases. Biomedicine has enormously contributed to the progress of medicine and healthcare and has become the preferred approach to medical problems in the West. The developments in statistical inference and machine learning techniques have provided the foundation for personalised medicine where clinical management can be fully informed by biomedicine. The deployment of precision medicine may impact the autonomy and (...) self-normativity of the patients. Understanding the relationship between biomedicine and medical practice can help navigate the benefits and challenges offered by precision medicine. Methods Conventional content analysis was applied to “Le Normal and le Pathologique” (Canguilhem G. The Normal and the Pathological. Princeton: Princeton University Press; 1991) and further investigated with respect to its relationship with techne and precision medicine using PubMed and Google Scholar and the Standford Encyclopedia of Philosophy to search for the following keywords singularly or in combination: “Canguilhem”, “techne”, “episteme”, “precision medicine”, “machine learning AND medicine”. Results The Hippocratic concept of techne accounts for many characteristics of medical knowledge and practice. The advances of biomedicine, experimental medicine and, more recently, machine learning offer, in contrast, the model of a medicine based purely on episteme. I argue that Canguilhem medical epistemology establishes a framework where episteme and data-driven medicine is compatible with the promotion of patient’s autonomy and self-normativity. Conclusions Canguilhem’s medical epistemology orders the relationship of applied medicine with experimental sciences, ethics and social sciences. It provides guidance to define the scope of medicine and the boundaries of medicalization of healthy life. Finally, it sets an agenda for a safe implementation of machine learning in medicine. (shrink)

The requirement that animals be used in research and testing in order to protect humans was formalized in the Nuremberg Code and subsequent national and international laws, codes, and declarations. We review the history of these requirements and contrast what was known via science about animal models then with what is known now. We further analyze the predictive value of animal models when used as test subjects for human response to drugs and disease. We explore the use of animals for (...) models in toxicity testing as an example of the problem with using animal models. We conclude that the requirements for animal testing found in the Nuremberg Code were based on scientifically outdated principles, compromised by people with a vested interest in animal experimentation, serve no useful function, increase the cost of drug development, and prevent otherwise safe and efficacious drugs and therapies from being implemented. (shrink)

Evidence-based medicine (EBM) makes use of explicit procedures for grading evidence for causal claims. Normally, these procedures categorise evidence of correlation produced by statistical trials as better evidence for a causal claim than evidence of mechanisms produced by other methods. We argue, in contrast, that evidence of mechanisms needs to be viewed as complementary to, rather than inferior to, evidence of correlation. In this paper we first set out the case for treating evidence of mechanisms alongside evidence of correlation in (...) explicit protocols for evaluating evidence. Next we provide case studies which exemplify the ways in which evidence of mechanisms complements evidence of correlation in practice. Finally, we put forward some general considerations as to how the two sorts of evidence can be more closely integrated by EBM. (shrink)

Although best known as a nineteenth-century neurologist and creator of the rest cure, S. Weir Mitchell was one of the first Americans to engage in large-scale animal experimentation. In 1860 he published Researches Upon the Venom of the Rattlesnake, and in 1886, in collaboration with Dr. Edward T. Reichert, he published Researches Upon the Venoms of Poisonous Serpents. Yet, Mitchell’s pioneering work in scientific medicine remains a little known aspect of his career. This essay, based mainly on primary source material, (...) tells the story of Mitchell’s medical education and research on venomous snakes in order to reveal the ways myth and metaphor influenced medicine as it was becoming a science. (shrink)

Despite the practical knowledge throughout the nineteenth century that citrus fruit cured scurvy, and that rickets and beriberi were diseases caused by poor diet, it was not until 1901 that animal feeding experiments led one investigator to propose the existence of 'accessory food factors,' a lack of which was determined to be the cause of some illnesses (Hopkins, 1949. In Joseph Needham and E. Baldwin (eds.), Hopkins and Biochemistry, 1861-1947: Papers Concerning Sir Frederick Gowland Hopkins, O.M., P.R.S., with a Selection (...) of His Addresses and a Bibliography of His Publications. Cambridge: W. Heifer and Sons Ltd). The discovery of vitamins has long been considered as a delayed discovery. This delay has been attributed to the power of the germ theory in physiology at the time. While the germ theory and theories of autointoxication certainly played a role in delaying the discovery of vitamins, I argue further that it is important to consider the difference made to physiology by understanding the vitamins’ catalytic function. The profound difference made to physiology by the vitamins’ catalytic function suggests that a vitamin concept had previously been systematically inaccessible to researchers working within the conceptual framework of Bernardian physiology. (shrink)

The article reevaluates the reception of Mendelism in France, and more generally considers the complex relationship between Mendelism and plant breeding in the first half on the 20th century. It shows on the one side that agricultural research and higher education institutions have played a key role in the development and institutionalization of genetics in France, whereas university biologists remained reluctant to accept this approach on heredity. But on the other side, plant breeders, and agricultural researchers, despite an interest in (...) Mendelism, never came to see it as the breeders' panacea, and regarded it instead as of only limited value for plant breeding. I account for this judgment in showing that the plant breeders and Mendelism designed two contrasting kinds of experimental systems and inhabited distinct experimental cultures. While Mendelian geneticists designed experimental systems that allowed the production of definite ratios of different forms that varied in relation to a few characters, plant breeders' experimental systems produced a wide range of variation, featuring combinations between hundreds of traits. Rather than breaking this multiple variation down into simple elements, breeders designed and monitored a genetic lottery. The gene was a unit in a Mendelian experimental culture, an "epistemic thing" as Rheinberger put it, that could be grasped by means of statistical regularities, but it remained of secondary importance for French plant breeders, for whom the strain or the variety -- not the gene -- was the fundamental unit of analysis and manipulation. (shrink)

Explaining the complex dynamics exhibited in many biological mechanisms requires extending the recent philosophical treatment of mechanisms that emphasizes sequences of operations. To understand how nonsequentially organized mechanisms will behave, scientists often advance what we call dynamic mechanistic explanations. These begin with a decomposition of the mechanism into component parts and operations, using a variety of laboratory-based strategies. Crucially, the mechanism is then recomposed by means of computational models in which variables or terms in differential equations correspond to properties of (...) its parts and operations. We provide two illustrations drawn from research on circadian rhythms. Once biologists identified some of the components of the molecular mechanism thought to be responsible for circadian rhythms, computational models were used to determine whether the proposed mechanisms could generate sustained oscillations. Modeling has become even more important as researchers have recognized that the oscillations generated in individual neurons are synchronized within networks; we describe models being employed to assess how different possible network architectures could produce the observed synchronized activity. (shrink)

Research in many fields of biology has been extremely successful in decomposing biological mechanisms to discover their parts and operations. It often remains a significant challenge for scientists to recompose these mechanisms to understand how they function as wholes and interact with the environments around them. This is true of the eukaryotic cell. Although initially identified in nineteenth-century cell theory as the fundamental unit of organisms, researchers soon learned how to decompose it into its organelles and chemical constituents and have (...) been highly successful in understanding how these carry out many operations important to life. The emphasis on decomposition is particularly evident in modern cell biology, which for the most part has viewed the cell as merely a locus of the mechanisms responsible for vital phenomena. The cell, however, is also an integrated system and for some explanatory purposes it is essential to recompose it and understand it as an organized whole. I illustrate both the virtues of decomposition (treating the cell as a locus) and recomposition (treating the cell as an object) with recent work on circadian rhythms. Circadian researchers have both identified critical intracellular operations that maintain endogenous oscillations and have also addressed the integration of cells into multicellular systems in which cells constitute units. Ó 2010 Elsevier Ltd. All rights reserved. (shrink)

This article argues that the basic account of mechanism and mechanistic explanation, involving sequential execution of qualitatively characterized operations, is itself insufficient to explain biological phenomena such as the capacity of living organisms to maintain themselves as systems distinct from their environment. This capacity depends on cyclic organization, including positive and negative feedback loops, which can generate complex dynamics. Understanding cyclically organized mechanisms with complex dynamics requires coordinating research directed at decomposing mechanisms into parts and operations with research using computational (...) models to recompose mechanisms and determine their dynamic behavior. This coordinated endeavor yields dynamic mechanistic explanations. (shrink)

Common folks “have” emotions and talk to others; and sometimes they make “their” emotions the topic of such talk. The emotions seem to be “theirs,” since they can be conceived of as private states ; and they can be topicalized, because we seem to be able to attribute or lend a conventionalized public form to some inner state or event. This is the way much of our folk-talk and folk-thinking about emotions, the expression thereof, the role of language in these (...) expressions, and communication in general are organized. However, as we have shown, such talk serves the purpose of communicating effectively and reaching mutual understanding. (shrink)

Since its introduction in 1987, Benjamin Freedman’s principle of clinical equipoise has enjoyed widespread uptake in bioethics discourse. Recent years, however, have witnessed a growing consensus that the principle is fundamentally flawed. One of the most vocal critics has undoubtedly been Franklin Miller. In a 2008 paper, Steven Joffe and Miller build on this critical work, offering a new conception of clinical research ethics based on science, taking what they call a “scientific orientation” toward the ethics of clinical research. Though (...) there is much to recommend Joffe and Miller’s scientifically oriented conception of clinical research ethics, I believe that both the critical and constructive projects suffer from the same basic mistake: inattention to context. The internal norms of science cannot be fully specified, let alone satisfied, independently of contextual (external) factors that only come into view when we are attentive to the particular context of that form of inquiry. (shrink)

Arguments for the autonomy of psychology or other higher-level sciences have often taken the form of denying the possibility of reduction. The form of reduction most proponents and critics of the autonomy of psychology have in mind is theory reduction. Mechanistic explanations provide a different perspective. Mechanistic explanations are reductionist insofar as they appeal to lower-level entities—the component parts of a mechanism and their operations— to explain a phenomenon. However, unlike theory reductions, mechanistic explanations also recognize the fundamental role of (...) organization in enabling mechanisms to engage their environments as units (as well as the role of yet higher-level structures in constraining such engagement). Especially when organization is non-linear, it can enable mechanisms to generate phenomena that are quite surprising given the operations of the components taken in isolation. Such organization must be discovered—it cannot simply be derived from knowledge of lower-level parts and their operations. Moreover, the organized environments in which mechanisms operate must also be discovered. It is typically the higher-level disciplines that have the tools for discovering the organization within and between mechanisms. Although these inquiries are constrained by the knowledge of the parts and operations constituting the mechanism, they make their own autonomous contribution to understanding how a mechanism actually behaves. Thus, mechanistic explanations provide a strong sense of autonomy for higher levels of organization and the inquiries addressing them even while recognizing the distinctive contributions of reductionistic research investigating the operations of the lower level components. (shrink)

Despite the burgeoning interest in new and more complex accounts of the organism-environment dyad by biologists and philosophers, little attention has been paid in the resulting discussions to the history of these ideas and to their deployment in disciplines outside biology—especially in the social sciences. Even in biology and philosophy, there is a lack of detailed conceptual models of the organism-environment relationship. This volume is designed to fill these lacunae by providing the first multidisciplinary discussion of the topic of organism-environment (...) interaction. It brings together scholars from history, philosophy, psychology, anthropology, medicine, and biology to discuss the common focus of their work: entangled life, or the complex interaction of organisms and environments. (shrink)

Contemporary research ethics policies started with reflection on the atrocities perpetrated upon concentration camp inmates by Nazi doctors. Apparently, as a consequence of that experience, the policies that now guide human subject research focus on the protection of human subjects by making informed consent the centerpiece of regulatory attention. I take the choice of context for policy design, the initial prioritization of informed consent, and several associated conceptual missteps, to have set research ethics off in the wrong direction. The aim (...) of this paper is to sort out these confusions and their implications and to offer instead a straightforward framework for considering the ethical conduct of human subject research. In the course of this discussion I clarify different senses of autonomy that have been confounded and present more intelligible justifications for informed consent. I also take issue with several of the now accepted dogmas that govern research ethics. These include: the primacy of informed consent, the protection of the vulnerable, the substitution of beneficence for research's social purpose, and the introduction of an untenable distinction between innovation and research. (shrink)

After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their deficient (...) practical reason or their stunted emotions that are at fault. The evidence supports both explanations. I conclude with an overview of the debate concerning whether they are morally or legally responsible for their actions. (shrink)

Analytical categories of scientific cultures have typically been used both exclusively and universally. For instance, when styles of scientific research are employed in attempts to understand and narrate science, styles alone are usually employed. This article is a thought experiment in interweaving categories. What would happen if rather than employ a single category, we instead investigated several categories simultaneously? What would we learn about the practices and theories, the agents and materials, and the political-technological impact of science if we analyzed (...) and applied styles, paradigms, and models simultaneously? I address these questions in general and for a specific case study: a brief history of systematics. (shrink)

At least historically, it was common for medical practitioners to believe causal hypotheses on the basis of standalone mechanistic reasoning. However, it is now widely acknowledged that standalone mechanistic reasoning is insufficient for appropriately believing a causal hypothesis in medicine, thanks in part to the so-called problem of masking. But standalone mechanistic reasoning is not the only type of mechanistic reasoning. When exactly then is it appropriate to believe a causal hypothesis on the basis of mechanistic reasoning? In this paper, (...) I argue that it has proved difficult to provide a satisfying answer to this question. I also argue that this difficulty is predicted by recent work in knowledge-first epistemology. I think this shows that recent work in epistemology has important implications for practice in the philosophy of science. It is therefore worth paying closer attention in the philosophy of science to this recent work in knowledge-first epistemology. (shrink)

Russo and Williamson put forward the following thesis: in order to establish a causal claim in medicine, one normally needs to establish both that the putative cause and putative effect are appropriately correlated and that there is some underlying mechanism that can account for this correlation. I argue that, although the Russo-Williamson thesis conflicts with the tenets of present-day evidence-based medicine, it offers a better causal epistemology than that provided by present-day EBM because it better explains two key aspects of (...) causal discovery. First, the thesis better explains the role of clinical studies in establishing causal claims. Second, it yields a better account of extrapolation. (shrink)

Sewall Wright first encountered the complex systems characteristic of gene combinations while a graduate student at Harvard's Bussey Institute from 1912 to 1915. In Mendelian breeding experiments, Wright observed a hierarchical dependence of the organism's phenotype on dynamic networks of genetic interaction and organization. An animal's physical traits, and thus its autonomy from surrounding environmental constraints, depended greatly on how genes behaved in certain combinations. Wright recognized that while genes are the material determinants of the animal phenotype, operating with great (...) regularity, the special nature of genetic systems contributes to the animal phenotype a degree of spontaneity and novelty, creating unpredictable trait variations by virtue of gene interactions. As a result of his experimentation, as well as his keen interest in the philosophical literature of his day, Wright was inspired to see genetic systems as conscious, living organisms in their own right. Moreover, he decided that since genetic systems maintain ordered stability and cause unpredictable novelty in their organic wholes (the animal phenotype), it would be necessary for biologists to integrate techniques for studying causally ordered phenomena (experimental method) and chance phenomena (correlation method). From 1914 to 1921 Wright developed his "method of path coefficient" (or "path analysis"), a new procedure drawing from both laboratory experimentation and statistical correlation in order to analyze the relative influence of specific genetic interactions on phenotype variation. In this paper I aim to show how Wright's philosophy for understanding complex genetic systems (panpsychic organicism) logically motivated his 1914-1921 design of path analysis. (shrink)

Sewall Wright first encountered the complex systems characteristic of gene combinations while a graduate student at Harvard's Bussey Institute from 1912 to 1915. In Mendelian breeding experiments, Wright observed a hierarchical dependence of the organism's phenotype on dynamic networks of genetic interaction and organization. An animal's physical traits, and thus its autonomy from surrounding environmental constraints, depended greatly on how genes behaved in certain combinations. Wright recognized that while genes are the material determinants of the animal phenotype, operating with great (...) regularity, the special nature of genetic systems contributes to the animal phenotype a degree of spontaneity and novelty, creating unpredictable trait variations by virtue of gene interactions. As a result of his experimentation, as well as his keen interest in the philosophical literature of his day, Wright was inspired to see genetic systems as conscious, living organisms in their own right. Moreover, he decided that since genetic systems maintain ordered stability and cause unpredictable novelty in their organic wholes, it would be necessary for biologists to integrate techniques for studying causally ordered phenomena and chance phenomena. From 1914 to 1921 Wright developed his "method of path coefficient", a new procedure drawing from both laboratory experimentation and statistical correlation in order to analyze the relative influence of specific genetic interactions on phenotype variation. In this paper I aim to show how Wright's philosophy for understanding complex genetic systems logically motivated his 1914-1921 design of path analysis. (shrink)

This paper addresses the visual culture of late-19th-century experimental physiology. Taking the case of Johann Nepomuk Czermak (1828-1873) as a key example, it argues that images played a crucial role in acquiring experimental physiological skills. Czermak, Emil Du Bois-Reymond (1818-1896) and other late-19th-century physiologists sought to present the achievements and perspective of their discipline by way of "immediate visual perception (unmittelbare Anschauung)." However, the images they produced and presented for this purpose were strongly mediated. By means of specifically designed instruments, (...) such as the "cardioscope," the "contraction telegraph," and the "frog pistol," and of specifically constructed rooms, so-called "spectatoriums," physiologists trained and controlled the perception of their students before allowing them to conduct experiments on their own. Studying the material culture of physiological image production reveals that technological resources such as telegraphy, photography, and even railways contributed to making physiological facts anschaulich. At the same time, it shows that the more traditional image techniques of anatomy played an important role in physiological lecture halls, especially when it came to displaying the details of vivisection experiments to the public. Thus, the images of late 19th century physiology stood half-way between machines and organisms, between books and instruments. (shrink)

This paper addresses the visual culture of late-19th-century experimental physiology. Taking the case of Johann Nepomuk Czermak as a key example, it argues that images played a crucial role in acquiring experimental physiological skills. Czermak, Emil Du Bois-Reymond and other late-19th-century physiologists sought to present the achievements and perspective of their discipline by way of "immediate visual perception." However, the images they produced and presented for this purpose were strongly mediated. By means of specifically designed instruments, such as the "cardioscope," (...) the "contraction telegraph," and the "frog pistol," and of specifically constructed rooms, so-called "spectatoriums," physiologists trained and controlled the perception of their students before allowing them to conduct experiments on their own. Studying the material culture of physiological image production reveals that technological resources such as telegraphy, photography, and even railways contributed to making physiological facts anschaulich. At the same time, it shows that the more traditional image techniques of anatomy played an important role in physiological lecture halls, especially when it came to displaying the details of vivisection experiments to the public. Thus, the images of late 19th century physiology stood half-way between machines and organisms, between books and instruments. (shrink)

In this article I consider some central aspects of the naturalist philosophy of science and science and technology studies in dealing with the contested status of technoscience in medicine. Focusing on the concepts of realism and representation, I argue that theories of science-as-practice in naturalist philosophy of science should expand their scope so as to reflect more thoroughly on the social and political context of technoscience. I develop a hermeneutic of technomedical objects in order to highlight the internal connectedness between (...) social action, material agency, and the actions of scientific communities. The framework thus developed is used to re-consider the genomic turn in medicine. Pointing to the discrepancies between socially dominant representations of genomic technology and the actual interventions brought about through those technologies, I raise the question of how and where to address problems of theory and policy. (shrink)

Louis Pasteur’s defeat of belief in spontaneous generation has been a classical rationalist example of how the experimental approach of modern science can reveal superstition. Farley and Geison told a counter-story of how Pasteur’s success was due to political and ideological support rather than superior experimental science. They claimed that Pasteur violated proper norms of scientific method, and that the French Academy of Science did not see this, or did not want to. Farley and Geison argued that Pouchet’s experiments were (...) as valid as those of Pasteur. In this paper I argue that the core of the scientific debate was not general theories for or against spontaneous generation but the outcome of specific experiments. It was on the conduct of these experiments that the Academy made judgements favorable to Pasteur. Claude Bernard was a colleague of Pasteur, supportive and sometimes critical. I argue that Bernard’s fact-oriented methodology of “experimental medicine” is a better guide to explaining the controversy than the hypothetic-deductive view of scientific method typical of logical empiricism. (shrink)

Contemporary research ethics policies started with reflection on the atrocities perpetrated upoconcentration camp inmates by Nazi doctors. Apparently, as a consequence of that experience, the policies that now guide human subject research focus on the protection of human subjects by making informed consent the centerpiece of regulatory attention. I take the choice of context for policy design, the initial prioritization of informed consent, and several associated conceptual missteps, to have set research ethics off in the wrong direction. The aim of (...) this paper is to sort out these confusions and their implications and to offer instead a straightforward framework for considering the ethical conduct of human subject research. In the course of this discussion I clarify different senses of autonomy that have been confounded and present more intelligible justifications for informed consent. I also take issue with several of the now accepted dogmas that govern research ethics. These include: the primacy of informed consent, the protection of the vulnerable, the substitution of beneficence for research's social purpose, and the introduction of an untenable distinction between innovation and research. (shrink)

Animals can be used in many ways in science and scientific research. Given that society values sentient animals and that basic research is not goal oriented, the question is raised.

The definition of biological individuality is one of the most discussed topics in philosophy of biology, but current debate has focused almost exclusively on evolution-based accounts. Moreover, several participants in this debate consider the notions of a biological individual and an organism as equivalent. In this paper, I show that the debates would be considerably enriched and clarified if philosophers took into account two elements. First, physiological fields are crucial for the understanding of biological individuality. Second, the category of biological (...) individuals should be divided into two subcategories: physiological individuals and evolutionary individuals, which suggests that the notions of organism and biological individual should not be used interchangeably. I suggest that the combination of an evolutionary and a physiological perspective will enable biologists and philosophers to supply an account of biological individuality that will be both more comprehensive and more in accordance with scientific practices. (shrink)

The rationale for the common rejection of classical societal functionalism is that it entails treating a society as an intelligent purposer, capable of directing its own internal organization in furtherance of survival. But a more acceptable alternative account of the origins of a society's functional organization is conceivable: the individual unconsciously recognizes the needs of his group and directs his behaviour so that they are met. The plausibility of this explanation hangs on whether selection between groups occurs to any significant (...) extent, however, and it is therefore on this question that the plausibility of classical societal functionalism itself depends. (shrink)

This article offers a systematic treatment of Beauvoir's reading of biology in The Second Sex. Following Gatens 's suggestion that this chapter has not received the scholarly consideration it demands and deserves, it explains key aspects of Beauvoir's relationship to biological reason by re-telling the story of Beauvoir's early life from the perspective of her scientific education, rationally reconstructing her argument in the chapter on "Biological Data," and exploring the philosophical orientation of her argument using the Frankfurt School model of (...) 'immanent critique.' By illuminating Beauvoir's reading of biology, this article contributes to our understanding of her philosophy while also deflating the widespread assumption that existentialist philosophy is inherently 'anti-science.'. (shrink)