This thesis is about the notions of health and pathology in medical theory. I develop a theory, which defines ‘health’ and ‘pathology’ in a way that solves several problems with earlier suggestions of how to define these terms. I call the theory ‘the disposition profile efficiency theory’, abbreviated ‘the DPE-theory’. According to the DPE-theory, a trait token is healthy, roughly, if and only if all of its dispositions for performing physiological functions are efficient enough. A trait token is pathological, roughly, (...) if and only if at least one of its dispositions for performing a physiological function is not efficient enough. The notion of efficiency, I suggest, is reference class-relative: the efficiency of a trait token’s disposition for performing a physiological function expresses a relation between the trait token and a health standard for the trait token’s bearer’s reference class. The thesis also examines the most discussed theory of health and pathology, “the biostatistical theory” proposed by Boorse. Both the DPE-theory and the biostatistical theory are evaluated against a number of desiderata: the theory should be theoretically sound; only use empirical, statistical, and logical terms; not involve values; be clear; both account for health and pathology as reference class-relative properties, and account for the importance of integration of different physiological functions for health; and have reasonable implications. It is argued that the DPE-theory satisfies the desiderata, and that it does so better than the biostatistical theory. The main contributions of the thesis are the DPE-theory’s models of dispositions, its approach to defining reference classes, its efficiency measure, and its way of drawing the line between high enough efficiencies and too low efficiencies. Other important contributions concern the desideratum about reasonable implications. It is shown how the DPE-theory contributes to solving two much discussed objections directed towards the biostatistical theory, “the problem of common diseases” and “Kingma’s dilemma”. Further, the DPE-theory is used to illuminate discussions about certain types of conditions for which it is contested whether they should count as healthy or pathological. (shrink)

There is a growing consensus among neuroscientists that people can become addicted to food, and that at least some cases of obesity have addiction as their cause. By contrast, the rest of the world continues to see obesity as either a disease of the metabolism, or as a reckless case of self-harm. Among obesity researchers, there has been a lively debate on the issue of whether obesity ought to be considered a disease. Few researchers, however, have suggested that obesity is (...) a disease in the same sense as addiction is usually claimed to be a disease—that is, a disease of behaviour with a neurological cause. In this piece, I review what is now a compelling body of evidence for food addiction, to establish that many or most cases of obesity have addiction at their foundation. I then argue that in spite of this, obesity ought not to be considered a neurobehavioural disease in the sense usually attributed to drug addiction. Given the link between addiction and obesity, this implies that the disease conception of addiction must be abandoned. I conclude by assessing some of the implications this move has for policy and ethics, with regard to both obesity and drug addiction. (shrink)

This article investigates five kinds of vagueness in medicine: disciplinary, ontological, conceptual, epistemic, and vagueness with respect to descriptive-prescriptive connections. First, medicine is a discipline with unclear borders, as it builds on a wide range of other disciplines and subjects. Second, medicine deals with many indistinct phenomena resulting in borderline cases. Third, medicine uses a variety of vague concepts, making it unclear which situations, conditions, and processes that fall under them. Fourth, medicine is based on and produces uncertain knowledge and (...) evidence. Fifth, vagueness emerges in medicine as a result of a wide range of fact-value-interactions. The various kinds of vagueness in medicine can explain many of the basic challenges of modern medicine, such as overdiagnosis, underdiagnosis, and medicalization. Even more, it illustrates how complex and challenging the field of medicine is, but also how important contributions from the philosophy can be for the practice of medicine. By clarifying and, where possible, reducing or limiting vagueness, philosophy can help improving care. Reducing the various types of vagueness can improve clinical decision-making, informing individuals, and health policy making. (shrink)