Despite several criticisms surrounding the DSM classification in psychiatry, a significant bulk of research on mental conditions still operates according to two core assumptions: a) homogeneity, that is the idea that mental conditions are sufficiently homogeneous to justify generalization; b) additive comorbidity, that is the idea that the coexistence of multiple conditions in the same individual can be interpreted as additive. In this paper we take autism research as a case study to show that, despite a plethora of criticism, psychiatric (...) research often continues to operate in accordance with this model. Then we argue that such a model runs into problems once facts about comorbidity are taken into account. Finally, we offer some suggestions on how to tackle the challenge raised by comorbidity and its impact on heterogeneity. To do so, we explore transdiagnostic stratification accounts and network models to show that combining these approaches can move us in the right direction. (shrink)

What is medicine? One obvious answer in the context of the contemporary clinical tradition is that medicine is the process of curing sick people. However, this “curative thesis” is not satisfactory, even when “cure” is defined generously and even when exceptions such as cosmetic surgery are set aside. Historian of medicine Roy Porter argues that the position of medicine in society has had, and still has, little to do with its ability to make people better. Moreover, the efficacy of medicine (...) for improving population health has been famously doubted by historians and epidemiologists. The curative thesis demands that we have mostly been stupid, duped, or staggeringly hopeful, given that medicine has not until recently offered more than a handful of effective cures. I suggest, in this article, that the core medical competence is neither to cure, nor to prevent, disease, but to understand and to predict it. I argue that this approach does a better job than the curative thesis at explaining why not all medicine is concerned with curative efforts and that it enjoys historical support from the ancient entanglement of prophecy and medicine and from the fact that medicine thrived for centuries with almost no effective cures and continues to thrive today in various forms that are mostly without curative efficacy. I suggest that this approach grounds a fairer approach to alternative, traditional, and other medical practices, as well as some fresh lessons for the development of mainstream medicine. (shrink)

What kind of a thing are chronic diseases? Are they objects, bundles of signs and symptoms, properties, processes, or fictions? Rather than using concept analysis—the standard approach to disease in the philosophy of medicine—to answer this metaphysical question, I use a bottom-up, inductive approach. I argue that chronic diseases are bodily states or properties—often dispositional, but sometimes categorical. I also investigate the nature of related pathological entities: pathogenesis, etiology, and signs and symptoms. Finally, I defend my view against alternate accounts (...) of the nature of disease. (shrink)

Despite several criticisms surrounding the DSM classification in psychiatry, a significant bulk of research on mental conditions still operates according to two core assumptions: a) homogeneity, that is the idea that mental conditions are sufficiently homogeneous to justify generalization; b) additive comorbidity, that is the idea that the coexistence of multiple conditions in the same individual can be interpreted as additive. In this paper we take autism research as a case study to show that, despite a plethora of criticism, psychiatric (...) research often continues to operate in accordance with this model. Then we argue that such a model runs into problems once facts about comorbidity are taken into account. Finally, we offer some suggestions on how to tackle the challenge raised by comorbidity and its impact on heterogeneity. To do so, we explore transdiagnostic stratification accounts and network models to show that combining these approaches can move us in the right direction. (shrink)

We are pleased to once again present to the readers of Theoretical Medicine and Bioethics papers from the Philosophy of Medicine Roundtable. Previous issues have followed the 3rd and 4th Roundtables, and the current issue presents a selection from the more than 20 papers presented at the 5th Philosophy of Medicine Roundtable, which took place in New York, at Columbia University, in November 2013. Like its predecessors, held in Birmingham, AL, Rotterdam, and San Sebastian, this Roundtable attracted speakers from around (...) the world. It also featured keynote presentations from Rita Charon of Columbia University and Ross Upshur of the University of Toronto.It may seem somewhat odd to feature a special issue on philosophy of medicine in a journal that effectively has philosophy of medicine in its title. However, a review of the contents of this journal and similar ones, such as the Journal of Medicine and Philosophy, will quickly reveal such an issue’s purpose. The dominant content of these j .. (shrink)