. Recent philosophers of science have not only revived the classical argument from inductive risk but extended it. I argue that some of the purported extensions do not fit cleanly within the schema of the original argument, and I discuss the problem of overdiagnosis of disease due to expanded disease definitions in order to show that there are some risks in the research process that are important and that very clearly fall outside of the domain of inductive risk. Finally, I (...) introduce the notion of epistemic risk in order to characterize such risks. (shrink)

Understanding the phenomenon of health is crucial for ageing research since there is often an implicit view on what constitutes health and how to measure it. We provide some reflections on how we might better understand and measure health, discuss the basic biological principles of survival, ageing, age-related diseases and eventual death, and end by tying these ideas together to rethink the nature of and implications for healthy ageing. We defend a more positive view on health understood in terms of (...) various phenotypic parameters, such as robustness and resilience, and show how it relates to the aim to support these parameters over time to achieve healthy ageing. Together, these ideas suggest that the most effective strategies for healthy ageing may come from the outside-in by altering those aspects of the environment that prevent robust and resilient phenotypic responses and by supporting those aspects which ensure such responses. (shrink)

The focus of this chapter will be on the epistemic and normative questions at issue in debates about cancer screening, with a special focus on mammography as a case study. Such questions include: How do we know who needs to be screened? What are the benefits and harms of cancer screening, and what is the quality of evidence for each? How ought we to measure and compare these benefits and harms? What are the sources of uncertainty about our estimates of (...) benefit and harm? Why are such issues so contested? What are the major drivers of dissent and consensus on the data and their interpretation? How, if at all, do values play a role in debates surrounding mammography screening? In sum: In what ways does inductive risk, broadly conceived, 1 come into play in the science behind cancer screening, and mammography screening in particular? (shrink)

Helen Longino seeks to break the current deadlock in the ongoing wars between philosophers of science and sociologists of science--academic battles founded on disagreement about the role of social forces in constructing scientific knowledge. While many philosophers of science downplay social forces, claiming that scientific knowledge is best considered as a product of cognitive processes, sociologists tend to argue that numerous noncognitive factors influence what scientists learn, how they package it, and how readily it is accepted. Underlying this disagreement, however, (...) is a common assumption that social forces are a source of bias and irrationality. Longino challenges this assumption, arguing that social interaction actually assists us in securing firm, rationally based knowledge. This important insight allows her to develop a durable and novel account of scientific knowledge that integrates the social and cognitive. Longino begins with a detailed discussion of a wide range of contemporary thinkers who write on scientific knowledge, clarifying the philosophical points at issue. She then critically analyzes the dichotomous understanding of the rational and the social that characterizes both sides of the science studies stalemate and the social account that she sees as necessary for an epistemology of science that includes the full spectrum of cognitive processes. Throughout, her account is responsive both to the normative uses of the term knowledge and to the social conditions in which scientific knowledge is produced. Building on ideas first advanced in her influential book Science as Social Knowledge, Longino brings her account into dialogue with current work in social epistemology and science studies and shows how her critical social approach can help solve a variety of stubborn problems. While the book focuses on epistemological concerns related to the sociality of inquiry, Longino also takes up its implications for scientific pluralism. The social approach, she concludes, best allows us to retain a meaningful concept of knowledge in the face of theoretical plurality and uncertainty. (shrink)

We must restrict to mere probability not only statements of comparatively great uncertainty, like predictions about the weather, where we would cautiously ...

As average lifespans stretch to new lengths, how are human values impacted? Should our values change over the course of our ever-increasing lifespans? Nancy S. Jecker introduces a new concept, the life stage relativity of values, which holds that at different life stages, different ethical concerns should take center stage. For Jecker, the privileging of midlife values raises fundamental problems of fairness, and reveals large gaps in ethical principles and theories. Jecker introduces a new philosophical framework that reflects the life (...) stage relativity of values and shows its relevance to practice and policy. (shrink)

Applied ethics is home to numerous productive subfields such as procreative ethics, intergenerational ethics and environmental ethics. By contrast, there is far less ethical work on ageing, and there is no boundary work that attempts to set the scope for ‘ageing ethics’ or the ‘ethics of ageing’. Yet ageing is a fundamental aspect of life; arguably even more fundamental and ubiquitous than procreation. To remedy this situation, I examine conceptions of what the ethics of ageing might mean and argue that (...) these conceptions fail to capture the requirements of the desired subfield. The key reasons for this are, first, that they view ageing as something that happens only when one is old, thereby ignoring the fact that ageing is a process to which we are all subject, and second that the ageing person is treated as an object in ethical discourse rather than as its subject. In response to these shortcomings I put forward a better conception, one which places the ageing person at the centre of ethical analysis, has relevance not just for the elderly and provides a rich yet workable scope. While clarifying and justifying the conceptual boundaries of the subfield, the proposed scope pleasingly broadens the ethics of ageing beyond common negative associations with ageing. (shrink)

The emerging concept of systems medicine (or ‘P4 medicine’—predictive, preventive, personalized and participatory) is at the vanguard of the post-genomic movement towards ‘precision medicine’. It is the medical application of systems biology, the biological study of wholes. Of particular interest, P4 systems medicine is currently promised as a revolutionary new biomedical approach that is holistic rather than reductionist. This article analyzes its concept of holism, both with regard to methods and conceptualization of health and disease. Rather than representing a medical (...) holism associated with basic humanistic ideas, we find a technoscientific holism resulting from altered technological and theoretical circumstances in biology. We argue that this holism, which is aimed at disease prevention and health optimization, points towards an expanded form of medicalization, which we call ‘holistic medicalization’: Each person’s whole life process is defined in biomedical, technoscientific terms as quantifiable and controllable and underlain a regime of medical control that is holistic in that it is all-encompassing. It is directed at all levels of functioning, from the molecular to the social, continual throughout life and aimed at managing the whole continuum from cure of disease to optimization of health. We argue that this medicalization is a very concrete materialization of a broader trend in medicine and society, which we call ‘the medicalization of health and life itself’. We explicate this holistic medicalization, discuss potential harms and conclude by calling for preventive measures aimed at avoiding eventual harmful effects of overmedicalization in systems medicine (quaternary prevention). (shrink)

Systems medicine, which is based on computational modelling of biological systems, is emerging as an increasingly prominent part of the personalized medicine movement. It is often promoted as ‘P4 medicine’. In this article, we test promises made by some of its proponents that systems medicine will be able to develop a scientific, quantitative metric for wellness that will eliminate the purported vagueness, ambiguity, and incompleteness—that is, normativity—of previous health definitions. We do so by examining the most concrete and relevant evidence (...) for such a metric available: a patent that describes a systems medicine method for assessing health and disease. We find that although systems medicine is promoted as heralding an era of transformative scientific objectivity, its definition of health seems at present still normatively based. As such, we argue that it will be open to influence from various stakeholders and that its purported objectivity may conceal important scientific, philosophical, and political issues. We also argue that this is an example of a general trend within biomedicine to create overly hopeful visions and expectations for the future. (shrink)

November 2009’s announcement of the USPSTF’s recommendations for screening for breast cancer raised a firestorm of objections. Chief among them were that the panel had insufficiently valued patients’ lives or allowed cost considerations to influence recommendations. The publicity about the recommendations, however, often either simplified the actual content of the recommendations or bypassed significant methodological issues, which a philosophical examination of both the science behind screening recommendations and their import reveals. In this article, I discuss two of the leading ethical (...) considerations at issue in screening recommendations: respect for patient autonomy and beneficence and then turn to the most significant methodological issues raised by cancer screening: the potential biases that may infect a trial of screening effectiveness, the problem of base rates in communicating risk, and the trade-offs involved in a judgment of screening effectiveness. These issues reach more broadly, into the use of “evidence-based” medicine generally, and have important implications for informed consent. (shrink)

Research on interdisciplinary science has for the most part concentrated on the institutional obstacles that discourage or hamper interdisciplinary work, with the expectation that interdisciplinary interaction can be improved through institutional reform strategies such as through reform of peer review systems. However institutional obstacles are not the only ones that confront interdisciplinary work. The design of policy strategies would benefit from more detailed investigation into the particular cognitive constraints, including the methodological and conceptual barriers, which also confront attempts to work (...) across disciplinary boundaries. Lessons from cognitive science and anthropological studies of labs in sociology of science suggest that scientific practices may be very domain specific, where domain specificity is an essential aspect of science that enables researchers to solve complex problems in a cognitively manageable way. The limit or extent of domain specificity in scientific practice, and how it constrains interdisciplinary research, is not yet fully understood, which attests to an important role for philosophers of science in the study of interdisciplinary science. This paper draws upon two cases of interdisciplinary collaboration; those between ecologists and economists, and those between molecular biologists and systems biologists, to illustrate some of the cognitive barriers which have contributed to failures and difficulties of interactions between these fields. Each exemplify some aspect of domain specificity in scientific practice and show how such specificity may constrain interdisciplinary work. (shrink)

"--Richard Grandy, Rice University "This is the first compelling diagnosis of what has gone awry in the raging 'science wars.

This paper argues that we can see our lives as a snapshot happening now or as a moving picture extending across time. These dual ways of seeing our lives inform how we conceive of the problem of age group justice. A snapshot view sees age group justice as an interpersonal problem between distinct age groups. A moving picture view sees age group justice as a first-person problem of prudential choice. This paper explores these different ways of thinking about age group (...) justice and illustrates them using a principle of respect for human dignity, understood in terms of reasonable support for floor level central human capabilities at each stage of life. I argue that different frames are suitable for different kinds of decisions, and each provides a true, but partial, picture of aging and age group justice. (shrink)

The reference class problem arises when we want to assign a probability to a proposition (or sentence, or event) X, which may be classified in various ways, yet its probability can change depending on how it is classified. The problem is usually regarded as one specifically for the frequentist interpretation of probability and is often considered fatal to it. I argue that versions of the classical, logical, propensity and subjectivist interpretations also fall prey to their own variants of the reference (...) class problem. Other versions of these interpretations apparently evade the problem. But I contend that they are all “no-theory” theories of probability - accounts that leave quite obscure why probability should function as a guide to life, a suitable basis for rational inference and action. The reference class problem besets those theories that are genuinely informative and that plausibly constrain our inductive reasonings and decisions. I distinguish a “metaphysical” and an “epistemological” reference class problem. I submit that we can dissolve the former problem by recognizing that probability is fundamentally a two-place notion: conditional probability is the proper primitive of probability theory. However, I concede that the epistemological problem remains. (shrink)

Recent efforts to argue that nonepistemic values have a legitimate role to play in assessing scientific models, theories, and hypotheses typically either reject the distinction between epistemic and nonepistemic values or incorporate nonepistemic values only as a secondary consideration for resolving epistemic uncertainty. Given that scientific representations can legitimately be evaluated not only based on their fit with the world but also with respect to their fit with the needs of their users, we show in two case studies that nonepistemic (...) values can play a legitimate role as factors that override epistemic considerations in assessing scientific representations for practical purposes. (shrink)

The Body Multiple is an extraordinary ethnography of an ordinary disease. Drawing on fieldwork in a Dutch university hospital, Annemarie Mol looks at the day-to-day diagnosis and treatment of atherosclerosis. A patient information leaflet might describe atherosclerosis as the gradual obstruction of the arteries, but in hospital practice this one medical condition appears to be many other things. From one moment, place, apparatus, specialty, or treatment, to the next, a slightly different “atherosclerosis” is being discussed, measured, observed, or stripped away. (...) This multiplicity does not imply fragmentation; instead, the disease is made to cohere through a range of tactics including transporting forms and files, making images, holding case conferences, and conducting doctor-patient conversations. The Body Multiple juxtaposes two distinct texts. Alongside Mol’s analysis of her ethnographic material—interviews with doctors and patients and observations of medical examinations, consultations, and operations—runs a parallel text in which she reflects on the relevant literature. Mol draws on medical anthropology, sociology, feminist theory, philosophy, and science and technology studies to reframe such issues as the disease-illness distinction, subject-object relations, boundaries, difference, situatedness, and ontology. In dialogue with one another, Mol’s two texts meditate on the multiplicity of reality-in-practice. Presenting philosophical reflections on the body and medical practice through vivid storytelling, The Body Multiple will be important to those in medical anthropology, philosophy, and the social study of science, technology, and medicine. (shrink)

Douglas proposes a new ideal in which values serve an essential function throughout scientific inquiry, but where the role values play is constrained at key points, protecting the integrity and objectivity of science.

The normal and the pathological are terms used for structures, activities, individual or collective situations proper to living beings and especially to man. The relation of a fact and a norm is its positive or negative value. Can the assessment of behaviours be reduced to noting a necessity? Is a living being's disease a fact similar to universal attraction? The author maintains that diseases are not merely predetermined effects, but are revealing of a normative regulation proper to living beings and (...) man. (shrink)

This book presents the concept of “complementary science” which contributes to scientific knowledge through historical and philosophical investigations. It emphasizes the fact that many simple items of knowledge that we take for granted were actually spectacular achievements obtained only after a great deal of innovative thinking, painstaking experiments, bold conjectures, and serious controversies. Each chapter in the book consists of two parts: a narrative part that states the philosophical puzzle and gives a problem-centred narrative on the historical attempts to solve (...) the puzzle; and the analysis part which provides in-depth analyses of certain scientific, historical, and philosophical aspects of the story. (shrink)

Proponents of the emerging field of P4 medicine argue that computational integration and analysis of patient-specific “big data” will revolutionize our health care systems, in particular primary care-based disease prevention. While many ambitions remain visionary, steps to personalize medicine are already taken via personalized genomics, mobile health technologies and pilot projects. An important aim of P4 medicine is to enable disease prevention among healthy persons through detection of risk factors. In this paper, we examine the current status of P4 medicine (...) in light of historical and current challenges to predictive and preventive medicine, including overdiagnosis and overtreatment. Moreover, we ask whether it is likely that in silico integration of patient-specific data will be able to better deal such challenges and to turn risk predictions into disease-preventive actions in a wider social context. Given the lack of evidence that P4 medicine can tip the balance between benefits and harms in preventive medicine, we raise concerns about the current promotion of P4 medicine as a solution to the current challenges in public health. (shrink)