It is unknown to what extent medical researchers generalize study findings beyond their samples when their sample size, sample diversity, or knowledge of conditions that support external validity do not warrant it. It is also unknown to what extent medical researchers describe their results with precise quantifications or unquantified generalizations, i.e., generics, that can obscure variations between individuals. We therefore systematically reviewed all prospective studies (n = 533) published in the top four highest ranking medical journals, Lancet, (...) New England Journal of Medicine (NEJM), Journal of the American Medical Association (JAMA), and the British Medical Journal (BMJ), from January 2022 to May 2023. We additionally reviewed all NEJM Journal Watch clinical research summaries (n = 143) published during the same time. Of all research articles reporting prospective studies, 52.5% included generalizations beyond specific national study populations, with the numbers of articles with generics varying significantly between journals (JAMA = 12%; Lancet = 77%) (p < 0.001, V = 0.48). There was no evidence that articles containing broader generalizations or generics were correlated with larger or more nationally diverse samples. Moreover, only 10.2% of articles with generalizations beyond specific national populations reported external validity strengthening factors that could potentially support such extrapolations. There was no evidence that original research articles and NEJM Journal Watch summaries intended for practitioners differed in their use of broad generalizations, including generics. Finally, from the journal with the highest citation impact, articles containing broader conclusions were correlated with more citations. Since there was no evidence that studies with generalizations beyond specific national study populations or with generics were associated with larger, more nationally diverse samples, or with reports of population similarity that may permit extensions of conclusions, our findings suggest that the generalizations in many articles were insufficiently supported. Caution against overly broad generalizations in medical research is warranted. (shrink)

Current challenges in medical practice, research, and administration demand physicians who are familiar with bioethics, health law, and health economics. Curriculum directors at American Association of Medical Colleges-affiliated medical schools were sent confidential surveys requesting the number of required hours of the above subjects and the years in which they were taught, as well as instructor names. The number of relevant publications since 1990 for each named instructor was assessed by a PubMed search.In sum, teaching (...) in all three subjects combined comprises less than two percent of the total hours in the American medical curriculum, and most instructors have not recently published articles in the fields they teach. This suggests that medical schools should reevaluate their curricula and instructors in bioethics, health law, and health economics. (shrink)

James Rachels’s distinction between killing and letting die maintains that there is morally no difference between killing a terminally ill patient and letting him/her die. Therefore, active and passive euthanasia dichotomy is a distinction without a difference. Hence, if passive euthanasia is allowed, active euthanasia should be permitted too. The paper demonstrated that the distinction between killing and letting die is: (1) irrelevant to euthanasia(2) extraneous to the medical profession, and (3) methodologically degressive. Furthermore, the paper demonstrated invalidity of (...) the bare difference argument of Rachels based on the distinction because of four reasons: (1) irrelevance to American Medical Association’s statement; (2) differences between the cases such as intentionality, causality, and agency; (3) straw man fallacy, (4) and weak analogy. Therefore, the paper concluded that relating the distinction between killings and letting die to bioethics and euthanasia is unjustifiable. (shrink)

The purpose of the research. The main purpose of the study is to find out the experience of researching and solving the problem of professional burnout for physicians including family ones in the United States, by analyzing recent surveys and scientific papers of American and European scientists. Methodology. While working on the article, general scientific theoretical methods were used to accom-plish the tasks and achieve the purpose of the research. The methodological basis of the research was the structural-functional method, (...) which allowed considering the phenomenon of professional burnout as a whole with separate elements and their dependencies. Using a historical method, a brief overview of the research development by US scientists on the problem of professional burnout of physicians with a focus on key events that occurred at each of the stages highlighted in the scientific papers. A comparative method was used to compare the results of surveys of different years and topics, data presented in the proceedings of the scientists, and research approaches. Methods of systematization and generalization were used to formulate the paper’s conclusions, in particular, to highlight the essential features of the American research experience and practical problem solution of professional burnout of physicians. Results. It has been found that the professional burnout of physicians has been a matter of concern for the government, professional medical associations, and the general public for physicians of various US specialties for a long time. Although burnout affects physicians of all disciplines, it has been discovered that, among family physicians, this phenomenon exceeds the average level, especially compared to the general economically active population of the United States. Two approaches to identifying and reducing the risk of occupational burnout in the United States have been identified and characterized: the first approach covers measures aimed directly at a physician, that is, a specific individual, and the second, involves measures aimed at an organization, that is, a medical institution. It has been found that Ameri-can scientists have concluded that organizational measures are more effective, but the first approach should be applied as a first step in overcoming professional burnout. Practical meaning. The results of the research are applicable for further scientific exploration and practical problem solution of professional burnout of physicians, including family ones, in Ukraine. Prospects for further research. Meth-odology of surveys of physicians of various specialties on burnout, depression and professional satisfac-tion. Factors of professional burnout for family physicians in Ukraine. (shrink)

An interview with the American Philosophical Association regarding my work as an academic.

Philosophers often claim that studying philosophy helps people to become better thinkers. Thanks to a grant from the American Philosophical Association, we were able to test this claim empirically, using a large sample of students (N = 122,352) graduating from 369 colleges and universities across the United States between 2010 and 2019. We investigated whether philosophy majors show more growth than non-philosophy majors in intellectual traits like open-mindedness and a tendency to think carefully and thoroughly, as well as (...) more personal forms of growth that might be fostered by philosophical study (e.g., self-understanding). Additionally, although this was not our primary question, we sought to better understand what students who major in philosophy are like. Specifically, we examined the demographics of philosophy majors, the other subjects that they tend to study when they double major, and the patterns of adding and dropping of philosophy majors between freshman and senior year. (shrink)

Since 1964, through 7 revisions, the World Medical Association’s Declaration of Helsinki has stood as an important statement regarding the ethical principles guiding medical research with human participants. It is consulted by ethics review committees, funders, researchers, and research participants. It has been incorporated into national legislation and is routinely invoked to ascertain the ethical appropriateness of clinical trials. There is much to praise about the revision process and the latest revision, which coincides with the declaration’s 50th (...) anniversary. Nevertheless, the proposed declaration contains persistent flaws... (shrink)

Review of British Medical Association handbook on human rights and doctors.

Recent studies show that racism still exists in the American medical profession, the fact of which legitimizes the historically long-legacy of mistrust towards medical profession and health authorities among African Americans. Thus, it was suspected that the participation of black patients in end-of-life care has always been significantly low stemmed primarily from their mistrust of the medical profession. On the other hand, much research finds that there are other reasons than the mistrust which makes African Americans (...) feel reluctant to the end-of-life care, such as cultural-religious difference and genuine misunderstanding of the services. If so, two crucial questions are raised. One is how pervasive or significant the mistrust is, compared to the other factors, when they opt out of the end-of-life care. The other is if there is a remedy or solution to the seemingly broken relationship. While no studies available answer these questions, we have conducted an experiment to explore them. The research was performed at two Philadelphia hospitals of Mercy Health System, and the result shows that Black patients’ mistrust is not too great to overcome and that education can remove the epistemic obstacles as well as overcome the mistrust. (shrink)

The practice of medicine frequently involves the unconsented restriction of liberty. The reasons for unilateral liberty restrictions are typically that being confined, strapped down, or sedated are necessary to prevent the person from harming themselves or others. In this paper, we target the ethics of chemical restraints, which are medications that are used to intentionally restrict the mental states associated with the unwanted behaviors, and are typically not specifically indicated for the condition for which the patient is being treated. Specifically, (...) we aim to identify the conditions under which chemical restraints are ethically permissible. It is wrong to assume that what is morally true of physical restraints is also true of chemical restraints. Our aim is thus to identify the conditions under which chemical restraints are permissible while distinguishing these conditions from those of the application of physical restraints. (shrink)

Much of the discussion of the role of emerging technologies associated with AI, machine learning, digital simulacra, and relevant ethical considerations such as those discussed in the target article, take a relatively narrow and episodic view of a person’s healthcare needs. There is much speculation about diagnostic, treatment, and predictive applications but relatively little consideration of how such technologies might be used to address a person’s lived experience of illness and ongoing care needs. This is likely due to the greater (...) weight or priority given to acute care needs and the role of medical treatment in care provision, but it may also reflect the limitations of current technologies and our limited vision of their potential application. Such limitations are not surprising given that we are still grappling with the complexities and nuances of achieving the ethical and humanistic ideals of care, namely, care that addresses the hermeneutical, relational, contextual, temporal, and agential dimensions of a person’s health and wellbeing. (shrink)

Aim: Low professional help-seeking intention (PHSI) hinders effective treatment of mental illness. PHSI among Chinese students is still understudied and under-recognized. This study aimed to evaluate the status of PHSI and its associated risk factors among Chinese medical students. -/- Methods: A cross-sectional survey was conducted in Hainan province, South China, between January 1, 2021, and May 31, 2021. A total of 2182 medical students were recruited and surveyed via an anonymous structured questionnaire. Logistic regression analyses were performed (...) to identify the factors associated with PHSI. -/- Results: Among the 2182 medical students (mean age 21.0 years (SD = 3.70), 61.5% females), those with and without PHSI were 72.0% and 28.0%, and 16.4% with moderate to severe depression. Male students, those with a high level of depression stigma, serious family dysfunction, and heavy dependence on mobile phones were significantly less likely to seek professional mental health help, with odds ratios (ORs) of 1.5, 2.0, 2.1, and 1.7, respectively. -/- Conclusion: A significant proportion of Chinese medical students demonstrate low PHSI, influenced by factors such as gender, depression stigma, family dysfunction, and mobile phone dependence. Future interventions aimed at increasing medical students’ PHSI should prioritize reducing depression stigma, mitigating reliance on mobile phone use, and enhancing family function to address these key barriers to seeking professional mental health support. (shrink)

Rationale and objectives: Medical humanities are becoming increasingly recognized as positively impacting medical education and medical practice. However, the extent of medical humanities teaching in medical schools is largely unknown. We reviewed medical school curricula in Canada, the UK and the US. We also explored the relationship between medical school ranking and the inclusion of medical humanities in the curricula. -/- Methods: We searched the curriculum websites of all accredited medical schools (...) in Canada, the UK and the US to check which medical humanities topics were taught, and whether they were mandatory or optional. We then noted rankings both by Times Higher Education and U.S. News and World Report and calculated the average rank. We formally explored whether there was an association between average medical school ranking and medical humanities offerings using Spearman's correlation and inverse variance weighting meta-analysis. -/- Results: We identified 18 accredited medical school programmes in Canada, 41 in the UK, and 154 in the US. Of these, nine (56%) in Canada, 34 (73%) in the UK and 124 (80%) in the US offered at least one medical humanity that was not ethics. The most common medical humanities were medical humanities (unspecified), history, and literature (Canada); sociology and social medicine, medical humanities (unspecified), and art (UK); and medical humanities (unspecified), literature and history (US). Higher ranked medical schools appeared less likely to offer medical humanities. -/- Conclusions: The extent and content of medical humanities offerings at accredited medical schools in Canada, the UK and the US varies, and there appears to be an inverse relationship between medical school quality and medical humanities offerings. Our analysis was limited by the data provided on the Universities' websites. Given the potential for medical humanities to improve medical education and medical practice, opportunities to reduce this variation should be exploited. (shrink)

In contemporary healthcare, medical image categorization is essential for illness prediction, diagnosis, and therapy planning. The emergence of digital imaging technology has led to a significant increase in research into the use of machine learning (ML) techniques for the categorization of images in medical data. We provide a thorough summary of recent developments in this area in this review, using knowledge from the most recent research and cutting-edge methods.We begin by discussing the unique challenges and opportunities associated with (...) medical image classification, including the complexity of anatomical structures, variability in imaging modalities, and the need for interpretability and reliability in clinical settings. Subsequently, we survey a wide range of ML algorithms and techniques employed for medical image classification, including traditional methods such as support vector machines and k-nearest neighbors, as well as deep learning approaches like convolutional neural networks (CNNs) and recurrent neural networks (RNNs). Furthermore, we examine key considerations in dataset preparation, feature extraction, and model evaluation specific to medical image classification tasks. We highlight the importance of large, annotated datasets, transfer learning, and data augmentation techniques in enhancing model performance and generalization. (shrink)

Recent theorists of cultural studies have noticed the emergence of metamodernity as an ideal type, categorized by an oscillation between postmodern deconstructivism and modern idealism, into a form of transcendentalism. I argue in this chapter that this type of transcendentalism, informed by the historical American Transcendentalist Movement, is the emerging ideal called “Transhumanism.” I use a case study of five Japanese anime to demonstrate how transhumanist, metamodernist, and transcendental thinking often recur in key core plot points and narratives found (...) within. I further suggest that meditation on the major themes in these anime, especially those of metamodernity and transhumanism, is necessary if we are to understand our place in the world today and into the future. -/- The final version of this paper can be found in Anime, Philosophy, and Religion, Ed. Hayashi and Anderson, by Vernon Press. See "external links" for how to order the whole volume, the final version is also available on google books (see link). -/- A previous version of this paper was awarded the Outstanding Doctoral Paper Award 2023, Southwestern Sociological Association. (shrink)

The Unified Medical Language System and the Gene Ontology are among the most widely used terminology resources in the biomedical domain. However, when we evaluate them in the light of simple principles for wellconstructed ontologies we find a number of characteristic inadequacies. Employing the theory of granular partitions, a new approach to the understanding of ontologies and of the relationships ontologies bear to instances in reality, we provide an application of this theory in relation to an example drawn from (...) the context of the pathophysiology of hypertension. This exercise is designed to demonstrate how, by taking ontological principles into account we can create more realistic biomedical ontologies which will also bring advantages in terms of efficiency and robustness of associated software applications. (shrink)

Medical assistance in dying, which includes voluntary euthanasia and assisted suicide, is legally permissible in a number of jurisdictions, including the Netherlands, Belgium, Switzerland and Canada. Although medical assistance in dying is most commonly provided for suffering associated with terminal somatic illness, some jurisdictions have also offered it for severe and irremediable psychiatric illness. Meanwhile, recent work in the philosophy of psychiatry has led to a renewed understanding of psychiatric illness that emphasises the role of the relation between (...) the person and the external environment in the constitution of mental disorder. In this paper, I argue that this externalist approach to mental disorder highlights an ethical challenge to the practice of medical assistance in dying for psychiatric illness. At the level of the clinical assessment, externalism draws attention to potential social and environmental interventions that might have otherwise been overlooked by the standard approach to mental disorder, which may confound the judgement that there is no further reasonable alternative that could alleviate the person’s suffering. At the level of the wider society, externalism underscores how social prejudices and structural barriers that contribute to psychiatric illness constrain the affordances available to people and result in them seeking medical assistance in dying when they otherwise might not have had under better social conditions. (shrink)

More than thirty-five years after its first release in 1971, Don McLean’s “American Pie” still resonates deeply with music listeners and consumers of popular culture. In a 2001 public poll sponsored by the National Endowment for the Arts and the Recording Industry Association of America, McLean’s eight-and-a-half-minute masterpiece was ranked number 5 among the 365 “most memorable” songs of the twentieth century. In 2002, the song was voted into the Grammy Hall of Fame. In 1997, Garth brooks performed (...) “American Pie” at a concert in Central Park, and in 2000, pop icon Madonna performed her own version of “American Pie” on the soundtrack of her movie The Next Best Thing. In 1999, American Pie became the title of a popular – and irreverently comical – coming-of-age movie starring Jason Biggs (the movie American Pie was followed by American Pie 2 in 2001, American Wedding in 2003, and American Pie Present – Band Camp in 2005). Like the movie to which it lent its name, the song “American Pie” presents a coming-of-age narrative; and, also like the movie, the song appealed strongly and immediately to its contemporary audience. Three months after its release in November of 1971, the song reached the number one slot on the charts in January of 1972, and it remained in the Top 40 for a total of seventeen weeks (longer than any other single during the year of 1972). Unlike the movie, however, the song “American Pie” is highly nuanced and sophisticated, containing multiple allusions and layers of meaning which challenge and heighten our understanding of rock ’n’ roll music and the possibility of self-reflection and self-critique in popular culture. (shrink)

Background: Critically ill patients often require complex clinical care by highly trained staff within a specialized intensive care unit (ICU) with advanced equipment. There are currently limited data on the costs of critical care in low-and middle-income countries (LMICs). This study aims to investigate the direct-medical costs of key infectious disease (tetanus, sepsis, and dengue) patients admitted to ICU in a hospital in Ho Chi Minh City (HCMC), Vietnam, and explores how the costs and cost drivers can vary between (...) the different diseases. -/- Methods: We calculated the direct medical costs for patients requiring critical care for tetanus, dengue and sepsis. Costing data (stratified into different cost categories) were extracted from the bills of patients hospitalized to the adult ICU with a dengue, sepsis and tetanus diagnosis that were enrolled in three studies conducted at the Hospital for Tropical Diseases in HCMC from January 2017 to December 2019. The costs were considered from the health sector perspective. The total sample size in this study was 342 patients. -/- Results: ICU care was associated with significant direct medical costs. For patients that did not require mechanical ventilation, the median total ICU cost per patient varied between US$64.40 and US$675 for the different diseases. The costs were higher for patients that required mechanical ventilation, with the median total ICU cost per patient for the different diseases varying between US$2,590 and US$4,250. The main cost drivers varied according to disease and associated severity. -/- Conclusion: This study demonstrates the notable cost of ICU care in Vietnam and in similar LMIC settings. Future studies are needed to further evaluate the costs and economic burden incurred by ICU patients. The data also highlight the importance of evaluating novel critical care interventions that could reduce the costs of ICU care. (shrink)

Trust is a core feature of the physician-patient relationship, and risk is central to trust. Patients take risks when they trust their providers to care for them effectively and appropriately. Not all patients take these risks: some medical relationships are marked by mistrust and suspicion. Empirical evidence suggests that some patients and families of color in the United States may be more likely to mistrust their providers and to be suspicious of specific medical practices and institutions. Given both (...) historical and ongoing oppression and injustice in American medical institutions, such mistrust can be apt. Yet it can also frustrate patient care, leading to family and provider distress. In this paper, I propose one way that providers might work to reestablish trust by taking risks in signaling their own trustworthiness. This interpersonal step is not meant to replace efforts to remedy systemic injustice, but is an immediate measure for addressing mistrust in occurrent cases. (shrink)

Definition of the problem The umbrella term “explicability” refers to the reduction of opacity of artificial intelligence (AI) systems. These efforts are challenging for medical AI applications because higher accuracy often comes at the cost of increased opacity. This entails ethical tensions because physicians and patients desire to trace how results are produced without compromising the performance of AI systems. The centrality of explicability within the informed consent process for medical AI systems compels an ethical reflection on the (...) trade-offs. Which levels of explicability are needed to obtain informed consent when utilizing medical AI? Arguments We proceed in five steps: First, we map the terms commonly associated with explicability as described in the ethics and computer science literature, i.e., disclosure, intelligibility, interpretability, and explainability. Second, we conduct a conceptual analysis of the ethical requirements for explicability when it comes to informed consent. Third, we distinguish hurdles for explicability in terms of epistemic and explanatory opacity. Fourth, this then allows to conclude the level of explicability physicians must reach and what patients can expect. In a final step, we show how the identified levels of explicability can technically be met from the perspective of computer science. Throughout our work, we take diagnostic AI systems in radiology as an example. Conclusion We determined four levels of explicability that need to be distinguished for ethically defensible informed consent processes and showed how developers of medical AI can technically meet these requirements. (shrink)

This essay fills in some historical, conceptual, and pedagogical gaps that appear in the most visible and recent professional efforts to “revive” Philosophy as a Way of Life (PWOL). I present “American Philosophy and Self-Culture” as an advanced undergraduate seminar that broadens who counts in and what counts as philosophy by immersing us in the lives, writings, and practices of seven representative U.S.-American philosophers of self-culture, community-building, and world-changing: Benjamin Franklin (1706–1790), Frederick Douglass (1818–1895), William Ellery Channing (1780–1842), (...) Henry David Thoreau (1817–1862), Margaret Fuller (1810-1850), Henry Bugbee (1915–1999), and Gloria Anzaldúa (1942–2004). Students enter the class with preconceptions about who philosophers are, what they do, how they write, and the languages in which they write. Students walk out with new senses of self, place, and language that emerge through new ways of seeing, doing, and writing philosophy. (shrink)

We are concerned in this paper to establish the rationality of American legal realism by adopting a theory of reconstruction. American realism is plagued with dichotomies in relating theory and practice; and the need to broach these dichotomies involves transcendence of experience and transference of consciousness. In doing this, we have both to excavate and to justify its philosophy, logic and science. American legal realism has its root in the philosophy of pragmatism and a logic that sets (...) out the essential elements associated with the making and determination of the law through instrumentality of the court. The validity of this category of legal theory tends to lie on the extent of immediate use to which law can be put or the benefits it can afford the American society. Believing in the possibility of a realistic theory of law that is purely American precludes belief in universal understanding of human legal experience distinct from the understanding gained through the cultural lenses of the American people. Although American realists differ remarkably even within a single paradigm, nevertheless three areas of logical unity among them are that: They bear a cross relevance, a complementing and interlocking of results, and a similar faith in attacking legal problems. A completely empirical understanding of American legal realism seems nebulous, because causality presupposes the interaction of American liberal and legalistic political attitudes. Legalism is the life wire of American culture and this makes distribution of rights and legal predictability possible: incidentally language is an important instrument for making this happens. Countries seeking to adopt the American model of legal order or something similar to it should be capable of an equivalent orientation in terms of formulating their philosophy, logic and science of adjudication. (shrink)

Forms of Artificial Intelligence (AI) are already being deployed into clinical settings and research into its future healthcare uses is accelerating. Despite this trajectory, more research is needed regarding the impacts on patients of increasing AI decision making. In particular, the impersonal nature of AI means that its deployment in highly sensitive contexts-of-use, such as in healthcare, raises issues associated with patients’ perceptions of (un) dignified treatment. We explore this issue through an experimental vignette study comparing individuals’ perceptions of being (...) treated in a dignified and respectful way in various healthcare decision contexts. Participants were subject to a 2 (human or AI decision maker) x 2 (positive or negative decision outcome) x 2 (diagnostic or resource allocation healthcare scenario) factorial design. We found evidence of a “human bias” (i.e., a preference for human over AI decision makers) and an “outcome bias” (i.e., a preference for positive over negative outcomes). However, we found that for perceptions of respectful and dignified interpersonal treatment, it matters more who makes the decisions in diagnostic cases and it matters more what the outcomes are for resource allocation cases. We also found that humans were consistently viewed as appropriate decision makers and AI was viewed as dehumanizing, and that participants perceived they were treated better when subject to diagnostic as opposed to resource allocation decisions. Thematic coding of open-ended text responses supported these results. We also outline the theoretical and practical implications of these findings. (shrink)

Over the past 25 years, several new “medicines” have come screeching onto health care’s various platforms, including narrative medicine, personalized medicine, precision medicine and person-centred medicine. Philosopher Miriam Solomon calls the first three of these movements different “ways of knowing” or “methods,” and argues that they are each a response to shortcomings of methods that came before them. They should also be understood as reactions to the current dominant model of medicine. In this article, I will describe our dominant model, (...) which I call “the new medical model.” I will argue that several towering problems in modern medicine can be traced to its philosophical foundations, which calls for philosophical analysis. (shrink)

According to what McMahan and Savulescu (2024) call the “popular position”, embryo selection is less ethically problematic than gene editing (other things being equal). The Two-Tier View, defended by McMahan and Savulescu, implies that the popular position is mistaken. The authors treat gene editing of embryos similarly to standard cases of medical treatments that promise expected benefits for the (subsequent) person even though gene editing also may create risks of harmful side effects for her. McMahan and Savulescu assume that (...) if gene editing is (successfully) done, it is better for the person who developed from the beneficently edited embryo. And, if the editing had not been done, although it was possible, that would have been worse for the same person in question. Thus, the comparator must always be a possible, even if unlikely, world in which she would have existed. That is why gene editing, in their view, resembles medical treatments. Therefore, assuming that standard medical treatments are not more ethically problematic than embryo selection, they conclude that (in general) gene editing should also be treated as not more problematic than embryo selection. In this paper, I am taking one step further than McMahan and Savulescu in questioning the central assumptions in the bioethical debates about new reproductive technologies. In the previous work, we argued that the very distinction between person-affecting and identity-affecting interventions is based on a questionable form of material-origin essentialism (Żuradzki and Dranseika 2022). Here, I argue that the bipartite distinction between person-affecting and impersonal reasons, as used by McMahan and Savulescu, insufficiently represents different possible counterfactual comparisons between real and merely possible outcomes. In particular, I argue that the evaluation of gene editing requires counterfactual comparisons to situations in which the benefited person might or might not exist. Such evaluation requires an additional class of reasons, let me call them “semi-person-affecting,” that cannot be reduced to either person-affecting or impersonal ones. This aspect of gene editing makes it dissimilar to standard cases of medical treatments. (shrink)

It is well-known that racism is encoded into the social practices and institutions of medicine. Less well-known is that racism is encoded into the material artifacts of medicine. We argue that many medical devices are not merely biased, but materialize oppression. An oppressive device exhibits a harmful bias that reflects and perpetuates unjust power relations. Using pulse oximeters and spirometers as case studies, we show how medical devices can materialize oppression along various axes of social difference, including race, (...) gender, class, and ability. Our account uses political philosophy and cognitive science to give a theoretical basis for understanding materialized oppression, explaining how artifacts encode and carry oppressive ideas from the past to the present and future. Oppressive medical devices present a moral aggregation problem. To remedy this problem, we suggest redundantly layered solutions that are coordinated to disrupt reciprocal causal connections between the attitudes, practices, and artifacts of oppressive systems. (shrink)

Bradford Hill (1965) highlighted nine aspects of the complex evidential situation a medical researcher faces when determining whether a causal relation exists between a disease and various conditions associated with it. These aspects are widely cited in the literature on epidemiological inference as justifying an inference to a causal claim, but the epistemological basis of the Hill aspects is not understood. We offer an explanatory coherentist interpretation, explicated by Thagard's ECHO model of explanatory coherence. The ECHO model captures the (...) complexity of epidemiological inference and provides a tractable model for inferring disease causation. We apply this model to three cases: the inference of a causal connection between the Zika virus and birth defects, the classic inference that smoking causes cancer, and John Snow’s inference about the cause of cholera. (shrink)

Medical terminology collects and organizes the many different kinds of terms employed in the biomedical domain both by practitioners and also in the course of biomedical research. In addition to serving as labels for biomedical classes, these names reflect the organizational principles of biomedical vocabularies and ontologies. Some names represent invariant features (classes, universals) of biomedical reality (i.e., they are a matter for ontology). Other names, however, convey also how this reality is perceived, measured, and understood by health professionals (...) (i.e., they belong to the domain of epistemology). We analyze terms from several biomedical vocabularies in order to throw light on the interactions between ontological and epistemological components of these terminologies. We identify four cases: 1) terms containing classification criteria, 2) terms reflecting detectability, modality, uncertainty, and vagueness, 3) terms created in order to obtain a complete partition of a given domain, and 4) terms reflecting mere fiat boundaries. We show that epistemology-loaded terms are pervasive in biomedical vocabularies, that the “classes” they name often do not comply with sound classification principles, and that they are therefore likely to cause problems in the evolution and alignment of terminologies and associated ontologies. (shrink)

The epidemiologist Bradford Hill famously argued that in epidemiology, specificity of association (roughly, the fact that an environmental or behavioral risk factor is associated with just one or at most a few medical outcomes) is strong evidence of causation. Prominent epidemiologists have dismissed Hill’s claim on the ground that it relies on a dubious `one-cause one effect’ model of disease causation. The paper examines this methodological controversy, and argues that specificity considerations do have a useful role to play (...) in causal inference in epidemiology. More precisely, I argue that specificity considerations help solve a pervasive inferential problem in contemporary epidemiology: the problem of determining whether an exposure-outcome correlation might be due to confounding by a social factor. This examination of specificity has interesting consequences for our understanding of the methodology of epidemiology. It highlights how the methodology of epidemiology relies on local tools designed to address specific inference problems peculiar to the discipline, and shows that observational causal inference in epidemiology can proceed with little prior knowledge of the causal structure of the phenomenon investigated. I also argue that specificity of association cannot (despite claims to the contrary) be entirely explained in terms of Woodward’s well-known concept of “one-to-one” causal specificity. This is because specificity as understood by epidemiologists depends on whether an exposure (or outcome) is associated with a `heterogeneous’ set of variables. This dimension of heterogeneity is not captured in Woodward’s notion, but is crucial for understanding the evidential import of specificity of association. (shrink)

When hospitals face surges of patients with COVID-19, fair allocation of scarce medical resources remains a challenge. Scarcity has at times encompassed not only hospital and intensive care unit beds—often reflecting staffing shortages—but also therapies and intensive treatments. Safe, highly effective COVID-19 vaccines have been free and widely available since mid-2021, yet many Americans remain unvaccinated by choice. Should their decision to forgo vaccination be considered when allocating scarce resources? Some have suggested it should, while others disagree. We offer (...) a framework for evaluating when it is ethical and briefly discuss its legality in American law. (shrink)

Integrating medical imaging with computing technologies, such as Artificial Intelligence (AI) and its subsets: Machine learning (ML) and Deep Learning (DL) has advanced into an essential facet of present-day medicine, signaling a pivotal role in diagnostic decision-making and treatment plans (Huang et al., 2023). The significance of medical imaging is escalated by its sustained growth within the realm of modern healthcare (Varoquaux and Cheplygina, 2022). Nevertheless, the ever-increasing volume of medical images compared to the availability of imaging (...) experts. Biomedical experts and radiologists have resulted in a widening disparity, causing an excess and overwhelming workload on these healthcare professionals (Chen et al., 2021). Several studies indicate that the present-day biomedical radiologist is now saddled with the daunting task of interpreting an image almost every 10 seconds to keep pace with the burgeoning clinical demands (McDonald et al., 2015; Hosny et al., 2018; Lantsman et al., 2022). This cognitive drain has invariably led to inevitable consequences such as delays in diagnosis and an amplified risk of diagnostic errors – thus, the biomedical imaging aspect is in dire need of methods that would aid accurate diagnostics and analytics for improved decision making. In this review, the importance of AI-related technologies such as ML and/or DL methods are reviewed in relation to the processing of medical or biomedical images along with their potentials, challenges, and possible suggestions for future studies in the health landscape. The focus will be on machine learning methods associated with the medical field of image classification. (shrink)

Dans le diagnostic du cancer, la précocité du diagnostic est généralement un élément valorisé. Selon la croyance commune, un cancer détecté tôt aura plus de chance d’être traitable. Or, cette conception des avantages du diagnostic précoce mène dans certains cas au phénomène de surdiagnostic, soit le fait de diagnostiquer un cancer à des individus qui n’en ont pas encore un et qui sont potentiellement en voie de le développer. Dans cet article, nous défendrons d’abord que le phénomène de surdiagnostic est (...) lié en majeure partie à notre connaissance grandissante du cancer, et au fait que ces nouvelles connaissances causent des biais dans les processus de dépistage, conduits en vue de trouver un cancer. Afin de remédier à cette problématique, nous tenterons de montrer que le fait de simplement modifier notre approche du cancer et le vocabulaire médical associé permettrait de réduire les cas de surdiagnostics. (shrink)

Abstract: The integration of Artificial Intelligence (AI) into medical imaging marks a transformative advancement in healthcare, significantly enhancing diagnostic accuracy, efficiency, and patient outcomes. This paper delves into the application of AI technologies in medical image analysis, with a particular focus on techniques such as convolutional neural networks (CNNs) and deep learning models. We examine how these technologies are employed across various imaging modalities, including X-rays, MRIs, and CT scans, to improve disease detection, image segmentation, and diagnostic support. (...) Furthermore, the paper discusses the challenges associated with AI-driven medical imaging, such as data quality, model interpretability, and ethical considerations. By analyzing recent advancements and real-world case studies, this paper offers insights into the current landscape of AI in medical imaging and explores its potential future directions. The findings underscore the ongoing evolution of AI technologies and their pivotal role in advancing medical diagnostics and treatment strategies. (shrink)

Medicine, like law, is a pragmatic, probabilistic activity. Both require that decisions be made on the basis of available evidence, within a limited time. In contrast to law, medicine, particularly evidence-based medicine as it is currently practiced, aspires to a scientific standard of proof, one that is more certain than the standards of proof courts apply in civil and criminal proceedings. But medicine, as Dr. William Osler put it, is an "art of probabilities," or at best, a "science of uncertainty." (...) One can better practice medicine by using other evidentiary standards in addition to the "scientific." To employ only the scientific standard of proof is inappropriate, if not impossible; furthermore, as this review will show, its application in medicine is fraught with bias. Evidence is information. It supports or undermines a proposition, whether a hypothesis in science, a diagnosis in medicine, or a fact or point in question in a legal investigation. In medicine, physicians marshal evidence to make decisions on how to best prevent, diagnose, and treat disease, and improve health. In law, courts decide the facts and render justice. Judges and juries assess evidence to establish liability, to settle custody and medical issues, and to determine a defendant's guilt or innocence. (shrink)

Less than one percent of U.S. philosophers are Asian American. This essay contends that the low percentage cannot be fully explained by considerations of demographics, immigration, and "Asian culture." Completeness of explanation requires reference to racial politics and Orientalism in their historic and national dynamics. It also requires reference to various kinds of identity derogation specific to the academy and to philosophy, in particular. The essay concludes with reflection on how the "model minority" discourse adds another layer of complication (...) to the way Asian American philosophers and philosophy students negotiate their way through the academy. (shrink)

Postpartum depression is a major maternal health problem after childbirth. It can start at any time within the first year after delivery and continue for several years. It is characterized by an inability to experience pleasure, anxiety symptoms, panic attacks, spontaneous crying and depressed mood. Some women with postpartum depression even have thoughts of harming their child and self-harm. This study aims to find out the status of postpartum depression and the associated factors among postnatal mothers at the first, fourth (...) and sixth month. This study is a prospective descriptive study, carried out in three major health facilities in Misurata. This study consists of a three-part questionnaire. Part 1 covers the demographic characteristics of the participants, while Part 2 explores the associated risk factors according to the variables used. Part 3 consists of the psychological evaluation of the participants. A hundred mothers (ages between 15 and 43 years) were enrolled in this study. The findings revealed that the prevalence of depression is 60.0% and 22.0% are suffering from borderline depression. Development of depression was strongly correlated with sleeping disturbances, the state of the neonate after birth, excess consumption of stimulants, less weight acceptance by mothers during pregnancy and infant illness. There was a weak relation between depression and delivery state, maternal admission to the hospital during the current pregnancy, and infant gender dissatisfaction. No correlation was found with the development of depression regarding miscarriage, maternal medical problems after delivery, previous child sex, maternal age, education, parity or neonate weight. Thus, this study shows that the chance of having a miscarriage and an unhealthy neonate increases with advanced maternal age. It also shows that caesarean section is associated with bad neonatal outcomes, more weight gain and having gestational diabetes or preeclampsia during pregnancy. Maternal sleeping problems are more pronounced in the first month, attributed to the baby's care, compared with the fourth and sixth months. The study indicates that depression is a common state of psychiatric disorders among Libyan women and should have appropriate attention by physicians and gynecologists. (shrink)

Postpartum depression is a major maternal health problem after childbirth. It can start at any time within the first year after delivery and continue for several years. It is characterized by an inability to experience pleasure, anxiety symptoms, panic attacks, spontaneous crying and depressed mood. Some women with postpartum depression even have thoughts of harming their child and self-harm. This study aims to find out the status of postpartum depression and the associated factors among postnatal mothers at the first, fourth (...) and sixth month. This study is a prospective descriptive study, carried out in three major health facilities in Misurata. This study consists of a three-part questionnaire. Part 1 covers the demographic characteristics of the participants, while Part 2 explores the associated risk factors according to the variables used. Part 3 consists of the psychological evaluation of the participants. A hundred mothers (ages between 15 and 43 years) were enrolled in this study. The findings revealed that the prevalence of depression is 60.0% and 22.0% are suffering from borderline depression. Development of depression was strongly correlated with sleeping disturbances, the state of the neonate after birth, excess consumption of stimulants, less weight acceptance by mothers during pregnancy and infant illness. There was a weak relation between depression and delivery state, maternal admission to the hospital during the current pregnancy, and infant gender dissatisfaction. No correlation was found with the development of depression regarding miscarriage, maternal medical problems after delivery, previous child sex, maternal age, education, parity or neonate weight. Thus, this study shows that the chance of having a miscarriage and an unhealthy neonate increases with advanced maternal age. It also shows that caesarean section is associated with bad neonatal outcomes, more weight gain and having gestational diabetes or preeclampsia during pregnancy. Maternal sleeping problems are more pronounced in the first month, attributed to the baby's care, compared with the fourth and sixth months. The study indicates that depression is a common state of psychiatric disorders among Libyan women and should have appropriate attention by physicians and gynecologists. (shrink)

Abstract: malaria is one of the most frequent hemoparasitic infections in tropical and sub-tropical countries. Malaria in Sudan is the major public health problem. This study was aimed to investigate the association of intraleukocytic pigment with malaria infection (severity, diagnosis and prognosis), and to investigate the correlation of parasite density levels with Malaria Severity. A total of 176 participants was drawn from the population of sudanese patient above 5 years, who attended or were admitted to the Bashayer Hospital, with (...) diagnosis suggestive of malaria, they were selected for inclusion in the study. Blood films were examined first for malaria parasites diagnosis ,this was followed by detection of malaria pigment in both negative and positive films.Then Immunochromatography test was done, Subsequently haemoglobin concentration was determined. This study was approves that malaria pigment in peripheral blood leukocytes is evident for malaria disease , and makes the method of pigment determination appropriate and useful in malaria diagnosis, especially in patients with an illness consistent clinically with malaria but with negative blood smear due to haemolytic anaemia .A total of 176, 73 male and 103 female aged from 7 years to 69 years , drawn to Bashayer hospital with symptoms of malaria showed ICT positive result .Blood films were positive in 98(55.7%) and negative in 78 (44.3%) of patients . Malaria pigment was observed with the mean (22.07). There was an association between ICT and malaria pigment (P-value = 0.000).There was no association between BF and malaria pigment ( P-value = 0.40).This study also approved that malaria pigment can be used in prognosis, were thirty five patient showed complications(19.9%) and 141 showed no complication(80.1%) ,there was association between complications and malaria pigment ( P-value = 0.004) .This study also validates the presence of malaria pigment in leukocyte as a marker for disease severity, there was association between severity and malaria pigment (P-value = 0.02). While there is no association between density and severity (P-value = 0.980). So we conclued, intraleukocytic malaria pigment produced by parasites during intra erythrocytic development is associated with severe disease, mortality and it is a useful diagnostic indicator in anaemic patients with negative blood smears. The varied complexities of the current diagnostic methods make the method of pigment determination appropriate and useful. Secondly, malaria pigment is significantly associated with severe malaria. Thirdly, parasitaemia levels are neither associated nor correlated with malaria severity and therefore parasitaemia alone is not a reliable measure of malaria severity. We recommend the use of malaria pigment as marker for malaria disease severity. We recommend that parasitaemia should not be used alone as an indicator of malaria severity. We further recommend that, the presence of pigment in leukocytes to be adopted for diagnosis of malaria especially in cases of negative blood films, and recommend using malaria pigment as indicator for malaria prognosis. (shrink)

The article aims at clarifying the historical status and cognitive potentials of such a genre of contemporary historiography of philosophy as biographical encyclopedia (dictionary). Based on extensive bibliographic material, the author demonstrates that in the late XX – early XXI centuries in the English-speaking countries there was a real outbreak of interest in encyclopedias and dictionaries, compiled from personalized articles about the life and works of philosophers of certain epochs, countries, trends, etc. According to the author, the increasing popularity of (...) this genre can be considered as a logical continuation of the historical and biographical turns that took place in the Anglo-American (analytic) philosophy in the 1980s and 1990s, respectively. The author specifically emphasizes that it caused the appearance of a significant number of encyclopedias and dictionaries, which contain the well-known facts as well as the significant elements of scholar novelty. The article also shows that similar tendencies have taken place in the contemporary Ukrainian historiography of philosophy. It is shown that Ukrainian experts also made their own significant contribution to the development of this genre. They have successfully developed a special approach, which presupposes the focus on life and works of the representatives of a particular academic institution. The intellectual value of this approach is demonstrated by the example of the recently published two-volume encyclopedia “Kyiv Theological Academy in Names: 1819-1924”. It contains a systematic and very informative presentation of the biographies of many representatives of the national philosophy, whose activities were associated with this institution. The author also shows that from the perspective of the historiography of philosophy, the general methodological foundations of this encyclopedic research is a matter of special interest. (shrink)

Published in the American Journal of Bioethics.

Mildred Cho and Nicole Martinez-Martin (2023) distinguish between two of the ways in which humans can be represented in medical contexts. One is technical: a digital model of aspects of a person’s...

Slurs such as spic, slut, wetback, and whore are linguistic expressions that are primarily understood to derogate certain group members on the basis of their descriptive attributes and expressions of this kind have been considered to pack some of the nastiest punches natural language affords. Although prior scholarship on slurs has uncovered several important facts concerning their meaning and use –including that slurs are potentially offensive, are felicitously applied towards some targets yet not others, and are often flexibly used not (...) only derogatorily to convey offense towards out-group members but also non-derogatorily to convey affiliation with in-group members– the literature remains largely focused on slurs that typically target African Americans, male homosexuals, and sexually active females. Since no account of slurs that typically target Hispanics or Mexican-Americans has so far been proposed, here I offer the first systematic and empirically informed analysis of these that accounts for both their derogatory and appropriative use. Importantly, this article reviews over a dozen Spanish stereotypes and slurs and explains how the descriptive attributes involved in a stereotype associated with a slur can contribute to the predication of certain content in the application of that slur toward its target in context. This article further explains how the psychological effects of stereotype threat and stereotype lift can be initiated through the application of a relevant slur towards its target in context as well. -/- ----- -/- Las expresiones peyorativas tales como spic (‘spic’), slut (‘zorra’), wetback (‘espalda mojada’) y whore (‘puta’) son expresiones lingüísticas que se entienden principalmente para minusvalorar ciertos miembros de un grupo sobre la base de sus atributos descriptivos (como la raza o el sexo). Se ha considerado que las expresiones de este tipo conllevan algunos de los puñetazos más desagradables que el lenguaje natural puede proporcionar. Aunque la literatura especializada sobre expresiones peyorativas ha descubierto varios hechos importantes en cuanto a significado y uso –entre los que se incluyen que tales expresiones son potencialmente ofensivas, apuntan efectivamente hacia unos objetivos pero no hacia otros, y con frecuencia se utilizan con flexibilidad no sólo despectivamente para ofender a miembros por fuera de un grupo, sino que también de forma no despectiva para afiliar con miembros dentro de un mismo grupo–, tal literatura sigue centrada en gran medida en las expresiones peyorativas que típicamente apuntan contra los afroamericanos (nigger ‘negro’), los homosexuales varones (fagot ‘maricón’), y las mujeres sexualmente activas (slut ‘zorra’). En tanto que no se ha propuesto al momento dar cuenta de expresiones peyorativas dirigidas contra hispanos o mexicano-americanos, en este trabajo se ofrece el primer análisis sistemático y empíricamente informado de tales expresiones, tanto en sus usos despectivos y de apropiación. Es importante destacar que en este artículo se revisan más de una docena de estereotipos y expresiones peyorativas en español, además de explicar cómo los atributos descriptivos que participan de un estereotipo asociado con una difamación pueden contribuir a la predicación de determinados contenidos en la aplicación de esa expresión hacia su objetivo en contexto. Asimismo, en este artículo se explica cómo comienzan los efectos psicológicos de la amenaza estereotipada y el realce estereotipado cuando se emplea una expresión peyorativa relevante contra un objetivo en contexto. (shrink)

In order to conduct medical examinations, physicians transform patients from social subjects into medical objects. The routines associated with conducting medical examinations constitute rituals for effecting this transformation: moving from public space to private space; changing into ritual costumes; taking up ritual positions in an examination room; conducting ritual verbal and physical examinations. The transformations endow participants with a different ontological status from the one they hold in everyday life. They address the phenomenological problem of how a (...) self is inserted into a body. (shrink)

The Asian American identity is intimately associated with upward class mobility as the model minority, yet women's earnings remain less than men's, and Asian American women are perceived to have strong family ties binding them to domestic responsibilities. As such, the exact class status of Asian American women is unclear. The immediate association of this ethnic identity with a specific class as demonstrated by the recently released Pew study that Asian Americans are “the highest-income, best-educated” ethnicity (...) contrasts with another study that finds Asian American women have the highest suicide rates in the United States. To understand these contrasting statistics, this article explores Asian American women's sense of authenticity. If the individual's sense of authenticity is intimately related with one's group identity, the association of the Asian American identity with a particular class ambivalently ensnares her as dichotomously inauthentic—as both the poor Asian American woman who fails to achieve economic upward mobility and the model minority Asian American woman who engages in assimilation practices. Feminist philosophers understand that identities change, but exactly how these transformations occur remains a mystery. The article ends with three speculations on the difficulties for practicing and recognizing individual acts that transform one's group identity. (shrink)

As a result of the world-wide COVID-19 epidemic, an internal tension in the goals of medicine has come to the forefront of public debate. Medical professionals are continuously faced with a tug of...

In its recent statement 'Sex Selection and Preimplantation Genetic Diagnosis', the Ethics Committee of the American Society of Reproductive Medicine concluded that preimplantation genetic diagnosis for sex selection for non-medical reasons should be discouraged because it poses a risk of unwarranted gender bias, social harm, and results in the diversion of medical resources from genuine medical need. We critically examine the arguments presented against sex selection using preimplantation genetic diagnosis. We argue that sex selection should be (...) available, at least within privately funded health care. (shrink)

Objectives: Machine learning (ML) has the potential to facilitate “continual learning” in medicine, in which an ML system continues to evolve in response to exposure to new data over time, even after being deployed in a clinical setting. In this article, we provide a tutorial on the range of ethical issues raised by the use of such “adaptive” ML systems in medicine that have, thus far, been neglected in the literature. -/- Target audience: The target audiences for this tutorial are (...) the developers of ML AI systems, healthcare regulators, the broader medical informatics community, and practicing clinicians. -/- Scope: Discussions of adaptive ML systems to date have overlooked the distinction between 2 sorts of variance that such systems may exhibit—diachronic evolution (change over time) and synchronic variation (difference between cotemporaneous instantiations of the algorithm at different sites)—and underestimated the significance of the latter. We highlight the challenges that diachronic evolution and synchronic variation present for the quality of patient care, informed consent, and equity, and discuss the complex ethical trade-offs involved in the design of such systems. (shrink)

Biomedical diagnostic science is a great deal less successful than we've been willing to acknowledge in bioethics, and this fact has far-reaching ethical implications. In this article I consider the surprising prevalence of medically unexplained symptoms, and the term's ambiguous meaning. Then I frame central questions that remain answered in this context with respect to informed consent, autonomy, and truth-telling. Finally, I show that while considerable attention in this area is given to making sure not to provide biological care to (...) patients without a need, comparatively little is given to the competing, ethically central task of making sure never to obstruct access to biological care for those with diagnostically confusing biological conditions. I suggest this problem arises from confusion about the philosophical value of vagueness when it comes to the line between biological and psychosocial needs. (shrink)

When people are making certain medical decisions – especially potentially transformative ones – the specter of regret may color their choices. In this paper, I ask: can predicting that we will regret a decision in the future serve any justificatory role in our present decision-making? And if so, what role? While there are many pitfalls to such reasoning, I ultimately conclude that considering future retrospective emotions like regret in our decisionmaking can be both rational and authentic. Rather than indicating (...) that one is about to make a mistake or that there is some underlying value that one already cares about but is overlooking, the prediction that one will regret a decision in the future makes one confront how her present values and priorities may change as a result of her choice in ways she cannot presently anticipate. (shrink)